Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LOAD UNIT SKIN STAPLER SM35W

Facility

$113.45

Hospital Charge Code	270658602
Hospital Revenue Code	270
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.73
Rate for Payer: Aetna Commercial	$43.11
Rate for Payer: Aetna Medicare Advantage	$34.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.93
Rate for Payer: Cigna Commercial	$56.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.03
Rate for Payer: Oxford Commercial	$22.69
Rate for Payer: Qualcare PPO/HMO/WC	$17.02
Rate for Payer: UnitedHealthcare Commercial	$22.69
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

LOAD UNIT SKIN STAPLER SM35W

Facility

$113.45

Hospital Charge Code	270658602
Hospital Revenue Code	270
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$17.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.02

LOAD UNIT SOFSIL 2/0 48 BLK

Facility

$102.25

Hospital Charge Code	270641756
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.12
Rate for Payer: Aetna Commercial	$38.85
Rate for Payer: Aetna Medicare Advantage	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.07
Rate for Payer: Cigna Commercial	$51.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.34
Rate for Payer: UnitedHealthcare Commercial	$20.45
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.71

LOAD UNIT SOFSIL 2/0 48 BLK

Facility

$102.25

Hospital Charge Code	270641756
Hospital Revenue Code	272
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$15.34

LOAD UNIT SURGIDAC 0 7 GREEN

Facility

$102.25

Hospital Charge Code	270669363
Hospital Revenue Code	272
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$15.34

LOAD UNIT SURGIDAC 0 7 GREEN

Facility

$102.25

Hospital Charge Code	270669363
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.12
Rate for Payer: Aetna Commercial	$38.85
Rate for Payer: Aetna Medicare Advantage	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.07
Rate for Payer: Cigna Commercial	$51.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.34
Rate for Payer: UnitedHealthcare Commercial	$20.45
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.71

LOAD UNIT TA60-3.5 SINGLE USE

Facility

$203.85

Hospital Charge Code	270630409
Hospital Revenue Code	272
Min. Negotiated Rate	$30.58
Max. Negotiated Rate	$30.58
Rate for Payer: Qualcare PPO/HMO/WC	$30.58

LOAD UNIT TA60-3.5 SINGLE USE

Facility

$203.85

Hospital Charge Code	270630409
Hospital Revenue Code	272
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$101.92
Rate for Payer: Aetna Commercial	$77.46
Rate for Payer: Aetna Medicare Advantage	$61.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.98
Rate for Payer: Cigna Commercial	$101.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.16
Rate for Payer: Oxford Commercial	$40.77
Rate for Payer: Qualcare PPO/HMO/WC	$30.58
Rate for Payer: UnitedHealthcare Commercial	$40.77
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

LOANER ARM TRIMANO POSITIONER

Facility

$1,250.00

Hospital Charge Code	270648820
Hospital Revenue Code	271
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

LOANER ARM TRIMANO POSITIONER

Facility

$1,250.00

Hospital Charge Code	270648820
Hospital Revenue Code	271
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

LOANER FEE ARTHOSCOPY TRAY

Facility

$1,000.00

Hospital Charge Code	270661562
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

LOANER FEE ARTHOSCOPY TRAY

Facility

$1,000.00

Hospital Charge Code	270661562
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

LOANER INSTRUMENT USAGE FEE

Facility

$1,000.00

Hospital Charge Code	270646571
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

LOANER INSTRUMENT USAGE FEE

Facility

$1,000.00

Hospital Charge Code	270646571
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

LOANER PRP

Facility

$750.00

Hospital Charge Code	270659982
Hospital Revenue Code	270
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LOANER PRP

Facility

$750.00

Hospital Charge Code	270659982
Hospital Revenue Code	270
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

LOBSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003E
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LOBSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$60,439.11

Service Code	MSDRG 496
Min. Negotiated Rate	$18,402.93
Max. Negotiated Rate	$60,439.11
Rate for Payer: Aetna Commercial	$41,785.88
Rate for Payer: Aetna Medicare Advantage	$60,439.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,289.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,289.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,371.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,289.39
Rate for Payer: Cigna Commercial	$33,758.18
Rate for Payer: Cigna Medicare Advantage	$19,371.51
Rate for Payer: Clover Medicare Advantage	$18,402.93
Rate for Payer: EmblemHealth Commercial	$58,114.53
Rate for Payer: Humana Medicare Advantage	$19,952.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,371.51
Rate for Payer: Oxford Commercial	$24,262.46
Rate for Payer: UnitedHealthcare Commercial	$42,544.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,371.51
Rate for Payer: Wellcare Medicare Advantage	$19,371.51

