Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SMA AND CELIAC DUPLEX LTD

Facility

$1,555.25

Service Code	HCPCS 93976
Hospital Charge Code	94053270
Hospital Revenue Code	921
Min. Negotiated Rate	$233.29
Max. Negotiated Rate	$233.29
Rate for Payer: Qualcare PPO/HMO/WC	$233.29

SMA AND CELIAC DUPLEX LTD

Facility

$1,555.25

Service Code	HCPCS 93976
Hospital Charge Code	94053270
Hospital Revenue Code	921
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$551.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$466.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$233.29
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$37.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.21

SMA AND CELIAC DUPLEX LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74115052
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA CARRIER TEST

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900027
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

SMA CARRIER TEST

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900027
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$372.64
Rate for Payer: Aetna Medicare Advantage	$443.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.53
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$137.00
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$109.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Medicare Advantage	$137.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

SMA & CELIAC LIMTD DUPLEX

Facility

$789.00

Hospital Charge Code	2692085
Hospital Revenue Code	921
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$299.82
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$394.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.70
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

SMA & CELIAC LIMTD DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053210
Hospital Revenue Code	921
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$627.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$40.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$44.52

SMA & CELIAC LIMTD DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053210
Hospital Revenue Code	921
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

SMA & CELIAC LIMTD DUPLEX

Facility

$789.00

Hospital Charge Code	2692085
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMALL 11MM 8 DEG PLATE

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704097
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

SMALL 11MM 8 DEG PLATE

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704097
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

SMALL BONE FIXATION SYSTEM

Facility

$7,145.00

Hospital Charge Code	270661291
Hospital Revenue Code	278
Min. Negotiated Rate	$172.19
Max. Negotiated Rate	$3,572.50
Rate for Payer: Aetna Commercial	$2,715.10
Rate for Payer: Aetna Medicare Advantage	$2,143.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,821.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,821.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,821.97
Rate for Payer: Cigna Commercial	$3,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,571.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.75
Rate for Payer: UnitedHealthcare Community & State	$172.19
Rate for Payer: Wellpoint Medicaid Managed Care	$189.34

SMALL BONE FIXATION SYSTEM

Facility

$7,145.00

Hospital Charge Code	270661291
Hospital Revenue Code	278
Min. Negotiated Rate	$1,071.75
Max. Negotiated Rate	$1,729.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,571.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.75

SMALL BONE FIX SYS 1.6mm

Facility

$1,575.00

Hospital Charge Code	270638258
Hospital Revenue Code	272
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.50
Rate for Payer: Oxford Commercial	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Commercial	$315.00
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

SMALL BONE FIX SYS 1.6mm

Facility

$1,575.00

Hospital Charge Code	270638258
Hospital Revenue Code	272
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$236.25
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

SMALL BOWEL SERIES

Facility

$510.00

Service Code	HCPCS 74250
Hospital Charge Code	94061143
Hospital Revenue Code	320
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

SMALL BOWEL SERIES

Facility

$510.00

Service Code	HCPCS 74250
Hospital Charge Code	94061143
Hospital Revenue Code	320
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

SMALL EX-FIX COMB CLAMMR COND

Facility

$1,629.55

Hospital Charge Code	270666874
Hospital Revenue Code	272
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$814.77
Rate for Payer: Aetna Commercial	$619.23
Rate for Payer: Aetna Medicare Advantage	$488.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.54
Rate for Payer: Cigna Commercial	$814.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.87
Rate for Payer: Oxford Commercial	$325.91
Rate for Payer: Qualcare PPO/HMO/WC	$244.43
Rate for Payer: UnitedHealthcare Commercial	$325.91
Rate for Payer: UnitedHealthcare Community & State	$39.27
Rate for Payer: Wellpoint Medicaid Managed Care	$43.18

SMALL EX-FIX COMB CLAMMR COND

Facility

$1,629.55

Hospital Charge Code	270666874
Hospital Revenue Code	272
Min. Negotiated Rate	$244.43
Max. Negotiated Rate	$244.43
Rate for Payer: Qualcare PPO/HMO/WC	$244.43

SMALL FRAGMENT PLATES

Facility

$249.00

Hospital Charge Code	270335005
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$94.62
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.78
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

SMALL FRAGMENT PLATES

Facility

$249.00

Hospital Charge Code	270335005
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.78
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

SMALL FRAGMENT SCREWS

Facility

$137.00

Hospital Charge Code	270335003
Hospital Revenue Code	278
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.50
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.14
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

SMALL FRAGMENT SCREWS

Facility

$137.00

Hospital Charge Code	270335003
Hospital Revenue Code	278
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.14
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

SMALL IMPACT TIP

Facility

$182.30

Hospital Charge Code	270652409
Hospital Revenue Code	272
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$27.34
Rate for Payer: Qualcare PPO/HMO/WC	$27.34

SMALL IMPACT TIP

Facility

$182.30

Hospital Charge Code	270652409
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.15
Rate for Payer: Aetna Commercial	$69.27
Rate for Payer: Aetna Medicare Advantage	$54.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$91.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.69
Rate for Payer: Oxford Commercial	$36.46
Rate for Payer: Qualcare PPO/HMO/WC	$27.34
Rate for Payer: UnitedHealthcare Commercial	$36.46
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

Know your out-of-pocket cost for care.

All Charges