Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPAN AID FT DRIP PR *********

Facility

$102.00

Hospital Charge Code	8001679
Hospital Revenue Code	279
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

SPAN AID WEDGE **********

Facility

$214.00

Hospital Charge Code	8001661
Hospital Revenue Code	279
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

SPAN AID WEDGE **********

Facility

$214.00

Hospital Charge Code	8001661
Hospital Revenue Code	279
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$107.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.20
Rate for Payer: Oxford Commercial	$42.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$42.80
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

SPANDAGE LEG MEDIUM 24 MT3X24

Facility

$6.80

Hospital Charge Code	270639041
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Aetna Medicare Advantage	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.04
Rate for Payer: Oxford Commercial	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.36
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

SPANDAGE LEG MEDIUM 24 MT3X24

Facility

$6.80

Hospital Charge Code	270639041
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

SPANDAGE SZ 8 MT8X24

Facility

$5.53

Hospital Charge Code	270640000W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

SPANDAGE SZ 8 MT8X24

Facility

$5.53

Hospital Charge Code	270640000W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.77
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.41
Rate for Payer: Cigna Commercial	$2.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.11
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SPANDAGE TOE 24 MT1X24

Facility

$10.00

Hospital Charge Code	270639040
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

SPANDAGE TOE 24 MT1X24

Facility

$10.00

Hospital Charge Code	270639040
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

SPATULA DISP 14-9300

Facility

$300.85

Hospital Charge Code	270609014
Hospital Revenue Code	272
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$150.43
Rate for Payer: Aetna Commercial	$114.32
Rate for Payer: Aetna Medicare Advantage	$90.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.72
Rate for Payer: Cigna Commercial	$150.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.25
Rate for Payer: Oxford Commercial	$60.17
Rate for Payer: Qualcare PPO/HMO/WC	$45.13
Rate for Payer: UnitedHealthcare Commercial	$60.17
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

SPATULA DISP 14-9300

Facility

$300.85

Hospital Charge Code	270609014
Hospital Revenue Code	272
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$45.13
Rate for Payer: Qualcare PPO/HMO/WC	$45.13

SPATULA ELECTRODE DISP *****

Facility

$78.00

Hospital Charge Code	1606300
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

SPATULA ELECTRODE DISP *****

Facility

$78.00

Hospital Charge Code	1606300
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$15.60
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

SP BONE AGRFT MORSEL ADD-ON

Facility

$6,322.68

Service Code	HCPCS 20937
Hospital Charge Code	16000603
Hospital Revenue Code	360
Min. Negotiated Rate	$152.38
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,402.62
Rate for Payer: Aetna Medicare Advantage	$1,896.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,612.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,612.28
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	$1,612.28
Rate for Payer: Cigna Commercial	$3,161.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,896.80
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$948.40
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$152.38

SP BONE AGRFT MORSEL ADD-ON

Facility

$6,322.68

Service Code	HCPCS 20937
Hospital Charge Code	16000603
Hospital Revenue Code	360
Min. Negotiated Rate	$948.40
Max. Negotiated Rate	$948.40
Rate for Payer: Qualcare PPO/HMO/WC	$948.40

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	162004
Hospital Revenue Code	360
Min. Negotiated Rate	$1,783.08
Max. Negotiated Rate	$1,783.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	162004
Hospital Revenue Code	360
Min. Negotiated Rate	$286.48
Max. Negotiated Rate	$5,943.61
Rate for Payer: Aetna Commercial	$4,517.14
Rate for Payer: Aetna Medicare Advantage	$3,566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,031.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,031.24
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	$3,031.24
Rate for Payer: Cigna Commercial	$5,943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,566.17
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$286.48
Rate for Payer: Wellpoint Medicaid Managed Care	$315.01

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	16000253
Hospital Revenue Code	360
Min. Negotiated Rate	$1,783.08
Max. Negotiated Rate	$1,783.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	16000253
Hospital Revenue Code	360
Min. Negotiated Rate	$286.48
Max. Negotiated Rate	$5,943.61
Rate for Payer: Aetna Commercial	$4,517.14
Rate for Payer: Aetna Medicare Advantage	$3,566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,031.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,031.24
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	$3,031.24
Rate for Payer: Cigna Commercial	$5,943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,566.17
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$286.48
Rate for Payer: Wellpoint Medicaid Managed Care	$315.01

SP BONE ALGRFT STRUCT ADD - ON

Facility

$25,282.63

Service Code	HCPCS 20931
Hospital Charge Code	16000669
Hospital Revenue Code	360
Min. Negotiated Rate	$609.31
Max. Negotiated Rate	$12,641.32
Rate for Payer: Aetna Commercial	$9,607.40
Rate for Payer: Aetna Medicare Advantage	$7,584.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,447.07
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	$6,447.07
Rate for Payer: Cigna Commercial	$12,641.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,584.79
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$609.31
Rate for Payer: Wellpoint Medicaid Managed Care	$669.99

SP BONE ALGRFT STRUCT ADD - ON

Facility

$25,282.63

Service Code	HCPCS 20931
Hospital Charge Code	16000669
Hospital Revenue Code	360
Min. Negotiated Rate	$3,792.39
Max. Negotiated Rate	$3,792.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39

SP COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS 96125GN
Hospital Charge Code	9100145
Hospital Revenue Code	440
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

SP COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS 96125GN
Hospital Charge Code	9100145
Hospital Revenue Code	440
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

SPCR PLATEAU-C 8MM 37-1613-708

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270698919
Hospital Revenue Code	278
Min. Negotiated Rate	$134.96
Max. Negotiated Rate	$2,800.00
Rate for Payer: Aetna Commercial	$2,128.00
Rate for Payer: Aetna Medicare Advantage	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,428.00
Rate for Payer: Cigna Commercial	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,232.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.00
Rate for Payer: UnitedHealthcare Community & State	$134.96
Rate for Payer: Wellpoint Medicaid Managed Care	$148.40

SPCR PLATEAU-C 8MM 37-1613-708

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270698919
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,355.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,232.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

Know your out-of-pocket cost for care.

All Charges