Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
Hospital Revenue Code	301
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

SODIUM, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

SODIUM, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SODIUM, URINE 24 HOUR

Facility

$46.00

Service Code	HCPCS 84300
Hospital Charge Code	3030830
Hospital Revenue Code	301
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SODIUM, URINE 24 HOUR

Facility

$46.00

Service Code	HCPCS 84300
Hospital Charge Code	3030830
Hospital Revenue Code	301
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

SOF-FOAM DRESSING 4X5

Facility

$11.00

Hospital Charge Code	9808240
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SOF-FOAM DRESSING 4X5

Facility

$11.00

Hospital Charge Code	9808240
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$135.75
Max. Negotiated Rate	$219.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.10
Rate for Payer: Qualcare PPO/HMO/WC	$135.75

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$21.81
Max. Negotiated Rate	$452.50
Rate for Payer: Aetna Commercial	$343.90
Rate for Payer: Aetna Medicare Advantage	$271.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.78
Rate for Payer: Cigna Commercial	$452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.10
Rate for Payer: Qualcare PPO/HMO/WC	$135.75
Rate for Payer: UnitedHealthcare Community & State	$21.81
Rate for Payer: Wellpoint Medicaid Managed Care	$23.98

SOFT SPLASH SHIELD STERILE

Facility

$172.00

Hospital Charge Code	270330544
Hospital Revenue Code	272
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$65.36
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.60
Rate for Payer: Oxford Commercial	$34.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$34.40
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

SOFT SPLASH SHIELD STERILE

Facility

$172.00

Hospital Charge Code	270330544
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

SOFT TISSUE PATCH 2 MM

Facility

$962.00

Hospital Charge Code	270335125
Hospital Revenue Code	278
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$481.00
Rate for Payer: Aetna Commercial	$365.56
Rate for Payer: Aetna Medicare Advantage	$288.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.31
Rate for Payer: Cigna Commercial	$481.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.64
Rate for Payer: Qualcare PPO/HMO/WC	$144.30
Rate for Payer: UnitedHealthcare Community & State	$23.18
Rate for Payer: Wellpoint Medicaid Managed Care	$25.49

SOFT TISSUE PATCH 2 MM

Facility

$962.00

Hospital Charge Code	270335125
Hospital Revenue Code	278
Min. Negotiated Rate	$144.30
Max. Negotiated Rate	$232.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.64
Rate for Payer: Qualcare PPO/HMO/WC	$144.30

SOFT TISSUE PROCEDURES WITH CC

Facility

$58,635.56

Service Code	MSDRG 501
Min. Negotiated Rate	$17,853.78
Max. Negotiated Rate	$58,635.56
Rate for Payer: Aetna Commercial	$40,546.65
Rate for Payer: Aetna Medicare Advantage	$58,635.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,793.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,474.14
Rate for Payer: Cigna Commercial	$32,713.94
Rate for Payer: Cigna Medicare Advantage	$18,793.45
Rate for Payer: Clover Medicare Advantage	$17,853.78
Rate for Payer: EmblemHealth Commercial	$56,380.35
Rate for Payer: Humana Medicare Advantage	$19,357.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,793.45
Rate for Payer: Oxford Commercial	$23,511.94
Rate for Payer: UnitedHealthcare Commercial	$41,228.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,793.45
Rate for Payer: Wellcare Medicare Advantage	$18,793.45

SOFT TISSUE PROCEDURES WITH MCC

Facility

$104,425.68

Service Code	MSDRG 500
Min. Negotiated Rate	$31,796.28
Max. Negotiated Rate	$104,425.68
Rate for Payer: Aetna Commercial	$72,009.68
Rate for Payer: Aetna Medicare Advantage	$104,425.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,365.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,365.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,469.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,365.64
Rate for Payer: Cigna Commercial	$59,226.07
Rate for Payer: Cigna Medicare Advantage	$33,469.77
Rate for Payer: Clover Medicare Advantage	$31,796.28
Rate for Payer: EmblemHealth Commercial	$100,409.31
Rate for Payer: Humana Medicare Advantage	$34,473.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,469.77
Rate for Payer: Oxford Commercial	$42,566.56
Rate for Payer: UnitedHealthcare Commercial	$74,641.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,469.77
Rate for Payer: Wellcare Medicare Advantage	$33,469.77

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$45,635.77

Service Code	MSDRG 502
Min. Negotiated Rate	$13,895.51
Max. Negotiated Rate	$45,635.77
Rate for Payer: Aetna Commercial	$31,614.31
Rate for Payer: Aetna Medicare Advantage	$45,635.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,100.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,100.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,626.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,100.18
Rate for Payer: Cigna Commercial	$25,187.17
Rate for Payer: Cigna Medicare Advantage	$14,626.85
Rate for Payer: Clover Medicare Advantage	$13,895.51
Rate for Payer: EmblemHealth Commercial	$43,880.55
Rate for Payer: Humana Medicare Advantage	$15,065.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,626.85
Rate for Payer: Oxford Commercial	$18,102.35
Rate for Payer: UnitedHealthcare Commercial	$31,743.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,626.85
Rate for Payer: Wellcare Medicare Advantage	$14,626.85

SOFT TISSUE SHAVER PLUS

Facility

$2,336.50

Hospital Charge Code	270701400
Hospital Revenue Code	278
Min. Negotiated Rate	$350.48
Max. Negotiated Rate	$565.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.03
Rate for Payer: Qualcare PPO/HMO/WC	$350.48

SOFT TISSUE SHAVER PLUS

Facility

$2,336.50

Hospital Charge Code	270701400
Hospital Revenue Code	278
Min. Negotiated Rate	$56.31
Max. Negotiated Rate	$1,168.25
Rate for Payer: Aetna Commercial	$887.87
Rate for Payer: Aetna Medicare Advantage	$700.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$595.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$595.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$595.81
Rate for Payer: Cigna Commercial	$1,168.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.03
Rate for Payer: Qualcare PPO/HMO/WC	$350.48
Rate for Payer: UnitedHealthcare Community & State	$56.31
Rate for Payer: Wellpoint Medicaid Managed Care	$61.92

SOLAR-S ALIF SPACER 40X28X16MM

Facility

$30,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705627
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

SOLAR-S ALIF SPACER 40X28X16MM

Facility

$30,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705627
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

Know your out-of-pocket cost for care.

All Charges