Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SOTROVIMAB IV INJ & MONITORING

Facility

$2,250.00

Service Code	HCPCS M0247
Hospital Charge Code	3230M0247
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

SOTROVIMAB IV INJ & MONITORING

Facility

$2,250.00

Service Code	HCPCS M0247
Hospital Charge Code	3230M0247
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SOUND FEMALE 16FR METAL 604216

Facility

$347.35

Hospital Charge Code	270660044
Hospital Revenue Code	272
Min. Negotiated Rate	$52.10
Max. Negotiated Rate	$52.10
Rate for Payer: Qualcare PPO/HMO/WC	$52.10

SOUND FEMALE 16FR METAL 604216

Facility

$347.35

Hospital Charge Code	270660044
Hospital Revenue Code	272
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$173.68
Rate for Payer: Aetna Commercial	$131.99
Rate for Payer: Aetna Medicare Advantage	$104.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.57
Rate for Payer: Cigna Commercial	$173.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.20
Rate for Payer: Oxford Commercial	$69.47
Rate for Payer: Qualcare PPO/HMO/WC	$52.10
Rate for Payer: UnitedHealthcare Commercial	$69.47
Rate for Payer: UnitedHealthcare Community & State	$8.37
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

SOURCE LIGHT MEDT DISP 9560702

Facility

$2,520.85

Hospital Charge Code	270629191
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$1,260.42
Rate for Payer: Aetna Commercial	$957.92
Rate for Payer: Aetna Medicare Advantage	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$642.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$642.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$642.82
Rate for Payer: Cigna Commercial	$1,260.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Oxford Commercial	$504.17
Rate for Payer: Qualcare PPO/HMO/WC	$378.13
Rate for Payer: UnitedHealthcare Commercial	$504.17
Rate for Payer: UnitedHealthcare Community & State	$60.75
Rate for Payer: Wellpoint Medicaid Managed Care	$66.80

SOURCE LIGHT MEDT DISP 9560702

Facility

$2,520.85

Hospital Charge Code	270629191
Hospital Revenue Code	272
Min. Negotiated Rate	$378.13
Max. Negotiated Rate	$378.13
Rate for Payer: Qualcare PPO/HMO/WC	$378.13

SP 02 EXTENSION CABLE

Facility

$2,420.00

Hospital Charge Code	270663690
Hospital Revenue Code	279
Min. Negotiated Rate	$58.32
Max. Negotiated Rate	$1,210.00
Rate for Payer: Aetna Commercial	$919.60
Rate for Payer: Aetna Medicare Advantage	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.10
Rate for Payer: Cigna Commercial	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Oxford Commercial	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.00
Rate for Payer: UnitedHealthcare Commercial	$484.00
Rate for Payer: UnitedHealthcare Community & State	$58.32
Rate for Payer: Wellpoint Medicaid Managed Care	$64.13

SP 02 EXTENSION CABLE

Facility

$2,420.00

Hospital Charge Code	270663690
Hospital Revenue Code	279
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.00

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$1,055.75
Rate for Payer: Aetna Commercial	$802.37
Rate for Payer: Aetna Medicare Advantage	$633.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.43
Rate for Payer: Cigna Commercial	$1,055.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.53
Rate for Payer: Qualcare PPO/HMO/WC	$316.73
Rate for Payer: UnitedHealthcare Community & State	$50.89
Rate for Payer: Wellpoint Medicaid Managed Care	$55.95

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$316.73
Max. Negotiated Rate	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.53
Rate for Payer: Qualcare PPO/HMO/WC	$316.73

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,775.00
Max. Negotiated Rate	$4,477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$445.85
Max. Negotiated Rate	$9,250.00
Rate for Payer: Aetna Commercial	$7,030.00
Rate for Payer: Aetna Medicare Advantage	$5,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,717.50
Rate for Payer: Cigna Commercial	$9,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00
Rate for Payer: UnitedHealthcare Community & State	$445.85
Rate for Payer: Wellpoint Medicaid Managed Care	$490.25

SPACER 5.0MM WITH BOLT 10495

Facility

$139.25

Hospital Charge Code	270621623
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

SPACER 5.0MM WITH BOLT 10495

Facility

$139.25

Hospital Charge Code	270621623
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.77
Rate for Payer: Oxford Commercial	$27.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$27.85
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

SPACER 6X18X60MM 10DEG

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270706233
Hospital Revenue Code	278
Min. Negotiated Rate	$5,418.75
Max. Negotiated Rate	$8,742.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,947.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75

SPACER 6X18X60MM 10DEG

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270706233
Hospital Revenue Code	278
Min. Negotiated Rate	$870.61
Max. Negotiated Rate	$18,062.50
Rate for Payer: Aetna Commercial	$13,727.50
Rate for Payer: Aetna Medicare Advantage	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,211.88
Rate for Payer: Cigna Commercial	$18,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,947.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75
Rate for Payer: UnitedHealthcare Community & State	$870.61
Rate for Payer: Wellpoint Medicaid Managed Care	$957.31

SPACER 8X18X55MM 10D

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703546
Hospital Revenue Code	278
Min. Negotiated Rate	$870.61
Max. Negotiated Rate	$18,062.50
Rate for Payer: Aetna Commercial	$13,727.50
Rate for Payer: Aetna Medicare Advantage	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,211.88
Rate for Payer: Cigna Commercial	$18,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,947.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75
Rate for Payer: UnitedHealthcare Community & State	$870.61
Rate for Payer: Wellpoint Medicaid Managed Care	$957.31

SPACER 8X18X55MM 10D

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703546
Hospital Revenue Code	278
Min. Negotiated Rate	$5,418.75
Max. Negotiated Rate	$8,742.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,947.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75

SPACER 8X34X24MM 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704557
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

SPACER 8X34X24MM 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704557
Hospital Revenue Code	278
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$798.31
Rate for Payer: Wellpoint Medicaid Managed Care	$877.81

SPACER ALTERA 10X26 9-13MM 15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698396
Hospital Revenue Code	278
Min. Negotiated Rate	$771.20
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$771.20
Rate for Payer: Wellpoint Medicaid Managed Care	$848.00

SPACER ALTERA 10X26 9-13MM 15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698396
Hospital Revenue Code	278
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

SPACERALTERA10X31 10 14MM15DEG

Facility

$32,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694881
Hospital Revenue Code	278
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

Know your out-of-pocket cost for care.

All Charges