Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$630.67
Rate for Payer: Qualcare PPO/HMO/WC	$630.67

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$101.33
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.35
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.67
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$101.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$111.42

SGOT (AST)

Facility

$47.25

Service Code	HCPCS 84450
Hospital Charge Code	8200329RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SGOT (AST)

Facility

$47.25

Service Code	HCPCS 84450
Hospital Charge Code	8200329RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SGPT (ALT)

Facility

$7.44

Service Code	HCPCS 84460CF
Hospital Charge Code	8200330RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SGPT (ALT)

Facility

$7.44

Service Code	HCPCS 84460CF
Hospital Charge Code	8200330RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SHAFT BIXCUT MOD TRINKLE

Facility

$2,375.00

Hospital Charge Code	270670465
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

SHAFT BIXCUT MOD TRINKLE

Facility

$2,375.00

Hospital Charge Code	270670465
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

SHAFT FIBULA

Facility

$3,250.00

Hospital Charge Code	270668464
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

SHAFT FIBULA

Facility

$3,250.00

Hospital Charge Code	270668464
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

SHAFT FIBULA 20MM

Facility

$3,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270676631
Hospital Revenue Code	278
Min. Negotiated Rate	$95.56
Max. Negotiated Rate	$1,982.50
Rate for Payer: Aetna Commercial	$1,506.70
Rate for Payer: Aetna Medicare Advantage	$1,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,011.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,011.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,011.08
Rate for Payer: Cigna Commercial	$1,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$959.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$872.30
Rate for Payer: Qualcare PPO/HMO/WC	$594.75
Rate for Payer: UnitedHealthcare Community & State	$95.56
Rate for Payer: Wellpoint Medicaid Managed Care	$105.07

SHAFT FIBULA 20MM

Facility

$3,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270676631
Hospital Revenue Code	278
Min. Negotiated Rate	$594.75
Max. Negotiated Rate	$959.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$959.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$872.30
Rate for Payer: Qualcare PPO/HMO/WC	$594.75

SHAFT FIBULA >4CM TISSUE LBTLM

Facility

$3,448.00

Hospital Charge Code	270614703
Hospital Revenue Code	278
Min. Negotiated Rate	$517.20
Max. Negotiated Rate	$834.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.56
Rate for Payer: Qualcare PPO/HMO/WC	$517.20

SHAFT FIBULA >4CM TISSUE LBTLM

Facility

$3,448.00

Hospital Charge Code	270614703
Hospital Revenue Code	278
Min. Negotiated Rate	$83.10
Max. Negotiated Rate	$1,724.00
Rate for Payer: Aetna Commercial	$1,310.24
Rate for Payer: Aetna Medicare Advantage	$1,034.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.24
Rate for Payer: Cigna Commercial	$1,724.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.56
Rate for Payer: Qualcare PPO/HMO/WC	$517.20
Rate for Payer: UnitedHealthcare Community & State	$83.10
Rate for Payer: Wellpoint Medicaid Managed Care	$91.37

SHAFT FIBULA 4CM X 14MM-18MM

Facility

$3,614.45

Hospital Charge Code	270614595
Hospital Revenue Code	278
Min. Negotiated Rate	$87.11
Max. Negotiated Rate	$1,807.22
Rate for Payer: Aetna Commercial	$1,373.49
Rate for Payer: Aetna Medicare Advantage	$1,084.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$722.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.68
Rate for Payer: Cigna Commercial	$1,807.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.18
Rate for Payer: Qualcare PPO/HMO/WC	$542.17
Rate for Payer: UnitedHealthcare Community & State	$87.11
Rate for Payer: Wellpoint Medicaid Managed Care	$95.78

SHAFT FIBULA 4CM X 14MM-18MM

Facility

$3,614.45

Hospital Charge Code	270614595
Hospital Revenue Code	278
Min. Negotiated Rate	$542.17
Max. Negotiated Rate	$874.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$722.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.18
Rate for Payer: Qualcare PPO/HMO/WC	$542.17

SHAFT FIBULA 6cx14-18MM 100730

Facility

$2,187.25

Hospital Charge Code	270617945
Hospital Revenue Code	272
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$1,093.62
Rate for Payer: Aetna Commercial	$831.15
Rate for Payer: Aetna Medicare Advantage	$656.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.75
Rate for Payer: Cigna Commercial	$1,093.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.17
Rate for Payer: Oxford Commercial	$437.45
Rate for Payer: Qualcare PPO/HMO/WC	$328.09
Rate for Payer: UnitedHealthcare Commercial	$437.45
Rate for Payer: UnitedHealthcare Community & State	$52.71
Rate for Payer: Wellpoint Medicaid Managed Care	$57.96

SHAFT FIBULA 6cx14-18MM 100730

Facility

$2,187.25

Hospital Charge Code	270617945
Hospital Revenue Code	272
Min. Negotiated Rate	$328.09
Max. Negotiated Rate	$328.09
Rate for Payer: Qualcare PPO/HMO/WC	$328.09

SHAFT FIBULAR 50MM

Facility

$5,750.00

Hospital Charge Code	270658156
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

SHAFT FIBULAR 50MM

Facility

$5,750.00

Hospital Charge Code	270658156
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

SHAFT LMT TIBIAL IMPLANT 184MM

Facility

$3,064.85

Hospital Charge Code	270615683
Hospital Revenue Code	278
Min. Negotiated Rate	$73.86
Max. Negotiated Rate	$1,532.42
Rate for Payer: Aetna Commercial	$1,164.64
Rate for Payer: Aetna Medicare Advantage	$919.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$781.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$781.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$612.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$781.54
Rate for Payer: Cigna Commercial	$1,532.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$674.27
Rate for Payer: Qualcare PPO/HMO/WC	$459.73
Rate for Payer: UnitedHealthcare Community & State	$73.86
Rate for Payer: Wellpoint Medicaid Managed Care	$81.22

SHAFT LMT TIBIAL IMPLANT 184MM

Facility

$3,064.85

Hospital Charge Code	270615683
Hospital Revenue Code	278
Min. Negotiated Rate	$459.73
Max. Negotiated Rate	$741.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$612.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$674.27
Rate for Payer: Qualcare PPO/HMO/WC	$459.73

SHAFT REMUR CURVED NCB

Facility

$3,305.00

Hospital Charge Code	270658845
Hospital Revenue Code	278
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$1,652.50
Rate for Payer: Aetna Commercial	$1,255.90
Rate for Payer: Aetna Medicare Advantage	$991.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$842.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$842.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$661.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$842.77
Rate for Payer: Cigna Commercial	$1,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$727.10
Rate for Payer: Qualcare PPO/HMO/WC	$495.75
Rate for Payer: UnitedHealthcare Community & State	$79.65
Rate for Payer: Wellpoint Medicaid Managed Care	$87.58

SHAFT REMUR CURVED NCB

Facility

$3,305.00

Hospital Charge Code	270658845
Hospital Revenue Code	278
Min. Negotiated Rate	$495.75
Max. Negotiated Rate	$799.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$661.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$727.10
Rate for Payer: Qualcare PPO/HMO/WC	$495.75

SHAFT SCREWDRIVER 165MM STARD

Facility

$1,460.85

Hospital Charge Code	270686030
Hospital Revenue Code	272
Min. Negotiated Rate	$219.13
Max. Negotiated Rate	$219.13
Rate for Payer: Qualcare PPO/HMO/WC	$219.13

Know your out-of-pocket cost for care.

All Charges