Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$20,492.47

Service Code	APR-DRG 4264
Min. Negotiated Rate	$20,090.66
Max. Negotiated Rate	$20,492.47
Rate for Payer: UnitedHealthcare Community & State	$20,090.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,492.47
Rate for Payer: Wellpoint Medicaid Managed Care	$20,090.66

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$7,625.77

Service Code	APR-DRG 4262
Min. Negotiated Rate	$7,476.25
Max. Negotiated Rate	$7,625.77
Rate for Payer: UnitedHealthcare Community & State	$7,476.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,625.77
Rate for Payer: Wellpoint Medicaid Managed Care	$7,476.25

NON INV STUDIES LOW EXTREM ART

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	36540009
Hospital Revenue Code	921
Min. Negotiated Rate	$243.69
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

NON INV STUDIES LOW EXTREM ART

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	36540009
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

NON-IONIC CONTRAST-PER ML

Facility

$8.00

Hospital Charge Code	94061441
Hospital Revenue Code	255
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

NON-IONIC CONTRAST-PER ML

Facility

$8.00

Hospital Charge Code	94061441
Hospital Revenue Code	255
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

NON LOCKING SCREW 2.9 16MM

Facility

$860.00

Service Code	HCPCS C1713
Hospital Charge Code	270684920
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

NON LOCKING SCREW 2.9 16MM

Facility

$860.00

Service Code	HCPCS C1713
Hospital Charge Code	270684920
Hospital Revenue Code	278
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

NON LOCKING SCREW 2.9 8MM

Facility

$1,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270684921
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$329.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$299.20
Rate for Payer: Qualcare PPO/HMO/WC	$204.00

NON LOCKING SCREW 2.9 8MM

Facility

$1,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270684921
Hospital Revenue Code	278
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$680.00
Rate for Payer: Aetna Commercial	$516.80
Rate for Payer: Aetna Medicare Advantage	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.80
Rate for Payer: Cigna Commercial	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$299.20
Rate for Payer: Qualcare PPO/HMO/WC	$204.00
Rate for Payer: UnitedHealthcare Community & State	$32.78
Rate for Payer: Wellpoint Medicaid Managed Care	$36.04

NON LOCKING SCREW 3.0X22MM

Facility

$980.00

Service Code	HCPCS C1713
Hospital Charge Code	270661003
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.60
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

NON LOCKING SCREW 3.0X22MM

Facility

$980.00

Service Code	HCPCS C1713
Hospital Charge Code	270661003
Hospital Revenue Code	278
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$372.40
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.60
Rate for Payer: Qualcare PPO/HMO/WC	$147.00
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: Wellpoint Medicaid Managed Care	$25.97

NON-LOCKING SCREW 3.5X12mm

Facility

$950.00

Hospital Charge Code	270669411
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

NON-LOCKING SCREW 3.5X12mm

Facility

$950.00

Hospital Charge Code	270669411
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

NON-LOCKING SCREW 3.5 X14MM

Facility

$1,385.00

Hospital Charge Code	270669412
Hospital Revenue Code	278
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$692.50
Rate for Payer: Aetna Commercial	$526.30
Rate for Payer: Aetna Medicare Advantage	$415.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.18
Rate for Payer: Cigna Commercial	$692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.70
Rate for Payer: Qualcare PPO/HMO/WC	$207.75
Rate for Payer: UnitedHealthcare Community & State	$33.38
Rate for Payer: Wellpoint Medicaid Managed Care	$36.70

NON-LOCKING SCREW 3.5 X14MM

Facility

$1,385.00

Hospital Charge Code	270669412
Hospital Revenue Code	278
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$335.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.70
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

NON-LOCKING SCREW 3X14mm

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270669410
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

NON-LOCKING SCREW 3X14mm

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270669410
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$35,800.32

Service Code	MSDRG 600
Min. Negotiated Rate	$10,900.74
Max. Negotiated Rate	$35,800.32
Rate for Payer: Aetna Commercial	$24,856.22
Rate for Payer: Aetna Medicare Advantage	$35,800.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,474.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,958.83
Rate for Payer: Cigna Commercial	$19,492.50
Rate for Payer: Cigna Medicare Advantage	$11,474.46
Rate for Payer: Clover Medicare Advantage	$10,900.74
Rate for Payer: EmblemHealth Commercial	$34,423.38
Rate for Payer: Humana Medicare Advantage	$11,818.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,474.46
Rate for Payer: Oxford Commercial	$14,009.52
Rate for Payer: UnitedHealthcare Commercial	$24,566.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,474.46
Rate for Payer: Wellcare Medicare Advantage	$11,474.46

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$21,688.68

Service Code	MSDRG 601
Min. Negotiated Rate	$6,603.93
Max. Negotiated Rate	$21,688.68
Rate for Payer: Aetna Commercial	$15,159.92
Rate for Payer: Aetna Medicare Advantage	$21,688.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,951.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,654.43
Rate for Payer: Cigna Commercial	$11,321.97
Rate for Payer: Cigna Medicare Advantage	$6,951.50
Rate for Payer: Clover Medicare Advantage	$6,603.93
Rate for Payer: EmblemHealth Commercial	$20,854.50
Rate for Payer: Humana Medicare Advantage	$7,160.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,951.50
Rate for Payer: Oxford Commercial	$8,137.25
Rate for Payer: UnitedHealthcare Commercial	$14,268.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,951.50
Rate for Payer: Wellcare Medicare Advantage	$6,951.50

NONOPASS REACH CRESCENT

Facility

$1,429.70

Hospital Charge Code	270670490
Hospital Revenue Code	272
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$714.85
Rate for Payer: Aetna Commercial	$543.29
Rate for Payer: Aetna Medicare Advantage	$428.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.57
Rate for Payer: Cigna Commercial	$714.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.91
Rate for Payer: Oxford Commercial	$285.94
Rate for Payer: Qualcare PPO/HMO/WC	$214.46
Rate for Payer: UnitedHealthcare Commercial	$285.94
Rate for Payer: UnitedHealthcare Community & State	$34.46
Rate for Payer: Wellpoint Medicaid Managed Care	$37.89

NONOPASS REACH CRESCENT

Facility

$1,429.70

Hospital Charge Code	270670490
Hospital Revenue Code	272
Min. Negotiated Rate	$214.46
Max. Negotiated Rate	$214.46
Rate for Payer: Qualcare PPO/HMO/WC	$214.46

NON. PVC/ 22 FILTER EXT SET

Facility

$35.00

Hospital Charge Code	270650262
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

NON. PVC/ 22 FILTER EXT SET

Facility

$35.00

Hospital Charge Code	270650262
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

NON-ROUTINE BL DRAW 3/> YRS

Facility

$40.76

Service Code	HCPCS 36410
Hospital Charge Code	16000342
Hospital Revenue Code	360
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.11

Know your out-of-pocket cost for care.

All Charges