Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83080030
Hospital Revenue Code	771
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83080030
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$17.01
Max. Negotiated Rate	$352.95
Rate for Payer: Aetna Commercial	$268.25
Rate for Payer: Aetna Medicare Advantage	$211.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.01
Rate for Payer: Cigna Commercial	$352.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.77
Rate for Payer: Oxford Commercial	$141.18
Rate for Payer: Qualcare PPO/HMO/WC	$105.89
Rate for Payer: UnitedHealthcare Commercial	$141.18
Rate for Payer: UnitedHealthcare Community & State	$17.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.71

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$105.89
Max. Negotiated Rate	$105.89
Rate for Payer: Qualcare PPO/HMO/WC	$105.89

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$268.47
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$4,233.20
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00
Rate for Payer: UnitedHealthcare Community & State	$268.47
Rate for Payer: Wellpoint Medicaid Managed Care	$295.21

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

PEEK CORKSCREW 4.5 MM

Facility

$2,040.00

Hospital Charge Code	270657692
Hospital Revenue Code	278
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$493.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$448.80
Rate for Payer: Qualcare PPO/HMO/WC	$306.00

PEEK CORKSCREW 4.5 MM

Facility

$2,040.00

Hospital Charge Code	270657692
Hospital Revenue Code	278
Min. Negotiated Rate	$49.16
Max. Negotiated Rate	$1,020.00
Rate for Payer: Aetna Commercial	$775.20
Rate for Payer: Aetna Medicare Advantage	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.20
Rate for Payer: Cigna Commercial	$1,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$448.80
Rate for Payer: Qualcare PPO/HMO/WC	$306.00
Rate for Payer: UnitedHealthcare Community & State	$49.16
Rate for Payer: Wellpoint Medicaid Managed Care	$54.06

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.75
Max. Negotiated Rate	$43,750.00
Rate for Payer: Aetna Commercial	$33,250.00
Rate for Payer: Aetna Medicare Advantage	$26,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,312.50
Rate for Payer: Cigna Commercial	$43,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00
Rate for Payer: UnitedHealthcare Community & State	$2,108.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2,318.75

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$13,125.00
Max. Negotiated Rate	$21,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

Know your out-of-pocket cost for care.

All Charges