Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERLOCK OCLUSION SYSTEM 8 MM

Facility

$1,885.75

Hospital Charge Code	270679434
Hospital Revenue Code	272
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$942.88
Rate for Payer: Aetna Commercial	$716.59
Rate for Payer: Aetna Medicare Advantage	$565.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$480.87
Rate for Payer: Cigna Commercial	$942.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.73
Rate for Payer: Oxford Commercial	$377.15
Rate for Payer: Qualcare PPO/HMO/WC	$282.86
Rate for Payer: UnitedHealthcare Commercial	$377.15
Rate for Payer: UnitedHealthcare Community & State	$45.45
Rate for Payer: Wellpoint Medicaid Managed Care	$49.97

INTERLOCK OCLUSION SYSTEM 8 MM

Facility

$1,885.75

Hospital Charge Code	270679434
Hospital Revenue Code	272
Min. Negotiated Rate	$282.86
Max. Negotiated Rate	$282.86
Rate for Payer: Qualcare PPO/HMO/WC	$282.86

INTERNAL BRACE IMPLANT KIT

Facility

$6,965.00

Hospital Charge Code	270662474
Hospital Revenue Code	272
Min. Negotiated Rate	$1,044.75
Max. Negotiated Rate	$1,044.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,044.75

INTERNAL BRACE IMPLANT KIT

Facility

$6,965.00

Hospital Charge Code	270662544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,044.75
Max. Negotiated Rate	$1,685.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,393.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,685.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,532.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,044.75

INTERNAL BRACE IMPLANT KIT

Facility

$6,965.00

Hospital Charge Code	270662474
Hospital Revenue Code	272
Min. Negotiated Rate	$167.86
Max. Negotiated Rate	$3,482.50
Rate for Payer: Aetna Commercial	$2,646.70
Rate for Payer: Aetna Medicare Advantage	$2,089.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,776.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,776.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,776.08
Rate for Payer: Cigna Commercial	$3,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,089.50
Rate for Payer: Oxford Commercial	$1,393.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,044.75
Rate for Payer: UnitedHealthcare Commercial	$1,393.00
Rate for Payer: UnitedHealthcare Community & State	$167.86
Rate for Payer: Wellpoint Medicaid Managed Care	$184.57

INTERNAL BRACE IMPLANT KIT

Facility

$6,965.00

Hospital Charge Code	270662544
Hospital Revenue Code	278
Min. Negotiated Rate	$167.86
Max. Negotiated Rate	$3,482.50
Rate for Payer: Aetna Commercial	$2,646.70
Rate for Payer: Aetna Medicare Advantage	$2,089.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,776.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,776.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,393.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,776.08
Rate for Payer: Cigna Commercial	$3,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,685.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,532.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,044.75
Rate for Payer: UnitedHealthcare Community & State	$167.86
Rate for Payer: Wellpoint Medicaid Managed Care	$184.57

INTERNAL BRACE IMPLANT SYSTEM

Facility

$5,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270680614
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Community & State	$144.00
Rate for Payer: Wellpoint Medicaid Managed Care	$158.34

INTERNAL BRACE IMPLANT SYSTEM

Facility

$5,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270680614
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

INTERP CERV MYELOGRAM

Facility

$2,963.00

Service Code	HCPCS 72240
Hospital Charge Code	84506070
Hospital Revenue Code	320
Min. Negotiated Rate	$71.41
Max. Negotiated Rate	$3,361.79
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$651.92
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$444.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$78.52

INTERP CERV MYELOGRAM

Facility

$2,963.00

Service Code	HCPCS 72240
Hospital Charge Code	84506070
Hospital Revenue Code	320
Min. Negotiated Rate	$444.45
Max. Negotiated Rate	$444.45
Rate for Payer: Qualcare PPO/HMO/WC	$444.45

INTERP LUMBAR MYELOGRAM

Facility

$2,963.00

Service Code	HCPCS 72265
Hospital Charge Code	84506080
Hospital Revenue Code	320
Min. Negotiated Rate	$71.41
Max. Negotiated Rate	$3,361.79
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$651.92
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$444.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$78.52

INTERP LUMBAR MYELOGRAM

Facility

$2,963.00

Service Code	HCPCS 72265
Hospital Charge Code	84506080
Hospital Revenue Code	320
Min. Negotiated Rate	$444.45
Max. Negotiated Rate	$444.45
Rate for Payer: Qualcare PPO/HMO/WC	$444.45

INTERP PSYCH RESULTS MD FAM AS

Facility

$401.70

Service Code	HCPCS 90877
Hospital Charge Code	94810240
Hospital Revenue Code	900
Min. Negotiated Rate	$60.26
Max. Negotiated Rate	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$60.26

INTERP PSYCH RESULTS MD FAM AS

Facility

$401.70

Service Code	HCPCS 90877
Hospital Charge Code	94810240
Hospital Revenue Code	900
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$152.65
Rate for Payer: Aetna Medicare Advantage	$120.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.43
Rate for Payer: Cigna Commercial	$200.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.51
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.26
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$9.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

INTERPRETATION AND REPORT

Facility

$111.00

Hospital Charge Code	3009345C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

INTERPRETATION AND REPORT

Facility

$111.00

Hospital Charge Code	3009069F
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

INTERPRETATION AND REPORT

Facility

$35.00

Service Code	HCPCS 83912
Hospital Charge Code	300935C
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

INTERPRETATION AND REPORT

Facility

$35.00

Service Code	HCPCS 83912
Hospital Charge Code	300935C
Hospital Revenue Code	301
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

INTERPRETATION AND REPORT

Facility

$111.00

Hospital Charge Code	3009069F
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

INTERPRETATION AND REPORT

Facility

$111.00

Hospital Charge Code	3009345C
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

INTERPRETATION OF OUTSIDE SLID

Facility

$680.00

Service Code	HCPCS 88321
Hospital Charge Code	38474079
Hospital Revenue Code	310
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$76.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

INTERPRETATION OF OUTSIDE SLID

Facility

$680.00

Service Code	HCPCS 88321
Hospital Charge Code	38474079
Hospital Revenue Code	310
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

INTERPSTIN ARTHROPL IC/ICM JNT

Facility

$16,063.45

Service Code	HCPCS 25447
Hospital Charge Code	16000395
Hospital Revenue Code	360
Min. Negotiated Rate	$2,409.52
Max. Negotiated Rate	$2,409.52
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.52

INTERPSTIN ARTHROPL IC/ICM JNT

Facility

$16,063.45

Service Code	HCPCS 25447
Hospital Charge Code	16000395
Hospital Revenue Code	360
Min. Negotiated Rate	$387.13
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.03
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.52
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$387.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$425.68

INTERP THORACIC MYELOGRAM

Facility

$2,963.00

Service Code	HCPCS 72255
Hospital Charge Code	84506075
Hospital Revenue Code	320
Min. Negotiated Rate	$444.45
Max. Negotiated Rate	$444.45
Rate for Payer: Qualcare PPO/HMO/WC	$444.45

Know your out-of-pocket cost for care.

All Charges