Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SECOND LEVEL CER DISKECTOMY AD

Facility

$6,238.00

Service Code	HCPCS 22858
Hospital Charge Code	1600000582
Hospital Revenue Code	360
Min. Negotiated Rate	$150.34
Max. Negotiated Rate	$3,119.00
Rate for Payer: Aetna Commercial	$2,370.44
Rate for Payer: Aetna Medicare Advantage	$1,871.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,590.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,590.69
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	$1,590.69
Rate for Payer: Cigna Commercial	$3,119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,871.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$935.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$150.34
Rate for Payer: Wellpoint Medicaid Managed Care	$165.31

SECREFLO,16.MG

Facility

$5.00

Hospital Charge Code	60635462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SECREFLO,16.MG

Facility

$5.00

Hospital Charge Code	60635462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SECRETIN 16 MCG VIAL

Facility

$3,517.50

Service Code	HCPCS J2850
Hospital Charge Code	60628905
Hospital Revenue Code	636
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$851.24
Rate for Payer: Aetna Commercial	$109.43
Rate for Payer: Aetna Medicare Advantage	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.22
Rate for Payer: Cigna Medicare Advantage	$40.23
Rate for Payer: Clover Medicare Advantage	$38.22
Rate for Payer: EmblemHealth Commercial	$120.69
Rate for Payer: Humana Medicare Advantage	$41.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$84.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.23
Rate for Payer: Wellcare Medicare Advantage	$40.23
Rate for Payer: Wellpoint Medicaid Managed Care	$93.21

SECRETIN 16 MCG VIAL

Facility

$3,517.50

Service Code	HCPCS J2850
Hospital Charge Code	60628905
Hospital Revenue Code	636
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

SECRETIN INJ 75CU

Facility

$871.05

Hospital Charge Code	6010581
Hospital Revenue Code	250
Min. Negotiated Rate	$130.66
Max. Negotiated Rate	$130.66
Rate for Payer: Qualcare PPO/HMO/WC	$130.66

SECRETIN INJ 75CU

Facility

$871.05

Hospital Charge Code	6010581
Hospital Revenue Code	250
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$435.52
Rate for Payer: Aetna Commercial	$331.00
Rate for Payer: Aetna Medicare Advantage	$261.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.12
Rate for Payer: Cigna Commercial	$435.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.31
Rate for Payer: Oxford Commercial	$174.21
Rate for Payer: Qualcare PPO/HMO/WC	$130.66
Rate for Payer: UnitedHealthcare Commercial	$174.21
Rate for Payer: UnitedHealthcare Community & State	$20.99
Rate for Payer: Wellpoint Medicaid Managed Care	$23.08

SECTRAL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633857
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SECTRAL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633857
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SECURED LUM ANT CAGE SMALL H12

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705124
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

SECURED LUM ANT CAGE SMALL H12

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705124
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURED LUMBAR ANTERIOR CAGE M

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704527
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

SECURED LUMBAR ANTERIOR CAGE M

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704527
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURE STRAP 5MM

Facility

$862.50

Hospital Charge Code	270339466
Hospital Revenue Code	272
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$431.25
Rate for Payer: Aetna Commercial	$327.75
Rate for Payer: Aetna Medicare Advantage	$258.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.94
Rate for Payer: Cigna Commercial	$431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.75
Rate for Payer: Oxford Commercial	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$129.38
Rate for Payer: UnitedHealthcare Commercial	$172.50
Rate for Payer: UnitedHealthcare Community & State	$20.79
Rate for Payer: Wellpoint Medicaid Managed Care	$22.86

SECURE STRAP 5MM

Facility

$862.50

Hospital Charge Code	270339466
Hospital Revenue Code	272
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$129.38
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

SECUR-FIT MAX 132 HIP SYSTEM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270692858
Hospital Revenue Code	278
Min. Negotiated Rate	$275.93
Max. Negotiated Rate	$5,724.70
Rate for Payer: Aetna Commercial	$4,350.77
Rate for Payer: Aetna Medicare Advantage	$3,434.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.60
Rate for Payer: Cigna Commercial	$5,724.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,518.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41
Rate for Payer: UnitedHealthcare Community & State	$275.93
Rate for Payer: Wellpoint Medicaid Managed Care	$303.41

SECUR-FIT MAX 132 HIP SYSTEM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270692858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.41
Max. Negotiated Rate	$2,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,518.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41

SECUR-IT FOR PAS PMV SECURE-IT

Facility

$6.00

Hospital Charge Code	270637550
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SECUR-IT FOR PAS PMV SECURE-IT

Facility

$6.00

Hospital Charge Code	270637550
Hospital Revenue Code	272
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SEDIMENTATION RATE (ESR)

Facility

$667.59

Service Code	HCPCS 85651
Hospital Charge Code	3006087
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SEDIMENTATION RATE (ESR)

Facility

$667.59

Service Code	HCPCS 85651
Hospital Charge Code	3006087
Hospital Revenue Code	305
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.78

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare Advantage	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.75
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare Advantage	$2.70
Rate for Payer: Clover Medicare Advantage	$2.56
Rate for Payer: EmblemHealth Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$2.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.70
Rate for Payer: Wellcare Medicare Advantage	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

Know your out-of-pocket cost for care.

All Charges