Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NC TREK NEO RX 5.50 X 12

Facility

$500.00

Hospital Charge Code	270704333
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

NC TREK NEO RX 5.50 X 12

Facility

$500.00

Hospital Charge Code	270704333
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 5.50 X 15

Facility

$500.00

Hospital Charge Code	270704334
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

NC TREK NEO RX 5.50 X 15

Facility

$500.00

Hospital Charge Code	270704334
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 5.50 X 20

Facility

$500.00

Hospital Charge Code	270704335
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 5.50 X 20

Facility

$500.00

Hospital Charge Code	270704335
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

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
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

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
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

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
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

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NCV (MOTOR) W/ F-WAVE

Facility

$285.65

Service Code	HCPCS 95903
Hospital Charge Code	5500036
Hospital Revenue Code	922
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$42.85

NCV (MOTOR) W/ F-WAVE

Facility

$285.65

Service Code	HCPCS 95903
Hospital Charge Code	5500036
Hospital Revenue Code	922
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$108.55
Rate for Payer: Aetna Medicare Advantage	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.84
Rate for Payer: Cigna Commercial	$142.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.69
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.85
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.57

NCV (MOTOR) W/O F-WAVE

Facility

$285.65

Service Code	HCPCS 95900
Hospital Charge Code	5500034
Hospital Revenue Code	922
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$108.55
Rate for Payer: Aetna Medicare Advantage	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.84
Rate for Payer: Cigna Commercial	$142.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.69
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.85
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.57

NCV (MOTOR) W/O F-WAVE

Facility

$285.65

Service Code	HCPCS 95900
Hospital Charge Code	5500034
Hospital Revenue Code	922
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$42.85

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$4.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

NDLE ECLPSE 25GX1-1/2 305767

Facility

$0.85

Hospital Charge Code	270632923
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna Commercial	$0.32
Rate for Payer: Aetna Medicare Advantage	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.22
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$0.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.13
Rate for Payer: UnitedHealthcare Commercial	$0.17
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

NDLE ECLPSE 25GX1-1/2 305767

Facility

$0.85

Hospital Charge Code	270632923
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.13

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$4.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

Know your out-of-pocket cost for care.

All Charges