Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DORZOLAMIDE OPH SOL .2% 5ML

Facility

$97.30

Hospital Charge Code	6017370
Hospital Revenue Code	252
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367
Hospital Revenue Code	278
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367N
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367S
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT/SLOT BLOT PRODUCTION

Facility

$99.00

Service Code	HCPCS 83893
Hospital Charge Code	38472804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

DOT/SLOT BLOT PRODUCTION

Facility

$99.00

Service Code	HCPCS 83893
Hospital Charge Code	38472804
Hospital Revenue Code	301
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

DOUBLE ARM MENISCAL REPAIR NEE

Facility

$128.00

Hospital Charge Code	270665314
Hospital Revenue Code	270
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

DOUBLE ARM MENISCAL REPAIR NEE

Facility

$128.00

Hospital Charge Code	270665314
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

DOUBLE ECCENTER

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686875
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

DOUBLE ECCENTER

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686875
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

DOUBLE JOINT W/END PIECE

Facility

$2,724.00

Hospital Charge Code	270669838
Hospital Revenue Code	278
Min. Negotiated Rate	$408.60
Max. Negotiated Rate	$659.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.28
Rate for Payer: Qualcare PPO/HMO/WC	$408.60

DOUBLE JOINT W/END PIECE

Facility

$2,724.00

Hospital Charge Code	270669838
Hospital Revenue Code	278
Min. Negotiated Rate	$65.65
Max. Negotiated Rate	$1,362.00
Rate for Payer: Aetna Commercial	$1,035.12
Rate for Payer: Aetna Medicare Advantage	$817.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.62
Rate for Payer: Cigna Commercial	$1,362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.28
Rate for Payer: Qualcare PPO/HMO/WC	$408.60
Rate for Payer: UnitedHealthcare Community & State	$65.65
Rate for Payer: Wellpoint Medicaid Managed Care	$72.19

DOUBLE LOADED KNOTLESS KNEE FI

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703166
Hospital Revenue Code	278
Min. Negotiated Rate	$405.56
Max. Negotiated Rate	$654.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.83
Rate for Payer: Qualcare PPO/HMO/WC	$405.56

DOUBLE LOADED KNOTLESS KNEE FI

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703166
Hospital Revenue Code	278
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$1,351.88
Rate for Payer: Aetna Commercial	$1,027.42
Rate for Payer: Aetna Medicare Advantage	$811.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.46
Rate for Payer: Cigna Commercial	$1,351.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.83
Rate for Payer: Qualcare PPO/HMO/WC	$405.56
Rate for Payer: UnitedHealthcare Community & State	$65.16
Rate for Payer: Wellpoint Medicaid Managed Care	$71.65

DOUBLE LOADED TIGHTROPE 10 MM

Facility

$3,475.00

Hospital Charge Code	270679791
Hospital Revenue Code	272
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.50
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Commercial	$695.00
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

DOUBLE LOADED TIGHTROPE 10 MM

Facility

$3,475.00

Hospital Charge Code	270679791
Hospital Revenue Code	272
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$521.25
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

DOUBLE PIGTAIL STENT 7FR 24CM

Facility

$907.00

Hospital Charge Code	270331901
Hospital Revenue Code	278
Min. Negotiated Rate	$136.05
Max. Negotiated Rate	$219.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.54
Rate for Payer: Qualcare PPO/HMO/WC	$136.05

DOUBLE PIGTAIL STENT 7FR 24CM

Facility

$907.00

Hospital Charge Code	270331901
Hospital Revenue Code	278
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$453.50
Rate for Payer: Aetna Commercial	$344.66
Rate for Payer: Aetna Medicare Advantage	$272.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.28
Rate for Payer: Cigna Commercial	$453.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.54
Rate for Payer: Qualcare PPO/HMO/WC	$136.05
Rate for Payer: UnitedHealthcare Community & State	$21.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

DOUCHE *********

Facility

$23.00

Hospital Charge Code	8000473
Hospital Revenue Code	279
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DOUCHE *********

Facility

$23.00

Hospital Charge Code	8000473
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

DOUGHNUT HEADREST 9 PINS

Facility

$5.40

Hospital Charge Code	270654881
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

DOUGHNUT HEADREST 9 PINS

Facility

$5.40

Hospital Charge Code	270654881
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare Advantage	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.08
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

Know your out-of-pocket cost for care.

All Charges