Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LAT INTERBODY 18X50X12 12 DEG

Facility

$21,000.00

Hospital Charge Code	270702452
Hospital Revenue Code	278
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$5,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

LAT INTERBODY 18X50X12 12 DEG

Facility

$21,000.00

Hospital Charge Code	270702452
Hospital Revenue Code	278
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$10,500.00
Rate for Payer: Aetna Commercial	$7,980.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,355.00
Rate for Payer: Cigna Commercial	$10,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Community & State	$506.10
Rate for Payer: Wellpoint Medicaid Managed Care	$556.50

LAT THOR/LUMB ADDL SEG

Facility

$9,420.05

Service Code	HCPCS 22534
Hospital Charge Code	1600000881
Hospital Revenue Code	360
Min. Negotiated Rate	$1,413.01
Max. Negotiated Rate	$1,413.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.01

LAT THOR/LUMB ADDL SEG

Facility

$9,420.05

Service Code	HCPCS 22534
Hospital Charge Code	1600000881
Hospital Revenue Code	360
Min. Negotiated Rate	$227.02
Max. Negotiated Rate	$4,710.02
Rate for Payer: Aetna Commercial	$3,579.62
Rate for Payer: Aetna Medicare Advantage	$2,826.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,402.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,402.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,402.11
Rate for Payer: Cigna Commercial	$4,710.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,826.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.01
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$227.02
Rate for Payer: Wellpoint Medicaid Managed Care	$249.63

LAYER 1.5 X 10

Facility

$117.50

Hospital Charge Code	270690217
Hospital Revenue Code	272
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$58.75
Rate for Payer: Aetna Commercial	$44.65
Rate for Payer: Aetna Medicare Advantage	$35.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.96
Rate for Payer: Cigna Commercial	$58.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.25
Rate for Payer: Oxford Commercial	$23.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.62
Rate for Payer: UnitedHealthcare Commercial	$23.50
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

LAYER 1.5 X 10

Facility

$117.50

Hospital Charge Code	270690217
Hospital Revenue Code	272
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

LAYER SINGLE CONTACT 4x4

Facility

$125.00

Hospital Charge Code	270676733
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

LAYER SINGLE CONTACT 4x4

Facility

$125.00

Hospital Charge Code	270676733
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

LCKNG SCR FOR IM NL 4/18/XL25

Facility

$2,049.20

Service Code	HCPCS C1713
Hospital Charge Code	270705551
Hospital Revenue Code	278
Min. Negotiated Rate	$307.38
Max. Negotiated Rate	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.82
Rate for Payer: Qualcare PPO/HMO/WC	$307.38

LCKNG SCR FOR IM NL 4/18/XL25

Facility

$2,049.20

Service Code	HCPCS C1713
Hospital Charge Code	270705551
Hospital Revenue Code	278
Min. Negotiated Rate	$49.39
Max. Negotiated Rate	$1,024.60
Rate for Payer: Aetna Commercial	$778.70
Rate for Payer: Aetna Medicare Advantage	$614.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.55
Rate for Payer: Cigna Commercial	$1,024.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.82
Rate for Payer: Qualcare PPO/HMO/WC	$307.38
Rate for Payer: UnitedHealthcare Community & State	$49.39
Rate for Payer: Wellpoint Medicaid Managed Care	$54.30

LCKNG SCR FOR IM NL 4/20/XL25

Facility

$2,049.20

Service Code	HCPCS C1713
Hospital Charge Code	270705552
Hospital Revenue Code	278
Min. Negotiated Rate	$307.38
Max. Negotiated Rate	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.82
Rate for Payer: Qualcare PPO/HMO/WC	$307.38

LCKNG SCR FOR IM NL 4/20/XL25

Facility

$2,049.20

Service Code	HCPCS C1713
Hospital Charge Code	270705552
Hospital Revenue Code	278
Min. Negotiated Rate	$49.39
Max. Negotiated Rate	$1,024.60
Rate for Payer: Aetna Commercial	$778.70
Rate for Payer: Aetna Medicare Advantage	$614.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.55
Rate for Payer: Cigna Commercial	$1,024.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.82
Rate for Payer: Qualcare PPO/HMO/WC	$307.38
Rate for Payer: UnitedHealthcare Community & State	$49.39
Rate for Payer: Wellpoint Medicaid Managed Care	$54.30

