Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

F-SERIES CANN SCREW 2.0X40MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270681049
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

F-SERIES CANN SCREW 2.0X40MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270681049
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

F-SERIES CANN SCREW 2.0X45MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270681048
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

F-SERIES CANN SCREW 2.0X45MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270681048
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

F-SERIES CANN SCREW 4.0 X 45MM

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270679981
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

F-SERIES CANN SCREW 4.0 X 45MM

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270679981
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

FSH

Facility

$633.00

Service Code	HCPCS 83001
Hospital Charge Code	38472284
Hospital Revenue Code	301
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$50.54
Rate for Payer: Aetna Medicare Advantage	$60.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.07
Rate for Payer: Cigna Commercial	$316.50
Rate for Payer: Cigna Medicare Advantage	$18.58
Rate for Payer: Clover Medicare Advantage	$17.65
Rate for Payer: EmblemHealth Commercial	$55.74
Rate for Payer: Humana Medicare Advantage	$19.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.58
Rate for Payer: Wellcare Medicare Advantage	$18.58
Rate for Payer: Wellpoint Medicaid Managed Care	$16.77

FSH

Facility

$192.85

Service Code	HCPCS 83001
Hospital Charge Code	39900416
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

FSH

Facility

$633.00

Service Code	HCPCS 83001
Hospital Charge Code	38472284
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

FSH

Facility

$192.85

Service Code	HCPCS 83001
Hospital Charge Code	39900416
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.54
Rate for Payer: Aetna Medicare Advantage	$60.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.07
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: Cigna Medicare Advantage	$18.58
Rate for Payer: Clover Medicare Advantage	$17.65
Rate for Payer: EmblemHealth Commercial	$55.74
Rate for Payer: Humana Medicare Advantage	$19.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.58
Rate for Payer: Wellcare Medicare Advantage	$18.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

FTA -ABS

Facility

$124.00

Service Code	HCPCS 86780
Hospital Charge Code	38476210
Hospital Revenue Code	302
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

FTA -ABS

Facility

$124.00

Service Code	HCPCS 86780
Hospital Charge Code	38476210
Hospital Revenue Code	302
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

FTA-ABS, CSF

Facility

$141.65

Service Code	HCPCS 86780
Hospital Charge Code	3009750
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

FTA-ABS, CSF

Facility

$141.65

Service Code	HCPCS 86780
Hospital Charge Code	3009750
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

FTA-ABS,SERUM

Facility

$667.59

Service Code	HCPCS 86780
Hospital Charge Code	39990049EX
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

FTA-ABS,SERUM

Facility

$667.59

Service Code	HCPCS 86780
Hospital Charge Code	39990049EX
Hospital Revenue Code	302
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

FTA-ABS,SERUM, I

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39990049A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

FTA-ABS,SERUM, I

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39990049A
Hospital Revenue Code	306
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

F.TULARENSIS AB,DA (SERUM)

Facility

$390.00

Service Code	HCPCS 86000
Hospital Charge Code	397080011
Hospital Revenue Code	305
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.99
Rate for Payer: Aetna Medicare Advantage	$22.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.98
Rate for Payer: Clover Medicare Advantage	$6.63
Rate for Payer: EmblemHealth Commercial	$20.94
Rate for Payer: Humana Medicare Advantage	$7.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.98
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	$5.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.98
Rate for Payer: Wellcare Medicare Advantage	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

F.TULARENSIS AB,DA (SERUM)

Facility

$390.00

Service Code	HCPCS 86000
Hospital Charge Code	397080011
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FULL CORE BIOPSY 16GX15CM

Facility

$235.00

Hospital Charge Code	270670786
Hospital Revenue Code	272
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

FULL CORE BIOPSY 16GX15CM

Facility

$235.00

Hospital Charge Code	270670786
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

FULL RAD BONECUTTER 4.5MM PLAT

Facility

$400.00

Hospital Charge Code	270692790
Hospital Revenue Code	272
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

FULL RAD BONECUTTER 4.5MM PLAT

Facility

$400.00

Hospital Charge Code	270692790
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

FULL RING 155MM

Facility

$8,025.00

Hospital Charge Code	270674285
Hospital Revenue Code	272
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$3,049.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.50
Rate for Payer: Oxford Commercial	$1,605.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75
Rate for Payer: UnitedHealthcare Commercial	$1,605.00
Rate for Payer: UnitedHealthcare Community & State	$193.40
Rate for Payer: Wellpoint Medicaid Managed Care	$212.66

Know your out-of-pocket cost for care.

All Charges