Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROBE MCV SWISS 1.6 423 840214

Facility

$3,050.00

Hospital Charge Code	270624051
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$1,525.00
Rate for Payer: Aetna Commercial	$1,159.00
Rate for Payer: Aetna Medicare Advantage	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.75
Rate for Payer: Cigna Commercial	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.00
Rate for Payer: Oxford Commercial	$610.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50
Rate for Payer: UnitedHealthcare Commercial	$610.00
Rate for Payer: UnitedHealthcare Community & State	$73.50
Rate for Payer: Wellpoint Medicaid Managed Care	$80.83

PROBENECID 500 MG TAB

Facility

$7.71

Service Code	NDC 378015601
Hospital Charge Code	60627982
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

PROBENECID 500 MG TAB

Facility

$7.71

Service Code	NDC 378015601
Hospital Charge Code	60627982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PROBE NEURO ALARA NEEDLE KIT

Facility

$1,650.00

Hospital Charge Code	270691876
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

PROBE NEURO ALARA NEEDLE KIT

Facility

$1,650.00

Hospital Charge Code	270691876
Hospital Revenue Code	272
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

PROBE NVM5 SINGLE USE

Facility

$2,062.50

Hospital Charge Code	270691827
Hospital Revenue Code	272
Min. Negotiated Rate	$309.38
Max. Negotiated Rate	$309.38
Rate for Payer: Qualcare PPO/HMO/WC	$309.38

PROBE NVM5 SINGLE USE

Facility

$2,062.50

Hospital Charge Code	270691827
Hospital Revenue Code	272
Min. Negotiated Rate	$49.71
Max. Negotiated Rate	$1,031.25
Rate for Payer: Aetna Commercial	$783.75
Rate for Payer: Aetna Medicare Advantage	$618.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$525.94
Rate for Payer: Cigna Commercial	$1,031.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.75
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$309.38
Rate for Payer: UnitedHealthcare Commercial	$412.50
Rate for Payer: UnitedHealthcare Community & State	$49.71
Rate for Payer: Wellpoint Medicaid Managed Care	$54.66

PROBE OCUTOME PHAC EMUL

Facility

$1,524.85

Hospital Charge Code	270061201
Hospital Revenue Code	276
Min. Negotiated Rate	$228.73
Max. Negotiated Rate	$369.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.47
Rate for Payer: Qualcare PPO/HMO/WC	$228.73

PROBE OCUTOME PHAC EMUL

Facility

$1,524.85

Hospital Charge Code	270061201
Hospital Revenue Code	276
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.42
Rate for Payer: Aetna Commercial	$579.44
Rate for Payer: Aetna Medicare Advantage	$457.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.84
Rate for Payer: Cigna Commercial	$762.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.47
Rate for Payer: Qualcare PPO/HMO/WC	$228.73
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

PROBE OCUTOME PHACO IRRIG 1006

Facility

$826.65

Hospital Charge Code	270626659
Hospital Revenue Code	272
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$413.32
Rate for Payer: Aetna Commercial	$314.13
Rate for Payer: Aetna Medicare Advantage	$248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.80
Rate for Payer: Cigna Commercial	$413.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.00
Rate for Payer: Oxford Commercial	$165.33
Rate for Payer: Qualcare PPO/HMO/WC	$124.00
Rate for Payer: UnitedHealthcare Commercial	$165.33
Rate for Payer: UnitedHealthcare Community & State	$19.92
Rate for Payer: Wellpoint Medicaid Managed Care	$21.91

PROBE OCUTOME PHACO IRRIG 1006

Facility

$826.65

Hospital Charge Code	270626659
Hospital Revenue Code	272
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.00

PROBE ORTHO-DRI ABSORB

Facility

$170.45

Hospital Charge Code	270600355
Hospital Revenue Code	270
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$85.22
Rate for Payer: Aetna Commercial	$64.77
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$85.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.13
Rate for Payer: Oxford Commercial	$34.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$34.09
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

PROBE ORTHO-DRI ABSORB

Facility

$170.45

Hospital Charge Code	270600355
Hospital Revenue Code	270
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

PROBE ORTHO DRI ABSORB ZIM****

Facility

$64.00

Hospital Charge Code	1606243
Hospital Revenue Code	274
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

PROBE ORTHO DRI ABSORB ZIM****

Facility

$64.00

Hospital Charge Code	1606243
Hospital Revenue Code	274
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PROBE PEDICLE SCREW

Facility

$24,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688006
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

PROBE PEDICLE SCREW

Facility

$24,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688006
Hospital Revenue Code	278
Min. Negotiated Rate	$584.42
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$584.42
Rate for Payer: Wellpoint Medicaid Managed Care	$642.62

PROBE PERCUTANEOUS DISCECTOMY

Facility

$11,916.35

Hospital Charge Code	270692007
Hospital Revenue Code	272
Min. Negotiated Rate	$1,787.45
Max. Negotiated Rate	$1,787.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.45

PROBE PERCUTANEOUS DISCECTOMY

Facility

$11,916.35

Hospital Charge Code	270692007
Hospital Revenue Code	272
Min. Negotiated Rate	$287.18
Max. Negotiated Rate	$5,958.18
Rate for Payer: Aetna Commercial	$4,528.21
Rate for Payer: Aetna Medicare Advantage	$3,574.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,038.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,038.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,038.67
Rate for Payer: Cigna Commercial	$5,958.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,574.91
Rate for Payer: Oxford Commercial	$2,383.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.45
Rate for Payer: UnitedHealthcare Commercial	$2,383.27
Rate for Payer: UnitedHealthcare Community & State	$287.18
Rate for Payer: Wellpoint Medicaid Managed Care	$315.78

PROBE POSTERIOR LUCENT L 180MM

Facility

$3,200.00

Service Code	HCPCS A4649
Hospital Charge Code	270694865
Hospital Revenue Code	272
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

PROBE POSTERIOR LUCENT L 180MM

Facility

$3,200.00

Service Code	HCPCS A4649
Hospital Charge Code	270694865
Hospital Revenue Code	272
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$960.00
Rate for Payer: Oxford Commercial	$640.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Commercial	$640.00
Rate for Payer: UnitedHealthcare Community & State	$77.12
Rate for Payer: Wellpoint Medicaid Managed Care	$84.80

PROBE PRASS NERVE STIMULATOR

Facility

$930.00

Hospital Charge Code	270657321
Hospital Revenue Code	272
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.00
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Commercial	$186.00
Rate for Payer: UnitedHealthcare Community & State	$22.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.64

PROBE PRASS NERVE STIMULATOR

Facility

$930.00

Hospital Charge Code	270657321
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

PROBE PRASS STIMULATR 8225101E

Facility

$450.00

Hospital Charge Code	270639301
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

PROBE PRASS STIMULATR 8225101E

Facility

$450.00

Hospital Charge Code	270639301
Hospital Revenue Code	270
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

Know your out-of-pocket cost for care.

All Charges