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$119,322.72

Service Code	MSDRG 495
Min. Negotiated Rate	$36,332.24
Max. Negotiated Rate	$119,322.72
Rate for Payer: Aetna Commercial	$82,245.62
Rate for Payer: Aetna Medicare Advantage	$119,322.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83,274.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83,274.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,244.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83,274.38
Rate for Payer: Cigna Commercial	$67,851.35
Rate for Payer: Cigna Medicare Advantage	$38,244.46
Rate for Payer: Clover Medicare Advantage	$36,332.24
Rate for Payer: EmblemHealth Commercial	$114,733.38
Rate for Payer: Humana Medicare Advantage	$39,391.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,244.46
Rate for Payer: Oxford Commercial	$48,765.67
Rate for Payer: UnitedHealthcare Commercial	$85,512.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,244.46
Rate for Payer: Wellcare Medicare Advantage	$38,244.46

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$41,188.27

Service Code	MSDRG 497
Min. Negotiated Rate	$12,541.30
Max. Negotiated Rate	$41,188.27
Rate for Payer: Aetna Commercial	$28,558.35
Rate for Payer: Aetna Medicare Advantage	$41,188.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,263.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,263.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,201.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,263.23
Rate for Payer: Cigna Commercial	$21,552.91
Rate for Payer: Cigna Medicare Advantage	$13,201.37
Rate for Payer: Clover Medicare Advantage	$12,541.30
Rate for Payer: EmblemHealth Commercial	$39,604.11
Rate for Payer: Humana Medicare Advantage	$13,597.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,201.37
Rate for Payer: Oxford Commercial	$15,490.36
Rate for Payer: UnitedHealthcare Commercial	$27,162.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,201.37
Rate for Payer: Wellcare Medicare Advantage	$13,201.37

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$99,642.07

Service Code	MSDRG 498
Min. Negotiated Rate	$30,339.73
Max. Negotiated Rate	$99,642.07
Rate for Payer: Aetna Commercial	$68,722.79
Rate for Payer: Aetna Medicare Advantage	$99,642.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,711.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,711.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,936.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,711.21
Rate for Payer: Cigna Commercial	$56,456.40
Rate for Payer: Cigna Medicare Advantage	$31,936.56
Rate for Payer: Clover Medicare Advantage	$30,339.73
Rate for Payer: EmblemHealth Commercial	$95,809.68
Rate for Payer: Humana Medicare Advantage	$32,894.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31,936.56
Rate for Payer: Oxford Commercial	$40,575.96
Rate for Payer: UnitedHealthcare Commercial	$71,151.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,936.56
Rate for Payer: Wellcare Medicare Advantage	$31,936.56

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$67,255.69

Service Code	MSDRG 499
Min. Negotiated Rate	$20,478.49
Max. Negotiated Rate	$67,255.69
Rate for Payer: Aetna Commercial	$46,469.66
Rate for Payer: Aetna Medicare Advantage	$67,255.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,006.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,006.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,556.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,006.69
Rate for Payer: Cigna Commercial	$37,704.97
Rate for Payer: Cigna Medicare Advantage	$21,556.31
Rate for Payer: Clover Medicare Advantage	$20,478.49
Rate for Payer: EmblemHealth Commercial	$64,668.93
Rate for Payer: Humana Medicare Advantage	$22,203.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,556.31
Rate for Payer: Oxford Commercial	$27,099.06
Rate for Payer: UnitedHealthcare Commercial	$47,519.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,556.31
Rate for Payer: Wellcare Medicare Advantage	$21,556.31

LOCALIZATION NEEDLE BREAST 7.5

Facility

$180.00

Hospital Charge Code	270665028
Hospital Revenue Code	270
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

LOCALIZATION NEEDLE BREAST 7.5

Facility

$180.00

Hospital Charge Code	270665028
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

Know your out-of-pocket cost for care.

All Charges