Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NL SCREW 2.7 X12

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684670
Hospital Revenue Code	278
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

NL SCREW 2.7 X12

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684670
Hospital Revenue Code	278
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$242.50
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

NL SCREW 2.7 X14

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684671
Hospital Revenue Code	278
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$242.50
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

NL SCREW 2.7 X14

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684671
Hospital Revenue Code	278
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

NL SCREW 2.7 X 16

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684674
Hospital Revenue Code	278
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$242.50
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

NL SCREW 2.7 X 16

Facility

$485.00

Service Code	HCPCS C1713
Hospital Charge Code	270684674
Hospital Revenue Code	278
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

NM ABSCESS LOCALIZ WB

Facility

$12,000.00

Service Code	HCPCS 78806
Hospital Charge Code	4500617
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM ABSCESS LOCALIZ WB

Facility

$12,000.00

Service Code	HCPCS 78806
Hospital Charge Code	4500617
Hospital Revenue Code	341
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM ACUTE VENOUS THROMB IMAGING

Facility

$738.60

Service Code	HCPCS 78456
Hospital Charge Code	4500937
Hospital Revenue Code	341
Min. Negotiated Rate	$110.79
Max. Negotiated Rate	$110.79
Rate for Payer: Qualcare PPO/HMO/WC	$110.79

NM ACUTE VENOUS THROMB IMAGING

Facility

$738.60

Service Code	HCPCS 78456
Hospital Charge Code	4500937
Hospital Revenue Code	341
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.58
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.79
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$17.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$19.57

NM ADRENAL IMA CORTEX &/OR MED

Facility

$2,616.85

Service Code	HCPCS 78075
Hospital Charge Code	4500906
Hospital Revenue Code	341
Min. Negotiated Rate	$392.53
Max. Negotiated Rate	$392.53
Rate for Payer: Qualcare PPO/HMO/WC	$392.53

NM ADRENAL IMA CORTEX &/OR MED

Facility

$2,616.85

Service Code	HCPCS 78075
Hospital Charge Code	4500906
Hospital Revenue Code	341
Min. Negotiated Rate	$63.07
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$785.05
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.53
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$63.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$69.35

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74117070
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74116070
Hospital Revenue Code	343
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74116070
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74115070
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74115070
Hospital Revenue Code	343
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	4500295
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	74117070
Hospital Revenue Code	343
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

NM AMMONIA ISOTOPE N13

Facility

$1,425.00

Hospital Charge Code	4500295
Hospital Revenue Code	343
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

NM BLOOD OTHER

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500938
Hospital Revenue Code	341
Min. Negotiated Rate	$33.46
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.56
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.28
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$36.80

NM BLOOD OTHER

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500938
Hospital Revenue Code	341
Min. Negotiated Rate	$208.28
Max. Negotiated Rate	$208.28
Rate for Payer: Qualcare PPO/HMO/WC	$208.28

NM BONE DENSITY SINGLE PHOTON

Facility

$258.55

Service Code	HCPCS 78350
Hospital Charge Code	4500940
Hospital Revenue Code	341
Min. Negotiated Rate	$38.78
Max. Negotiated Rate	$38.78
Rate for Payer: Qualcare PPO/HMO/WC	$38.78

NM BONE DENSITY SINGLE PHOTON

Facility

$258.55

Service Code	HCPCS 78350
Hospital Charge Code	4500940
Hospital Revenue Code	341
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$98.25
Rate for Payer: Aetna Medicare Advantage	$77.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.93
Rate for Payer: Cigna Commercial	$129.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.78
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

NM BONE IMAGING LIMITED

Facility

$1,415.50

Service Code	HCPCS 78300
Hospital Charge Code	4500941
Hospital Revenue Code	341
Min. Negotiated Rate	$34.11
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.32
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$34.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$185.13
Rate for Payer: Wellpoint Medicaid Managed Care	$37.51

Know your out-of-pocket cost for care.

All Charges