Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,379.72
Max. Negotiated Rate	$28,625.00
Rate for Payer: Aetna Commercial	$21,755.00
Rate for Payer: Aetna Medicare Advantage	$17,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,598.75
Rate for Payer: Cigna Commercial	$28,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50
Rate for Payer: UnitedHealthcare Community & State	$1,379.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1,517.12

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$8,587.50
Max. Negotiated Rate	$13,854.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

NEUROTHERM ELECTRODE

Facility

$525.00

Hospital Charge Code	270339098
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

NEUROTHERM ELECTRODE

Facility

$525.00

Hospital Charge Code	270339098
Hospital Revenue Code	272
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

NEUROTHERM INTRODUCER

Facility

$225.00

Hospital Charge Code	270339465
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

NEUROTHERM INTRODUCER

Facility

$225.00

Hospital Charge Code	270339465
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

NEUROWRAP 7mmX4 cm

Facility

$6,540.00

Service Code	HCPCS C9353
Hospital Charge Code	270682015
Hospital Revenue Code	278
Min. Negotiated Rate	$157.61
Max. Negotiated Rate	$3,270.00
Rate for Payer: Aetna Commercial	$2,485.20
Rate for Payer: Aetna Medicare Advantage	$1,962.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,667.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,667.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,667.70
Rate for Payer: Cigna Commercial	$3,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,582.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,438.80
Rate for Payer: Qualcare PPO/HMO/WC	$981.00
Rate for Payer: UnitedHealthcare Community & State	$157.61
Rate for Payer: Wellpoint Medicaid Managed Care	$173.31

NEUROWRAP 7mmX4 cm

Facility

$6,540.00

Service Code	HCPCS C9353
Hospital Charge Code	270682015
Hospital Revenue Code	278
Min. Negotiated Rate	$981.00
Max. Negotiated Rate	$1,582.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,582.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,438.80
Rate for Payer: Qualcare PPO/HMO/WC	$981.00

NEURPLASTY,MEDN NRV AT CRP TNL

Facility

$16,437.00

Service Code	HCPCS 64721
Hospital Charge Code	16000267
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEURPLASTY,MEDN NRV AT CRP TNL

Facility

$16,437.00

Service Code	HCPCS 64721
Hospital Charge Code	16000267
Hospital Revenue Code	360
Min. Negotiated Rate	$396.13
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,931.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$396.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$435.58

NEUT ELECTS SELF ADHESIVE

Facility

$100.00

Hospital Charge Code	270664857
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

NEUT ELECTS SELF ADHESIVE

Facility

$100.00

Hospital Charge Code	270664857
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

NEUT INJ

Facility

$50.65

Service Code	NDC 409660902
Hospital Charge Code	60635046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.60

NEUT INJ

Facility

$50.65

Service Code	NDC 409660902
Hospital Charge Code	60635046
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$25.32
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Aetna Medicare Advantage	$15.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$25.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.20
Rate for Payer: Oxford Commercial	$10.13
Rate for Payer: Qualcare PPO/HMO/WC	$7.60
Rate for Payer: UnitedHealthcare Commercial	$10.13
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

NEUTRAPHOS 1.25MG PKT

Facility

$2.00

Hospital Charge Code	60635562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

NEUTRAPHOS 1.25MG PKT

Facility

$2.00

Hospital Charge Code	60635562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

NEUTRON BEAM TX COMPLEX

Facility

$1,164.28

Service Code	HCPCS 77423
Hospital Charge Code	85000775
Hospital Revenue Code	333
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,369.52
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.28
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.64
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$30.85

NEUTRON BEAM TX COMPLEX

Facility

$1,164.28

Service Code	HCPCS 77423
Hospital Charge Code	85000775
Hospital Revenue Code	333
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$174.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.64

NEUTRON BEAM TX SIMPLE

Facility

$1,164.28

Service Code	HCPCS 77422
Hospital Charge Code	85000770
Hospital Revenue Code	333
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$442.43
Rate for Payer: Aetna Medicare Advantage	$349.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.89
Rate for Payer: Cigna Commercial	$582.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.28
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.64
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: Wellpoint Medicaid Managed Care	$30.85

NEUTRON BEAM TX SIMPLE

Facility

$1,164.28

Service Code	HCPCS 77422
Hospital Charge Code	85000770
Hospital Revenue Code	333
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$174.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.64

NEVIRAPINE 200 MG TAB

Facility

$72.63

Service Code	NDC 51991033106
Hospital Charge Code	6063943219
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$36.31
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$21.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.52
Rate for Payer: Cigna Commercial	$36.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.79
Rate for Payer: Oxford Commercial	$14.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.89
Rate for Payer: UnitedHealthcare Commercial	$14.53
Rate for Payer: UnitedHealthcare Community & State	$1.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

NEVIRAPINE 200 MG TAB

Facility

$72.63

Service Code	NDC 51991033106
Hospital Charge Code	6063943219
Hospital Revenue Code	250
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.89

NEVIRAPINE 200MG TAB

Facility

$4.00

Hospital Charge Code	6063943147
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges