Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$16,293.75
Max. Negotiated Rate	$26,287.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,897.50
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$2,617.86
Max. Negotiated Rate	$54,312.50
Rate for Payer: Aetna Commercial	$41,277.50
Rate for Payer: Aetna Medicare Advantage	$32,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,699.38
Rate for Payer: Cigna Commercial	$54,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,897.50
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75
Rate for Payer: UnitedHealthcare Community & State	$2,617.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2,878.56

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	7411768
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	7411768
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$12,576.82

Service Code	APR-DRG 7931
Min. Negotiated Rate	$12,330.22
Max. Negotiated Rate	$12,576.82
Rate for Payer: UnitedHealthcare Community & State	$12,330.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,576.82
Rate for Payer: Wellpoint Medicaid Managed Care	$12,330.22

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$46,437.75

Service Code	APR-DRG 7934
Min. Negotiated Rate	$45,527.21
Max. Negotiated Rate	$46,437.75
Rate for Payer: UnitedHealthcare Community & State	$45,527.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,437.75
Rate for Payer: Wellpoint Medicaid Managed Care	$45,527.21

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$16,446.60

Service Code	APR-DRG 7932
Min. Negotiated Rate	$16,124.12
Max. Negotiated Rate	$16,446.60
Rate for Payer: UnitedHealthcare Community & State	$16,124.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,446.60
Rate for Payer: Wellpoint Medicaid Managed Care	$16,124.12

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$24,247.29

Service Code	APR-DRG 7933
Min. Negotiated Rate	$23,771.85
Max. Negotiated Rate	$24,247.29
Rate for Payer: UnitedHealthcare Community & State	$23,771.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,247.29
Rate for Payer: Wellpoint Medicaid Managed Care	$23,771.85

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$18,457.36

Service Code	APR-DRG 9512
Min. Negotiated Rate	$18,095.45
Max. Negotiated Rate	$18,457.36
Rate for Payer: UnitedHealthcare Community & State	$18,095.45
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,457.36
Rate for Payer: Wellpoint Medicaid Managed Care	$18,095.45

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$49,459.72

Service Code	APR-DRG 9514
Min. Negotiated Rate	$48,489.92
Max. Negotiated Rate	$49,459.72
Rate for Payer: UnitedHealthcare Community & State	$48,489.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49,459.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48,489.92

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$13,944.21

Service Code	APR-DRG 9511
Min. Negotiated Rate	$13,670.79
Max. Negotiated Rate	$13,944.21
Rate for Payer: UnitedHealthcare Community & State	$13,670.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,944.21
Rate for Payer: Wellpoint Medicaid Managed Care	$13,670.79

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$27,566.71

Service Code	APR-DRG 9513
Min. Negotiated Rate	$27,026.19
Max. Negotiated Rate	$27,566.71
Rate for Payer: UnitedHealthcare Community & State	$27,026.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$27,026.19

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MODERNACOV19BIVALADLDOADM6TO11

Facility

$50.00

Service Code	HCPCS 0141A
Hospital Charge Code	39500144A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNACOV19BIVALADLDOADM6TO11

Facility

$50.00

Service Code	HCPCS 0141A
Hospital Charge Code	39500144A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNACOV19BIVALADLDOSEADMADT

Facility

$50.00

Service Code	HCPCS 0134A
Hospital Charge Code	39500134A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

Know your out-of-pocket cost for care.

All Charges