Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DISCECTOMY SYSTEM

Facility

$7,475.00

Hospital Charge Code	270657256
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

DISCECTOMY SYSTEM

Facility

$7,475.00

Hospital Charge Code	270657256
Hospital Revenue Code	272
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

DISCHARGE > 30 MIN

Facility

$350.00

Service Code	HCPCS 99239
Hospital Charge Code	83246245
Hospital Revenue Code	914
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

DISCHARGE > 30 MIN

Facility

$350.00

Service Code	HCPCS 99239
Hospital Charge Code	83246245
Hospital Revenue Code	914
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

DISCHARGE < OR = 30 MIN

Facility

$350.00

Service Code	HCPCS 99238
Hospital Charge Code	83246240
Hospital Revenue Code	914
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

DISCHARGE < OR = 30 MIN

Facility

$350.00

Service Code	HCPCS 99238
Hospital Charge Code	83246240
Hospital Revenue Code	914
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

DISC MOBI-C CERVICAL 5X15X15MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690974
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC MOBI-C CERVICAL 5X15X15MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690974
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC MOBI-C MOD 13X17MM HT5MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692671
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC MOBI-C MOD 13X17MM HT5MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692671
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC MONITOR PROBE 407-290-000

Facility

$2,057.41

Hospital Charge Code	270646547
Hospital Revenue Code	272
Min. Negotiated Rate	$49.58
Max. Negotiated Rate	$1,028.70
Rate for Payer: Aetna Commercial	$781.82
Rate for Payer: Aetna Medicare Advantage	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$524.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$524.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$524.64
Rate for Payer: Cigna Commercial	$1,028.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Oxford Commercial	$411.48
Rate for Payer: Qualcare PPO/HMO/WC	$308.61
Rate for Payer: UnitedHealthcare Commercial	$411.48
Rate for Payer: UnitedHealthcare Community & State	$49.58
Rate for Payer: Wellpoint Medicaid Managed Care	$54.52

DISC MONITOR PROBE 407-290-000

Facility

$2,057.41

Hospital Charge Code	270646547
Hospital Revenue Code	272
Min. Negotiated Rate	$308.61
Max. Negotiated Rate	$308.61
Rate for Payer: Qualcare PPO/HMO/WC	$308.61

DISCOGRAPHY SYSTEM

Facility

$187.00

Hospital Charge Code	270332614
Hospital Revenue Code	272
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$93.50
Rate for Payer: Aetna Commercial	$71.06
Rate for Payer: Aetna Medicare Advantage	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.69
Rate for Payer: Cigna Commercial	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.10
Rate for Payer: Oxford Commercial	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.05
Rate for Payer: UnitedHealthcare Commercial	$37.40
Rate for Payer: UnitedHealthcare Community & State	$4.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

DISCOGRAPHY SYSTEM

Facility

$187.00

Hospital Charge Code	270332614
Hospital Revenue Code	272
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$28.05
Rate for Payer: Qualcare PPO/HMO/WC	$28.05

DISC ROI LORDOTIC 7MM X 15.5

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690495
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

DISC ROI LORDOTIC 7MM X 15.5

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690495
Hospital Revenue Code	278
Min. Negotiated Rate	$281.13
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$4,432.70
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75
Rate for Payer: UnitedHealthcare Community & State	$281.13
Rate for Payer: Wellpoint Medicaid Managed Care	$309.12

DISC SZ 2, HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270705514
Hospital Revenue Code	278
Min. Negotiated Rate	$4,048.69
Max. Negotiated Rate	$6,531.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69

DISC SZ 2, HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270705514
Hospital Revenue Code	278
Min. Negotiated Rate	$650.49
Max. Negotiated Rate	$13,495.62
Rate for Payer: Aetna Commercial	$10,256.67
Rate for Payer: Aetna Medicare Advantage	$8,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,882.77
Rate for Payer: Cigna Commercial	$13,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,938.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69
Rate for Payer: UnitedHealthcare Community & State	$650.49
Rate for Payer: Wellpoint Medicaid Managed Care	$715.27

DISC TZM QUICK LAMP LG OV PNO1

Facility

$18.45

Hospital Charge Code	270608608
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

DISC TZM QUICK LAMP LG OV PNO1

Facility

$18.45

Hospital Charge Code	270608608
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$7.01
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

DISC XMD EPI 8MM 14-17100

Facility

$325.00

Hospital Charge Code	270622519
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

DISC XMD EPI 8MM 14-17100

Facility

$325.00

Hospital Charge Code	270622519
Hospital Revenue Code	272
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$65.00
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

DISIPAL

Facility

$3.00

Hospital Charge Code	60634466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DISIPAL

Facility

$3.00

Hospital Charge Code	60634466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DISIPAL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634369
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

Know your out-of-pocket cost for care.

All Charges