Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

10-HYDROXYCARBAZEPINE

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900106
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

10-HYDROXYCARBAZEPINE

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900106
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.03
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
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	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

10MM/125DEG TI CANN TFNA

Facility

$9,256.50

Service Code	HCPCS C1713
Hospital Charge Code	270698943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.47
Max. Negotiated Rate	$2,240.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,240.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.47

10MM/125DEG TI CANN TFNA

Facility

$9,256.50

Service Code	HCPCS C1713
Hospital Charge Code	270698943
Hospital Revenue Code	278
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$4,628.25
Rate for Payer: Aetna Commercial	$3,517.47
Rate for Payer: Aetna Medicare Advantage	$2,776.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.41
Rate for Payer: Cigna Commercial	$4,628.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,240.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.47
Rate for Payer: UnitedHealthcare Community & State	$223.08
Rate for Payer: Wellpoint Medicaid Managed Care	$245.30

10MM/12MM CUTTER-SHORT

Facility

$762.00

Hospital Charge Code	270339030
Hospital Revenue Code	272
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.30

10MM/12MM CUTTER-SHORT

Facility

$762.00

Hospital Charge Code	270339030
Hospital Revenue Code	272
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$381.00
Rate for Payer: Aetna Commercial	$289.56
Rate for Payer: Aetna Medicare Advantage	$228.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.31
Rate for Payer: Cigna Commercial	$381.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.60
Rate for Payer: Oxford Commercial	$152.40
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$152.40
Rate for Payer: UnitedHealthcare Community & State	$18.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.19

10MM/130 DEG TI CANN TFNA 325M

Facility

$7,919.65

Service Code	HCPCS C1713
Hospital Charge Code	270679722
Hospital Revenue Code	278
Min. Negotiated Rate	$190.86
Max. Negotiated Rate	$3,959.82
Rate for Payer: Aetna Commercial	$3,009.47
Rate for Payer: Aetna Medicare Advantage	$2,375.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.51
Rate for Payer: Cigna Commercial	$3,959.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.95
Rate for Payer: UnitedHealthcare Community & State	$190.86
Rate for Payer: Wellpoint Medicaid Managed Care	$209.87

10MM/130 DEG TI CANN TFNA 325M

Facility

$7,919.65

Service Code	HCPCS C1713
Hospital Charge Code	270679722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.95
Max. Negotiated Rate	$1,916.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.95

10MM/13 DEG TI CANN TFNA380MM/

Facility

$9,942.75

Service Code	HCPCS C1713
Hospital Charge Code	270685117
Hospital Revenue Code	278
Min. Negotiated Rate	$239.62
Max. Negotiated Rate	$4,971.38
Rate for Payer: Aetna Commercial	$3,778.24
Rate for Payer: Aetna Medicare Advantage	$2,982.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.40
Rate for Payer: Cigna Commercial	$4,971.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41
Rate for Payer: UnitedHealthcare Community & State	$239.62
Rate for Payer: Wellpoint Medicaid Managed Care	$263.48

10MM/13 DEG TI CANN TFNA380MM/

Facility

$9,942.75

Service Code	HCPCS C1713
Hospital Charge Code	270685117
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.41
Max. Negotiated Rate	$2,406.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41

10 MM CARTIVA IMPLANT

Facility

$18,750.00

Service Code	HCPCS L8699
Hospital Charge Code	270679213
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

10 MM CARTIVA IMPLANT

Facility

$18,750.00

Service Code	HCPCS L8699
Hospital Charge Code	270679213
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

10MM DRILL BIT

Facility

$1,500.00

Hospital Charge Code	270680776
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

10MM DRILL BIT

Facility

$1,500.00

Hospital Charge Code	270680776
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

10MM INSTRUMENTATION SRT

Facility

$1,250.00

Hospital Charge Code	270686577
Hospital Revenue Code	272
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

10MM INSTRUMENTATION SRT

Facility

$1,250.00

Hospital Charge Code	270686577
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

10MM LOCKING SCREW

Facility

$545.00

Hospital Charge Code	270655999
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$131.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

10MM LOCKING SCREW

Facility

$375.00

Hospital Charge Code	270655998
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

10MM LOCKING SCREW

Facility

$375.00

Hospital Charge Code	270655998
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

10MM LOCKING SCREW

Facility

$545.00

Hospital Charge Code	270655999
Hospital Revenue Code	278
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.44

10MM ONE LEVEL PLATE

Facility

$11,455.00

Hospital Charge Code	270656606
Hospital Revenue Code	278
Min. Negotiated Rate	$276.07
Max. Negotiated Rate	$5,727.50
Rate for Payer: Aetna Commercial	$4,352.90
Rate for Payer: Aetna Medicare Advantage	$3,436.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,921.03
Rate for Payer: Cigna Commercial	$5,727.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,520.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25
Rate for Payer: UnitedHealthcare Community & State	$276.07
Rate for Payer: Wellpoint Medicaid Managed Care	$303.56

10MM ONE LEVEL PLATE

Facility

$11,455.00

Hospital Charge Code	270656606
Hospital Revenue Code	278
Min. Negotiated Rate	$1,718.25
Max. Negotiated Rate	$2,772.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,520.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25

10MM R 3-5+ CD PSN REV CCK VE

Facility

$19,975.55

Service Code	HCPCS 19975.55
Hospital Charge Code	270704151
Hospital Revenue Code	278
Min. Negotiated Rate	$481.41
Max. Negotiated Rate	$9,987.77
Rate for Payer: Aetna Commercial	$7,590.71
Rate for Payer: Aetna Medicare Advantage	$5,992.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.77
Rate for Payer: Cigna Commercial	$9,987.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,834.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.33
Rate for Payer: UnitedHealthcare Community & State	$481.41
Rate for Payer: Wellpoint Medicaid Managed Care	$529.35

10MM R 3-5+ CD PSN REV CCK VE

Facility

$19,975.55

Service Code	HCPCS 19975.55
Hospital Charge Code	270704151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.33
Max. Negotiated Rate	$4,834.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,834.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.33

10MM TI CANN RETRO/ANTEGRADE N

Facility

$7,266.10

Service Code	HCPCS C1713
Hospital Charge Code	270686849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,089.91
Max. Negotiated Rate	$1,758.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,453.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,758.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,598.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,089.91

Know your out-of-pocket cost for care.

All Charges