Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AXILLARY BLOCK NEEDLE 22GX1

Facility

$26.00

Hospital Charge Code	270332389
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

AXIONICS NEUROSTIMULATOR F15

Facility

$60,750.00

Hospital Charge Code	270702118
Hospital Revenue Code	278
Min. Negotiated Rate	$9,112.50
Max. Negotiated Rate	$14,701.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50

AXIONICS NEUROSTIMULATOR F15

Facility

$60,750.00

Hospital Charge Code	270702118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.08
Max. Negotiated Rate	$30,375.00
Rate for Payer: Aetna Commercial	$23,085.00
Rate for Payer: Aetna Medicare Advantage	$18,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,491.25
Rate for Payer: Cigna Commercial	$30,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50
Rate for Payer: UnitedHealthcare Community & State	$1,464.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,609.88

AXIONICS PNE LEAD I 1901

Facility

$200.00

Service Code	HCPCS C1778
Hospital Charge Code	270702028
Hospital Revenue Code	278
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

AXIONICS PNE LEAD I 1901

Facility

$200.00

Service Code	HCPCS C1778
Hospital Charge Code	270702028
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

AXIONICS PNE LEAD IMPLANT KIT.

Facility

$1,300.00

Service Code	HCPCS C1778
Hospital Charge Code	270702027
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

AXIONICS PNE LEAD IMPLANT KIT.

Facility

$1,300.00

Service Code	HCPCS C1778
Hospital Charge Code	270702027
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

AXIONICS TINED LEAD KIT. I.

Facility

$17,500.00

Hospital Charge Code	270702119
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

AXIONICS TINED LEAD KIT. I.

Facility

$17,500.00

Hospital Charge Code	270702119
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

AXIOS STENT 20X10MM

Facility

$22,750.00

Service Code	HCPCS C1874
Hospital Charge Code	270686630
Hospital Revenue Code	278
Min. Negotiated Rate	$548.27
Max. Negotiated Rate	$11,375.00
Rate for Payer: Aetna Commercial	$8,645.00
Rate for Payer: Aetna Medicare Advantage	$6,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,801.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,801.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,801.25
Rate for Payer: Cigna Commercial	$11,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,505.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,412.50
Rate for Payer: UnitedHealthcare Community & State	$548.27
Rate for Payer: Wellpoint Medicaid Managed Care	$602.88

AXIOS STENT 20X10MM

Facility

$22,750.00

Service Code	HCPCS C1874
Hospital Charge Code	270686630
Hospital Revenue Code	278
Min. Negotiated Rate	$3,412.50
Max. Negotiated Rate	$5,505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,505.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,412.50

AXLE PROSTHESIS HIP

Facility

$2,440.00

Service Code	HCPCS C1776
Hospital Charge Code	270638565
Hospital Revenue Code	278
Min. Negotiated Rate	$366.00
Max. Negotiated Rate	$590.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$536.80
Rate for Payer: Qualcare PPO/HMO/WC	$366.00

AXLE PROSTHESIS HIP

Facility

$2,440.00

Service Code	HCPCS C1776
Hospital Charge Code	270638565
Hospital Revenue Code	278
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$1,220.00
Rate for Payer: Aetna Commercial	$927.20
Rate for Payer: Aetna Medicare Advantage	$732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$622.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$622.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$622.20
Rate for Payer: Cigna Commercial	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$536.80
Rate for Payer: Qualcare PPO/HMO/WC	$366.00
Rate for Payer: UnitedHealthcare Community & State	$58.80
Rate for Payer: Wellpoint Medicaid Managed Care	$64.66

AXLE RS OSS

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270667949
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

AXLE RS OSS

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270667949
Hospital Revenue Code	278
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,368.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00
Rate for Payer: UnitedHealthcare Community & State	$86.76
Rate for Payer: Wellpoint Medicaid Managed Care	$95.40

AXOTAL/TAB

Facility

$3.00

Hospital Charge Code	60632517
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

AXOTAL/TAB

Facility

$3.00

Hospital Charge Code	60632517
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$276.55
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$276.55
Rate for Payer: Wellpoint Medicaid Managed Care	$304.09

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$276.55
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$276.55
Rate for Payer: Wellpoint Medicaid Managed Care	$304.09

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$1,163.30
Rate for Payer: Aetna Commercial	$876.57
Rate for Payer: Aetna Medicare Advantage	$1,044.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,163.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,163.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$322.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,163.30
Rate for Payer: Cigna Medicare Advantage	$225.59
Rate for Payer: Clover Medicare Advantage	$306.16
Rate for Payer: EmblemHealth Commercial	$966.81
Rate for Payer: Humana Medicare Advantage	$331.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$322.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.20
Rate for Payer: Qualcare PPO/HMO/WC	$275.10
Rate for Payer: UnitedHealthcare Community & State	$44.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$322.27
Rate for Payer: Wellcare Medicare Advantage	$322.27
Rate for Payer: Wellpoint Medicaid Managed Care	$48.60

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$275.10
Rate for Payer: Qualcare PPO/HMO/WC	$275.10

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.01
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

Know your out-of-pocket cost for care.

All Charges