Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

2.0X16MM CANNULATED SCREW

Facility

$1,074.75

Service Code	HCPCS C1713
Hospital Charge Code	270668752
Hospital Revenue Code	278
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$537.38
Rate for Payer: Aetna Commercial	$408.40
Rate for Payer: Aetna Medicare Advantage	$322.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.06
Rate for Payer: Cigna Commercial	$537.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.44
Rate for Payer: Qualcare PPO/HMO/WC	$161.21
Rate for Payer: UnitedHealthcare Community & State	$25.90
Rate for Payer: Wellpoint Medicaid Managed Care	$28.48

20 X 30CM STARIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683833
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

20 X 30CM STARIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683833
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

2.0X5MM BONESCREW AXS

Facility

$461.85

Service Code	HCPCS C1713
Hospital Charge Code	270705886
Hospital Revenue Code	278
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$230.93
Rate for Payer: Aetna Commercial	$175.50
Rate for Payer: Aetna Medicare Advantage	$138.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.77
Rate for Payer: Cigna Commercial	$230.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.61
Rate for Payer: Qualcare PPO/HMO/WC	$69.28
Rate for Payer: UnitedHealthcare Community & State	$11.13
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

2.0X5MM BONESCREW AXS

Facility

$461.85

Service Code	HCPCS C1713
Hospital Charge Code	270705886
Hospital Revenue Code	278
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$111.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.61
Rate for Payer: Qualcare PPO/HMO/WC	$69.28

2.0X85MM PARTIAL TH SCREW

Facility

$145.00

Hospital Charge Code	270656438
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

2.0X85MM PARTIAL TH SCREW

Facility

$145.00

Hospital Charge Code	270656438
Hospital Revenue Code	278
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

21-HYDROXYLASE ANTIBODY

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	38479746
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

21-HYDROXYLASE ANTIBODY

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	38479746
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

21X34X14MM CAGE

Facility

$31,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704062
Hospital Revenue Code	278
Min. Negotiated Rate	$759.15
Max. Negotiated Rate	$15,750.00
Rate for Payer: Aetna Commercial	$11,970.00
Rate for Payer: Aetna Medicare Advantage	$9,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,032.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,032.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,032.50
Rate for Payer: Cigna Commercial	$15,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,623.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,930.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,725.00
Rate for Payer: UnitedHealthcare Community & State	$759.15
Rate for Payer: Wellpoint Medicaid Managed Care	$834.75

21X34X14MM CAGE

Facility

$31,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704062
Hospital Revenue Code	278
Min. Negotiated Rate	$4,725.00
Max. Negotiated Rate	$7,623.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,623.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,930.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,725.00

22G 5 INCH SPINAL NEEDLE

Facility

$935.00

Hospital Charge Code	270325445
Hospital Revenue Code	272
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.50
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Commercial	$187.00
Rate for Payer: UnitedHealthcare Community & State	$22.53
Rate for Payer: Wellpoint Medicaid Managed Care	$24.78

22G 5 INCH SPINAL NEEDLE

Facility

$935.00

Hospital Charge Code	270325445
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

22 GUAGE 3.5 INCH SPINL NEEDLE

Facility

$935.00

Hospital Charge Code	270325443
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

22 GUAGE 3.5 INCH SPINL NEEDLE

Facility

$935.00

Hospital Charge Code	270325443
Hospital Revenue Code	272
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.50
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Commercial	$187.00
Rate for Payer: UnitedHealthcare Community & State	$22.53
Rate for Payer: Wellpoint Medicaid Managed Care	$24.78

22MM PLATE

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706107
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

22MM PLATE

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706107
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

2-2 SQUARE ELECTRODES

Facility

$14.99

Hospital Charge Code	270660517
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.82
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

2-2 SQUARE ELECTRODES

Facility

$14.99

Hospital Charge Code	270660517
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

22X11 BIFURCATED GRAFT

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270683831
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

22X11 BIFURCATED GRAFT

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270683831
Hospital Revenue Code	278
Min. Negotiated Rate	$110.02
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,734.70
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$684.75
Rate for Payer: UnitedHealthcare Community & State	$110.02
Rate for Payer: Wellpoint Medicaid Managed Care	$120.97

22 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683834
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

22 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683834
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

2-2 X 4 RECTANGLE ELECTRODES

Facility

$18.49

Hospital Charge Code	270660516
Hospital Revenue Code	270
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.24
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.55
Rate for Payer: Oxford Commercial	$3.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.70
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

2-2 X 4 RECTANGLE ELECTRODES

Facility

$18.49

Hospital Charge Code	270660516
Hospital Revenue Code	270
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

Know your out-of-pocket cost for care.

All Charges