Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REV SH HUMERAL TRAY NEUTRAL0MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700224
Hospital Revenue Code	278
Min. Negotiated Rate	$291.01
Max. Negotiated Rate	$6,037.50
Rate for Payer: Aetna Commercial	$4,588.50
Rate for Payer: Aetna Medicare Advantage	$3,622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,079.12
Rate for Payer: Cigna Commercial	$6,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,656.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25
Rate for Payer: UnitedHealthcare Community & State	$291.01
Rate for Payer: Wellpoint Medicaid Managed Care	$319.99

REV SH HUMERAL TRAY NEUTRAL0MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$2,922.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,656.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

REWIRE 2 PHONES, 2 DATA, 2 REA

Facility

$1,819.00

Hospital Charge Code	270659145
Hospital Revenue Code	278
Min. Negotiated Rate	$43.84
Max. Negotiated Rate	$909.50
Rate for Payer: Aetna Commercial	$691.22
Rate for Payer: Aetna Medicare Advantage	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.85
Rate for Payer: Cigna Commercial	$909.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$400.18
Rate for Payer: Qualcare PPO/HMO/WC	$272.85
Rate for Payer: UnitedHealthcare Community & State	$43.84
Rate for Payer: Wellpoint Medicaid Managed Care	$48.20

REWIRE 2 PHONES, 2 DATA, 2 REA

Facility

$1,819.00

Hospital Charge Code	270659145
Hospital Revenue Code	278
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$440.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$400.18
Rate for Payer: Qualcare PPO/HMO/WC	$272.85

REWIRE PHONE LINES AND DATA

Facility

$2,006.25

Hospital Charge Code	270659144
Hospital Revenue Code	278
Min. Negotiated Rate	$300.94
Max. Negotiated Rate	$485.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.38
Rate for Payer: Qualcare PPO/HMO/WC	$300.94

REWIRE PHONE LINES AND DATA

Facility

$2,006.25

Hospital Charge Code	270659144
Hospital Revenue Code	278
Min. Negotiated Rate	$48.35
Max. Negotiated Rate	$1,003.12
Rate for Payer: Aetna Commercial	$762.38
Rate for Payer: Aetna Medicare Advantage	$601.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.59
Rate for Payer: Cigna Commercial	$1,003.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.38
Rate for Payer: Qualcare PPO/HMO/WC	$300.94
Rate for Payer: UnitedHealthcare Community & State	$48.35
Rate for Payer: Wellpoint Medicaid Managed Care	$53.17

REZULIN 200MG TAB

Facility

$21.00

Hospital Charge Code	60635170
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

REZULIN 200MG TAB

Facility

$21.00

Hospital Charge Code	60635170
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

REZULIN 400MG TAB

Facility

$27.00

Hospital Charge Code	60635171
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

REZULIN 400MG TAB

Facility

$27.00

Hospital Charge Code	60635171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

RF ABLTJ NRV NRVTG SI JT

Facility

$10,782.78

Service Code	HCPCS 64625
Hospital Charge Code	321564625
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

RF ABLTJ NRV NRVTG SI JT

Facility

$10,782.78

Service Code	HCPCS 64625
Hospital Charge Code	321564625
Hospital Revenue Code	361
Min. Negotiated Rate	$259.86
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.83
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$259.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$285.74

RF ABLTJ NRV NRVTG SI JT

Facility

$8,648.20

Service Code	HCPCS 64625
Hospital Charge Code	1600000855
Hospital Revenue Code	360
Min. Negotiated Rate	$1,297.23
Max. Negotiated Rate	$1,297.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.23

RF ABLTJ NRV NRVTG SI JT

Facility

$8,648.20

Service Code	HCPCS 64625
Hospital Charge Code	1600000855
Hospital Revenue Code	360
Min. Negotiated Rate	$208.42
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,594.46
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.23
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$208.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$229.18

RF BIPOLAR 350MM

Facility

$3,750.00

Hospital Charge Code	270688534
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

RF BIPOLAR 350MM

Facility

$3,750.00

Hospital Charge Code	270688534
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

RF MULTIGEN RENTAL0406900000

Facility

$7,500.00

Hospital Charge Code	270661959
Hospital Revenue Code	270
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

RF MULTIGEN RENTAL0406900000

Facility

$7,500.00

Hospital Charge Code	270661959
Hospital Revenue Code	270
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,250.00
Rate for Payer: Oxford Commercial	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Commercial	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

RFNA 10MM 420MM 5DEG BEND

Facility

$8,474.10

Service Code	HCPCS C1713
Hospital Charge Code	270692416
Hospital Revenue Code	278
Min. Negotiated Rate	$204.23
Max. Negotiated Rate	$4,237.05
Rate for Payer: Aetna Commercial	$3,220.16
Rate for Payer: Aetna Medicare Advantage	$2,542.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,160.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,160.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,160.90
Rate for Payer: Cigna Commercial	$4,237.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.12
Rate for Payer: UnitedHealthcare Community & State	$204.23
Rate for Payer: Wellpoint Medicaid Managed Care	$224.56

RFNA 10MM 420MM 5DEG BEND

Facility

$8,474.10

Service Code	HCPCS C1713
Hospital Charge Code	270692416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.12
Max. Negotiated Rate	$2,050.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.12

RF NEEDLE 100MM 10MM 20GA

Facility

$266.55

Hospital Charge Code	270650125
Hospital Revenue Code	272
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$133.28
Rate for Payer: Aetna Commercial	$101.29
Rate for Payer: Aetna Medicare Advantage	$79.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.97
Rate for Payer: Cigna Commercial	$133.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.97
Rate for Payer: Oxford Commercial	$53.31
Rate for Payer: Qualcare PPO/HMO/WC	$39.98
Rate for Payer: UnitedHealthcare Commercial	$53.31
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.06

RF NEEDLE 100MM 10MM 20GA

Facility

$266.55

Hospital Charge Code	270650125
Hospital Revenue Code	272
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$39.98
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

RF NEEDLE 100MM 5MM

Facility

$300.00

Hospital Charge Code	270680979
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

RF NEEDLE 100MM 5MM

Facility

$300.00

Hospital Charge Code	270680979
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

RF TITER

Facility

$68.00

Service Code	HCPCS 86431
Hospital Charge Code	38476034
Hospital Revenue Code	302
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

Know your out-of-pocket cost for care.

All Charges