Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FORCEP VEC TTS PYLOR 6 4806

Facility

$973.65

Hospital Charge Code	270603926
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 8 4808

Facility

$973.65

Hospital Charge Code	270603927
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 8 4808

Facility

$973.65

Hospital Charge Code	270603927
Hospital Revenue Code	270
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$369.99
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.10
Rate for Payer: Oxford Commercial	$194.73
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Commercial	$194.73
Rate for Payer: UnitedHealthcare Community & State	$23.46
Rate for Payer: Wellpoint Medicaid Managed Care	$25.80

FOREARM AP & LAT-BILAT

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	94061223
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

FOREARM AP & LAT-BILAT

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	94061223
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	94061305
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	94061305
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

FOREARM AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	94061307
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	94061307
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

FORECEP BPSY RADIAL EDGE 1.8MM

Facility

$1,600.00

Hospital Charge Code	270656986
Hospital Revenue Code	278
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$352.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

FORECEP BPSY RADIAL EDGE 1.8MM

Facility

$1,600.00

Hospital Charge Code	270656986
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$352.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

FOREIGNBODY 1 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061151
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

FOREIGNBODY 1 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061151
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

FOREIGNBODY 2 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061153
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

FOREIGNBODY 2 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061153
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

FOREIGN BODY RETRIEVAL

Facility

$315.33

Service Code	HCPCS 37197
Hospital Charge Code	2200402
Hospital Revenue Code	350
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.60
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.30
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$7.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8.36

FOREIGN BODY RETRIEVAL

Facility

$315.33

Service Code	HCPCS 37197
Hospital Charge Code	2200402
Hospital Revenue Code	350
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$47.30

FORESKIN MANIPULATION

Facility

$1,247.64

Service Code	HCPCS 54450
Hospital Charge Code	16001001
Hospital Revenue Code	360
Min. Negotiated Rate	$187.15
Max. Negotiated Rate	$187.15
Rate for Payer: Qualcare PPO/HMO/WC	$187.15

FORESKIN MANIPULATION

Facility

$1,247.64

Service Code	HCPCS 54450
Hospital Charge Code	16001001
Hospital Revenue Code	360
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
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	$1,071.47
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.29
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.15
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$30.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$33.06

FORG BODY REM EXT AUD CNL

Facility

$8,054.80

Service Code	HCPCS 69205
Hospital Charge Code	5790220
Hospital Revenue Code	450
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$213.45

FORG BODY REM EXT AUD CNL

Facility

$8,054.80

Service Code	HCPCS 69205
Hospital Charge Code	5790220
Hospital Revenue Code	450
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

FORMAGRAFT LARGE

Facility

$9,000.00

Hospital Charge Code	270663769
Hospital Revenue Code	270
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

FORMAGRAFT LARGE

Facility

$9,000.00

Hospital Charge Code	270663769
Hospital Revenue Code	270
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.00
Rate for Payer: Oxford Commercial	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Commercial	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

FORMAGRAFT XL BLOCKS, LARGE

Facility

$11,465.00

Hospital Charge Code	270667570
Hospital Revenue Code	278
Min. Negotiated Rate	$276.31
Max. Negotiated Rate	$5,732.50
Rate for Payer: Aetna Commercial	$4,356.70
Rate for Payer: Aetna Medicare Advantage	$3,439.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,923.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,923.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,923.57
Rate for Payer: Cigna Commercial	$5,732.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,774.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,522.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,719.75
Rate for Payer: UnitedHealthcare Community & State	$276.31
Rate for Payer: Wellpoint Medicaid Managed Care	$303.82

FORMAGRAFT XL BLOCKS, LARGE

Facility

$11,465.00

Hospital Charge Code	270667570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,719.75
Max. Negotiated Rate	$2,774.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,293.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,774.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,522.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,719.75

Know your out-of-pocket cost for care.

All Charges