Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

24X36X12MM CAGE, 12 DEGREES

Facility

$31,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704954
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

2.5 DRILL

Facility

$1,570.00

Hospital Charge Code	270703460
Hospital Revenue Code	279
Min. Negotiated Rate	$235.50
Max. Negotiated Rate	$235.50
Rate for Payer: Qualcare PPO/HMO/WC	$235.50

2.5 DRILL

Facility

$750.00

Hospital Charge Code	270657972
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

2.5 DRILL

Facility

$1,570.00

Hospital Charge Code	270703460
Hospital Revenue Code	279
Min. Negotiated Rate	$37.84
Max. Negotiated Rate	$785.00
Rate for Payer: Aetna Commercial	$596.60
Rate for Payer: Aetna Medicare Advantage	$471.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.35
Rate for Payer: Cigna Commercial	$785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.00
Rate for Payer: Oxford Commercial	$314.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.50
Rate for Payer: UnitedHealthcare Commercial	$314.00
Rate for Payer: UnitedHealthcare Community & State	$37.84
Rate for Payer: Wellpoint Medicaid Managed Care	$41.60

2.5 DRILL

Facility

$750.00

Hospital Charge Code	270657972
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

2.5 DRILL BIT

Facility

$425.00

Hospital Charge Code	270656429
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

2.5 DRILL BIT

Facility

$316.65

Hospital Charge Code	270656288
Hospital Revenue Code	272
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$47.50

2.5 DRILL BIT

Facility

$316.65

Hospital Charge Code	270656288
Hospital Revenue Code	272
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$158.32
Rate for Payer: Aetna Commercial	$120.33
Rate for Payer: Aetna Medicare Advantage	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.75
Rate for Payer: Cigna Commercial	$158.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.00
Rate for Payer: Oxford Commercial	$63.33
Rate for Payer: Qualcare PPO/HMO/WC	$47.50
Rate for Payer: UnitedHealthcare Commercial	$63.33
Rate for Payer: UnitedHealthcare Community & State	$7.63
Rate for Payer: Wellpoint Medicaid Managed Care	$8.39

2.5 DRILL BIT

Facility

$425.00

Hospital Charge Code	270656429
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

2.5 DRILL BIT LONG

Facility

$730.00

Hospital Charge Code	270656858
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$176.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

2.5 DRILL BIT LONG

Facility

$730.00

Hospital Charge Code	270656858
Hospital Revenue Code	278
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$277.40
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

2.5 DRILL BIT SHORT

Facility

$271.00

Hospital Charge Code	270656859
Hospital Revenue Code	272
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$135.50
Rate for Payer: Aetna Commercial	$102.98
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.30
Rate for Payer: Oxford Commercial	$54.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.65
Rate for Payer: UnitedHealthcare Commercial	$54.20
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.18

2.5 DRILL BIT SHORT

Facility

$271.00

Hospital Charge Code	270656859
Hospital Revenue Code	272
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

25 G 5 INCH SPINAL NEEDLE

Facility

$935.00

Hospital Charge Code	270325444
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

25 G 5 INCH SPINAL NEEDLE

Facility

$935.00

Hospital Charge Code	270325444
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

2.5 GRADUATED DRILL BIT

Facility

$425.00

Hospital Charge Code	270656430
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

2.5 GRADUATED DRILL BIT

Facility

$425.00

Hospital Charge Code	270656430
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

25 HOUR URINE FOR KIDNEY STONE

Facility

$119.25

Service Code	HCPCS 84105
Hospital Charge Code	3038533B
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

25 HOUR URINE FOR KIDNEY STONE

Facility

$119.25

Service Code	HCPCS 84105
Hospital Charge Code	3038533B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

25 HYDROXYVITAMIN D

Facility

$390.00

Service Code	HCPCS 82306
Hospital Charge Code	401082306
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

25 HYDROXYVITAMIN D

Facility

$390.00

Service Code	HCPCS 82306
Hospital Charge Code	401082306
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$80.51
Rate for Payer: Aetna Medicare Advantage	$95.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$29.60
Rate for Payer: Clover Medicare Advantage	$28.12
Rate for Payer: EmblemHealth Commercial	$88.80
Rate for Payer: Humana Medicare Advantage	$30.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.60
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	$23.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.60
Rate for Payer: Wellcare Medicare Advantage	$29.60
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

2.5 MM 10 DIGIFUSE

Facility

$10,220.45

Service Code	HCPCS C1713
Hospital Charge Code	270687126
Hospital Revenue Code	278
Min. Negotiated Rate	$246.31
Max. Negotiated Rate	$5,110.23
Rate for Payer: Aetna Commercial	$3,883.77
Rate for Payer: Aetna Medicare Advantage	$3,066.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.21
Rate for Payer: Cigna Commercial	$5,110.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,248.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.07
Rate for Payer: UnitedHealthcare Community & State	$246.31
Rate for Payer: Wellpoint Medicaid Managed Care	$270.84

2.5 MM 10 DIGIFUSE

Facility

$10,220.45

Service Code	HCPCS C1713
Hospital Charge Code	270687126
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.07
Max. Negotiated Rate	$2,473.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,248.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.07

2.5MM HEADED SCREW LENGTH 12MM

Facility

$1,421.80

Service Code	HCPCS C1713
Hospital Charge Code	270687946
Hospital Revenue Code	278
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$710.90
Rate for Payer: Aetna Commercial	$540.28
Rate for Payer: Aetna Medicare Advantage	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.56
Rate for Payer: Cigna Commercial	$710.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$312.80
Rate for Payer: Qualcare PPO/HMO/WC	$213.27
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: Wellpoint Medicaid Managed Care	$37.68

2.5MM HEADED SCREW LENGTH 12MM

Facility

$1,421.80

Service Code	HCPCS C1713
Hospital Charge Code	270687946
Hospital Revenue Code	278
Min. Negotiated Rate	$213.27
Max. Negotiated Rate	$344.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$312.80
Rate for Payer: Qualcare PPO/HMO/WC	$213.27

Know your out-of-pocket cost for care.

All Charges