LCL SURG WND/DEH EXTENS

Facility

$16,286.20

Service Code	HCPCS 13160
Hospital Charge Code	16000280
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

LCL SURG WND/DEH EXTENS

Facility

$16,286.20

Service Code	HCPCS 13160
Hospital Charge Code	16000280
Hospital Revenue Code	360
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,885.86
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$392.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,165.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5,064.59

l COLECTOMY/COLOPROCTOSTOMY

Facility

$2,998.75

Service Code	HCPCS 44208
Hospital Charge Code	1600000409
Hospital Revenue Code	360
Min. Negotiated Rate	$72.27
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$1,139.53
Rate for Payer: Aetna Medicare Advantage	$899.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.68
Rate for Payer: Cigna Commercial	$1,499.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$899.62
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.81
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$72.27
Rate for Payer: Wellpoint Medicaid Managed Care	$79.47

l COLECTOMY/COLOPROCTOSTOMY

Facility

$2,998.75

Service Code	HCPCS 44208
Hospital Charge Code	1600000409
Hospital Revenue Code	360
Min. Negotiated Rate	$449.81
Max. Negotiated Rate	$449.81
Rate for Payer: Qualcare PPO/HMO/WC	$449.81

L COLECTOMY COLOPROCTOSTOMY

Facility

$29,003.00

Service Code	HCPCS 44207
Hospital Charge Code	1600000788
Hospital Revenue Code	360
Min. Negotiated Rate	$698.97
Max. Negotiated Rate	$14,501.50
Rate for Payer: Aetna Commercial	$11,021.14
Rate for Payer: Aetna Medicare Advantage	$8,700.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.77
Rate for Payer: Cigna Commercial	$14,501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,700.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.45
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$698.97
Rate for Payer: Wellpoint Medicaid Managed Care	$768.58

L COLECTOMY COLOPROCTOSTOMY

Facility

$29,003.00

Service Code	HCPCS 44207
Hospital Charge Code	1600000788
Hospital Revenue Code	360
Min. Negotiated Rate	$4,350.45
Max. Negotiated Rate	$4,350.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.45

L&D ANESTH 1-15 MIN

Facility

$551.00

Hospital Charge Code	73190117
Hospital Revenue Code	370
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

L&D ANESTH 1-15 MIN

Facility

$551.00

Hospital Charge Code	73190117
Hospital Revenue Code	370
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: Aetna Medicare Advantage	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.50
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.30
Rate for Payer: Oxford Commercial	$110.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: UnitedHealthcare Community & State	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

L&D ANESTH 16-30 MIN

Facility

$1,103.00

Hospital Charge Code	73190119
Hospital Revenue Code	370
Min. Negotiated Rate	$165.45
Max. Negotiated Rate	$165.45
Rate for Payer: Qualcare PPO/HMO/WC	$165.45

L&D ANESTH 16-30 MIN

Facility

$1,103.00

Hospital Charge Code	73190119
Hospital Revenue Code	370
Min. Negotiated Rate	$26.58
Max. Negotiated Rate	$551.50
Rate for Payer: Aetna Commercial	$419.14
Rate for Payer: Aetna Medicare Advantage	$330.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.26
Rate for Payer: Cigna Commercial	$551.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.90
Rate for Payer: Oxford Commercial	$220.60
Rate for Payer: Qualcare PPO/HMO/WC	$165.45
Rate for Payer: UnitedHealthcare Commercial	$220.60
Rate for Payer: UnitedHealthcare Community & State	$26.58
Rate for Payer: Wellpoint Medicaid Managed Care	$29.23

LDCT FOR LUNG CA SCREENING

Facility

$599.85

Service Code	HCPCS G0297
Hospital Charge Code	2250425
Hospital Revenue Code	352
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$227.94
Rate for Payer: Aetna Medicare Advantage	$179.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.96
Rate for Payer: Cigna Commercial	$299.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.96
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.98
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

LDCT FOR LUNG CA SCREENING

Facility

$599.85

Service Code	HCPCS G0297
Hospital Charge Code	2250425
Hospital Revenue Code	352
Min. Negotiated Rate	$89.98
Max. Negotiated Rate	$89.98
Rate for Payer: Qualcare PPO/HMO/WC	$89.98

LD,FLUID

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38479016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.80
Rate for Payer: Cigna Commercial	$141.00
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

Know your out-of-pocket cost for care.

All Charges