Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INCORE 3.5 X 56MM SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687706
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$303.60
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 5.9MMX 28MM

Facility

$17,440.00

Service Code	HCPCS C1713
Hospital Charge Code	270687705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,616.00
Max. Negotiated Rate	$4,220.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,220.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,836.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,616.00

INCORE 5.9MMX 28MM

Facility

$17,440.00

Service Code	HCPCS C1713
Hospital Charge Code	270687705
Hospital Revenue Code	278
Min. Negotiated Rate	$420.30
Max. Negotiated Rate	$8,720.00
Rate for Payer: Aetna Commercial	$6,627.20
Rate for Payer: Aetna Medicare Advantage	$5,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,447.20
Rate for Payer: Cigna Commercial	$8,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,220.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,836.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,616.00
Rate for Payer: UnitedHealthcare Community & State	$420.30
Rate for Payer: Wellpoint Medicaid Managed Care	$462.16

INCORE 5.9MM X 28MM TI SCREW

Facility

$22,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270692230
Hospital Revenue Code	278
Min. Negotiated Rate	$3,427.50
Max. Negotiated Rate	$5,529.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,529.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,027.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.50

INCORE 5.9MM X 28MM TI SCREW

Facility

$22,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270692230
Hospital Revenue Code	278
Min. Negotiated Rate	$550.68
Max. Negotiated Rate	$11,425.00
Rate for Payer: Aetna Commercial	$8,683.00
Rate for Payer: Aetna Medicare Advantage	$6,855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,826.75
Rate for Payer: Cigna Commercial	$11,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,529.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,027.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.50
Rate for Payer: UnitedHealthcare Community & State	$550.68
Rate for Payer: Wellpoint Medicaid Managed Care	$605.52

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$705.00
Rate for Payer: Aetna Commercial	$535.80
Rate for Payer: Aetna Medicare Advantage	$423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.55
Rate for Payer: Cigna Commercial	$705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.00
Rate for Payer: Oxford Commercial	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.50
Rate for Payer: UnitedHealthcare Commercial	$282.00
Rate for Payer: UnitedHealthcare Community & State	$33.98
Rate for Payer: Wellpoint Medicaid Managed Care	$37.37

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$211.50
Rate for Payer: Qualcare PPO/HMO/WC	$211.50

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$135.88
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	$1,016.00
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	$1,691.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$845.75
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$135.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27
Rate for Payer: Wellpoint Medicaid Managed Care	$4,386.54

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$845.75
Max. Negotiated Rate	$845.75
Rate for Payer: Qualcare PPO/HMO/WC	$845.75

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$193.12
Rate for Payer: Qualcare PPO/HMO/WC	$193.12

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.24
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.12
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$31.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

INC & REM FB SQ TISSUE SIMPLE

Facility

$403.25

Service Code	HCPCS 10120
Hospital Charge Code	2500362
Hospital Revenue Code	761
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.97
Rate for Payer: Oxford Commercial	$80.65
Rate for Payer: Qualcare PPO/HMO/WC	$60.49
Rate for Payer: UnitedHealthcare Commercial	$80.65
Rate for Payer: UnitedHealthcare Community & State	$9.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$10.69

INC & REM FB SQ TISSUE SIMPLE

Facility

$403.25

Service Code	HCPCS 10120
Hospital Charge Code	2500362
Hospital Revenue Code	761
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$60.49
Rate for Payer: Qualcare PPO/HMO/WC	$60.49

INCUBATION SERUM & DRUGS EACH

Facility

$150.00

Service Code	HCPCS 86975
Hospital Charge Code	3100181
Hospital Revenue Code	300
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$1,915.74
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,915.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,915.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,915.74
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

INCUBATION SERUM & DRUGS EACH

Facility

$150.00

Service Code	HCPCS 86975
Hospital Charge Code	3100181
Hospital Revenue Code	300
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
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	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INCUBATION W INHIBITORS EACH

Facility

$200.00

Service Code	HCPCS 86977
Hospital Charge Code	3100184
Hospital Revenue Code	300
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

INCUBATION W INHIBITORS EACH

Facility

$200.00

Service Code	HCPCS 86977
Hospital Charge Code	3100184
Hospital Revenue Code	300
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$151.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.28
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$237.12
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.28
Rate for Payer: Qualcare PPO/HMO/WC	$93.60
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: Wellpoint Medicaid Managed Care	$16.54

Know your out-of-pocket cost for care.

All Charges