Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$192.75
Max. Negotiated Rate	$192.75
Rate for Payer: Qualcare PPO/HMO/WC	$192.75

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$30.97
Max. Negotiated Rate	$642.50
Rate for Payer: Aetna Commercial	$488.30
Rate for Payer: Aetna Medicare Advantage	$385.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.68
Rate for Payer: Cigna Commercial	$642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$385.50
Rate for Payer: Oxford Commercial	$257.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.75
Rate for Payer: UnitedHealthcare Commercial	$257.00
Rate for Payer: UnitedHealthcare Community & State	$30.97
Rate for Payer: Wellpoint Medicaid Managed Care	$34.05

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$1,021.50
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$1,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.90
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: Wellpoint Medicaid Managed Care	$54.14

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$952.50
Rate for Payer: Aetna Commercial	$723.90
Rate for Payer: Aetna Medicare Advantage	$571.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$485.77
Rate for Payer: Cigna Commercial	$952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$571.50
Rate for Payer: Qualcare PPO/HMO/WC	$285.75
Rate for Payer: UnitedHealthcare Community & State	$45.91
Rate for Payer: Wellpoint Medicaid Managed Care	$50.48

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$285.75
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$32,068.35

Service Code	APR-DRG 0923
Min. Negotiated Rate	$31,439.56
Max. Negotiated Rate	$32,068.35
Rate for Payer: UnitedHealthcare Community & State	$31,439.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,068.35
Rate for Payer: Wellpoint Medicaid Managed Care	$31,439.56

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$57,550.20

Service Code	APR-DRG 0924
Min. Negotiated Rate	$56,421.76
Max. Negotiated Rate	$57,550.20
Rate for Payer: UnitedHealthcare Community & State	$56,421.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$57,550.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56,421.76

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$20,546.07

Service Code	APR-DRG 0922
Min. Negotiated Rate	$20,143.21
Max. Negotiated Rate	$20,546.07
Rate for Payer: UnitedHealthcare Community & State	$20,143.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,546.07
Rate for Payer: Wellpoint Medicaid Managed Care	$20,143.21

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$16,063.56

Service Code	APR-DRG 0921
Min. Negotiated Rate	$15,748.59
Max. Negotiated Rate	$16,063.56
Rate for Payer: UnitedHealthcare Community & State	$15,748.59
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,063.56
Rate for Payer: Wellpoint Medicaid Managed Care	$15,748.59

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

Know your out-of-pocket cost for care.

All Charges