Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROSTHESIS SPECT 350CC

Facility

$3,830.45

Hospital Charge Code	270603856
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 450CC

Facility

$3,830.45

Hospital Charge Code	270603855
Hospital Revenue Code	278
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

PROSTHESIS SPECT 450CC

Facility

$3,830.45

Hospital Charge Code	270603855
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 550CC

Facility

$3,830.45

Hospital Charge Code	270603854
Hospital Revenue Code	278
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

PROSTHESIS SPECT 550CC

Facility

$3,830.45

Hospital Charge Code	270603854
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 650CC

Facility

$3,830.45

Hospital Charge Code	270603853
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 650CC

Facility

$3,830.45

Hospital Charge Code	270603853
Hospital Revenue Code	278
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

PROSTHESIS SPECTRA 9.5MM 20CM

Facility

$37,840.90

Service Code	HCPCS C1776
Hospital Charge Code	270674898
Hospital Revenue Code	278
Min. Negotiated Rate	$5,676.14
Max. Negotiated Rate	$9,157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,568.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,157.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,325.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,676.14

PROSTHESIS SPECTRA 9.5MM 20CM

Facility

$37,840.90

Service Code	HCPCS C1776
Hospital Charge Code	270674898
Hospital Revenue Code	278
Min. Negotiated Rate	$911.97
Max. Negotiated Rate	$18,920.45
Rate for Payer: Aetna Commercial	$14,379.54
Rate for Payer: Aetna Medicare Advantage	$11,352.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,649.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,649.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,568.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,649.43
Rate for Payer: Cigna Commercial	$18,920.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,157.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,325.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,676.14
Rate for Payer: UnitedHealthcare Community & State	$911.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1,002.78

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.55
Rate for Payer: Wellpoint Medicaid Managed Care	$5.01

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.15
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.15
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.15
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.15
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

PROSTHSIS GLDBRG MIDEAR 140964

Facility

$2,782.45

Hospital Charge Code	270621215
Hospital Revenue Code	272
Min. Negotiated Rate	$67.06
Max. Negotiated Rate	$1,391.22
Rate for Payer: Aetna Commercial	$1,057.33
Rate for Payer: Aetna Medicare Advantage	$834.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$709.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$709.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$709.52
Rate for Payer: Cigna Commercial	$1,391.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.74
Rate for Payer: Oxford Commercial	$556.49
Rate for Payer: Qualcare PPO/HMO/WC	$417.37
Rate for Payer: UnitedHealthcare Commercial	$556.49
Rate for Payer: UnitedHealthcare Community & State	$67.06
Rate for Payer: Wellpoint Medicaid Managed Care	$73.73

PROSTHSIS GLDBRG MIDEAR 140964

Facility

$2,782.45

Hospital Charge Code	270621215
Hospital Revenue Code	272
Min. Negotiated Rate	$417.37
Max. Negotiated Rate	$417.37
Rate for Payer: Qualcare PPO/HMO/WC	$417.37

PROSTIGMIN 1:2000/10ML

Facility

$66.00

Hospital Charge Code	60633768
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

PROSTIGMIN 1:2000/10ML

Facility

$66.00

Hospital Charge Code	60633768
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

PROSTIGMIN 1:2000/1ML

Facility

$8.00

Hospital Charge Code	60633767
Hospital Revenue Code	250
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

PROSTIGMIN 1:2000/1ML

Facility

$8.00

Hospital Charge Code	60633767
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

Know your out-of-pocket cost for care.

All Charges