Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LOW DENSITY LIPOPROTEIN (LDL)

Facility

$85.00

Service Code	HCPCS 83721
Hospital Charge Code	38472464
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$34.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.90
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: Cigna Medicare Advantage	$10.50
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Medicare Advantage	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$84,104.94

Service Code	MSDRG 493
Min. Negotiated Rate	$25,608.87
Max. Negotiated Rate	$84,104.94
Rate for Payer: Aetna Commercial	$58,047.02
Rate for Payer: Aetna Medicare Advantage	$84,104.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,826.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,826.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,956.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,826.40
Rate for Payer: Cigna Commercial	$47,460.58
Rate for Payer: Cigna Medicare Advantage	$26,956.71
Rate for Payer: Clover Medicare Advantage	$25,608.87
Rate for Payer: EmblemHealth Commercial	$80,870.13
Rate for Payer: Humana Medicare Advantage	$27,765.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,956.71
Rate for Payer: Oxford Commercial	$34,110.54
Rate for Payer: UnitedHealthcare Commercial	$59,813.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,956.71
Rate for Payer: Wellcare Medicare Advantage	$26,956.71

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$120,806.28

Service Code	MSDRG 492
Min. Negotiated Rate	$36,783.96
Max. Negotiated Rate	$120,806.28
Rate for Payer: Aetna Commercial	$83,265.01
Rate for Payer: Aetna Medicare Advantage	$120,806.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80,483.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80,483.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,719.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80,483.06
Rate for Payer: Cigna Commercial	$68,710.32
Rate for Payer: Cigna Medicare Advantage	$38,719.96
Rate for Payer: Clover Medicare Advantage	$36,783.96
Rate for Payer: EmblemHealth Commercial	$116,159.88
Rate for Payer: Humana Medicare Advantage	$39,881.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,719.96
Rate for Payer: Oxford Commercial	$49,383.02
Rate for Payer: UnitedHealthcare Commercial	$86,594.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,719.96
Rate for Payer: Wellcare Medicare Advantage	$38,719.96

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$66,987.52

Service Code	MSDRG 494
Min. Negotiated Rate	$20,396.84
Max. Negotiated Rate	$66,987.52
Rate for Payer: Aetna Commercial	$46,285.39
Rate for Payer: Aetna Medicare Advantage	$66,987.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,498.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,498.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,470.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,498.07
Rate for Payer: Cigna Commercial	$37,549.64
Rate for Payer: Cigna Medicare Advantage	$21,470.36
Rate for Payer: Clover Medicare Advantage	$20,396.84
Rate for Payer: EmblemHealth Commercial	$64,411.08
Rate for Payer: Humana Medicare Advantage	$22,114.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,470.36
Rate for Payer: Oxford Commercial	$26,987.42
Rate for Payer: UnitedHealthcare Commercial	$47,323.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,470.36
Rate for Payer: Wellcare Medicare Advantage	$21,470.36

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$62,028.93

Service Code	APR-DRG 1814
Min. Negotiated Rate	$60,812.68
Max. Negotiated Rate	$62,028.93
Rate for Payer: UnitedHealthcare Community & State	$60,812.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$62,028.93
Rate for Payer: Wellpoint Medicaid Managed Care	$60,812.68

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$26,573.45

Service Code	APR-DRG 1812
Min. Negotiated Rate	$26,052.40
Max. Negotiated Rate	$26,573.45
Rate for Payer: UnitedHealthcare Community & State	$26,052.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,573.45
Rate for Payer: Wellpoint Medicaid Managed Care	$26,052.40

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$19,266.85

Service Code	APR-DRG 1811
Min. Negotiated Rate	$18,889.07
Max. Negotiated Rate	$19,266.85
Rate for Payer: UnitedHealthcare Community & State	$18,889.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,266.85
Rate for Payer: Wellpoint Medicaid Managed Care	$18,889.07

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$40,276.37

Service Code	APR-DRG 1813
Min. Negotiated Rate	$39,486.64
Max. Negotiated Rate	$40,276.37
Rate for Payer: UnitedHealthcare Community & State	$39,486.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$40,276.37
Rate for Payer: Wellpoint Medicaid Managed Care	$39,486.64

LOWER MINOR PROCEDURE KIT

Facility

$146.00

Hospital Charge Code	270338742
Hospital Revenue Code	272
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Oxford Commercial	$29.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$29.20
Rate for Payer: UnitedHealthcare Community & State	$3.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

LOWER MINOR PROCEDURE KIT

Facility

$146.00

Hospital Charge Code	270338742
Hospital Revenue Code	272
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

LOW EXT INFANT 2VW-BIL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	94061245
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

LOW EXT INFANT 2VW-BIL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	94061245
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LOW EXTR INFANT 2VW-LT

Facility

$250.00

Service Code	HCPCS 73592LT
Hospital Charge Code	94061381
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

LOW EXTR INFANT 2VW-LT

Facility

$250.00

Service Code	HCPCS 73592LT
Hospital Charge Code	94061381
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

LOW EXTR INFANT 2VW-RT

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94061383
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LOW EXTR INFANT 2VW-RT

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94061383
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

LOW PROFILE NEURO ADAPTION PL

Facility

$1,655.00

Hospital Charge Code	270664778
Hospital Revenue Code	270
Min. Negotiated Rate	$248.25
Max. Negotiated Rate	$248.25
Rate for Payer: Qualcare PPO/HMO/WC	$248.25

LOW PROFILE NEURO ADAPTION PL

Facility

$1,655.00

Hospital Charge Code	270664778
Hospital Revenue Code	270
Min. Negotiated Rate	$39.89
Max. Negotiated Rate	$827.50
Rate for Payer: Aetna Commercial	$628.90
Rate for Payer: Aetna Medicare Advantage	$496.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.02
Rate for Payer: Cigna Commercial	$827.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.50
Rate for Payer: Oxford Commercial	$331.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.25
Rate for Payer: UnitedHealthcare Commercial	$331.00
Rate for Payer: UnitedHealthcare Community & State	$39.89
Rate for Payer: Wellpoint Medicaid Managed Care	$43.86

LOW PROFILE NEURO X PLATE 4 HO

Facility

$1,475.00

Hospital Charge Code	270664779
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

LOW PROFILE NEURO X PLATE 4 HO

Facility

$1,475.00

Hospital Charge Code	270664779
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

LOW PROFILE SCREW 2.0X12MM COR

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270690768
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

LOW PROFILE SCREW 2.0X12MM COR

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270690768
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

LOW PROFILE SCREW 2.0X16MM COR

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270690769
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

LOW PROFILE SCREW 2.0X16MM COR

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270690769
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

LOW PROFILE STNAILH PL 2 HOLE

Facility

$290.00

Hospital Charge Code	270664780
Hospital Revenue Code	270
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$58.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$58.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

Know your out-of-pocket cost for care.

All Charges