Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPEEDPLATE LAPIPLASTY 18X17MM

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700192
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

SPEED RELEASE DISP SN20

Facility

$2,500.00

Hospital Charge Code	270696796
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

SPEED RELEASE DISP SN20

Facility

$2,500.00

Hospital Charge Code	270696796
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

SPEEDSTITCH BLACK CO-BRAID

Facility

$1,416.67

Hospital Charge Code	270674888
Hospital Revenue Code	272
Min. Negotiated Rate	$34.14
Max. Negotiated Rate	$708.34
Rate for Payer: Aetna Commercial	$538.33
Rate for Payer: Aetna Medicare Advantage	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.25
Rate for Payer: Cigna Commercial	$708.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.00
Rate for Payer: Oxford Commercial	$283.33
Rate for Payer: Qualcare PPO/HMO/WC	$212.50
Rate for Payer: UnitedHealthcare Commercial	$283.33
Rate for Payer: UnitedHealthcare Community & State	$34.14
Rate for Payer: Wellpoint Medicaid Managed Care	$37.54

SPEEDSTITCH BLACK CO-BRAID

Facility

$1,416.67

Hospital Charge Code	270674888
Hospital Revenue Code	272
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$212.50
Rate for Payer: Qualcare PPO/HMO/WC	$212.50

SPEEDSTITCH CO-BRAID CUT CART

Facility

$1,375.00

Hospital Charge Code	270669994
Hospital Revenue Code	272
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SPEEDSTITCH CO-BRAID CUT CART

Facility

$1,375.00

Hospital Charge Code	270669994
Hospital Revenue Code	272
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.50
Rate for Payer: Oxford Commercial	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Commercial	$275.00
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

SPEED TITAN IMPLANT 25x20x20MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270680263
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

SPEED TITAN IMPLANT 25x20x20MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270680263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

SPERM ANTIBODIES

Facility

$75.59

Service Code	HCPCS 89325
Hospital Charge Code	38477075
Hospital Revenue Code	300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.02
Rate for Payer: Aetna Medicare Advantage	$34.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.52
Rate for Payer: Cigna Commercial	$37.80
Rate for Payer: Cigna Medicare Advantage	$10.67
Rate for Payer: Clover Medicare Advantage	$10.14
Rate for Payer: EmblemHealth Commercial	$32.01
Rate for Payer: Humana Medicare Advantage	$10.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.34
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.67
Rate for Payer: Wellcare Medicare Advantage	$10.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

SPERM ANTIBODIES

Facility

$75.59

Service Code	HCPCS 89325
Hospital Charge Code	38477075
Hospital Revenue Code	300
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$11.34
Rate for Payer: Qualcare PPO/HMO/WC	$11.34

SPERM EVAL-CERVICAL MUCUS PEN

Facility

$70.00

Service Code	HCPCS 89330
Hospital Charge Code	38477065
Hospital Revenue Code	300
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.23
Rate for Payer: Aetna Medicare Advantage	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.47
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: Cigna Medicare Advantage	$10.38
Rate for Payer: Clover Medicare Advantage	$9.86
Rate for Payer: EmblemHealth Commercial	$31.14
Rate for Payer: Humana Medicare Advantage	$10.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.38
Rate for Payer: Wellcare Medicare Advantage	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

SPERM EVAL-CERVICAL MUCUS PEN

Facility

$70.00

Service Code	HCPCS 89330
Hospital Charge Code	38477065
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

SPERM ISOLATION;COMPLEX PREP

Facility

$218.74

Service Code	HCPCS 89261
Hospital Charge Code	38477186
Hospital Revenue Code	300
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.81
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.80

SPERM ISOLATION;COMPLEX PREP

Facility

$218.74

Service Code	HCPCS 89261
Hospital Charge Code	38477186
Hospital Revenue Code	300
Min. Negotiated Rate	$32.81
Max. Negotiated Rate	$32.81
Rate for Payer: Qualcare PPO/HMO/WC	$32.81

SP EVAL TO FIT VOICE PROSTHSIS

Facility

$320.85

Service Code	HCPCS 92597GN
Hospital Charge Code	9100105
Hospital Revenue Code	440
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

SP EVAL TO FIT VOICE PROSTHSIS

Facility

$320.85

Service Code	HCPCS 92597GN
Hospital Charge Code	9100105
Hospital Revenue Code	440
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.25
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.50

SPHERE EYE 14MM E561414

Facility

$47.25

Hospital Charge Code	270608880
Hospital Revenue Code	272
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SPHERE EYE 14MM E561414

Facility

$47.25

Hospital Charge Code	270608880
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SPHERE EYE 16MM E561416

Facility

$39.25

Hospital Charge Code	270608882
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

SPHERE EYE 16MM E561416

Facility

$39.25

Hospital Charge Code	270608882
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$7.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.85
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SPHERE EYE 18MM E561418

Facility

$39.25

Hospital Charge Code	270608883
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

SPHERE EYE 18MM E561418

Facility

$39.25

Hospital Charge Code	270608883
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$7.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.85
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SPHERE EYE 20MM E561420

Facility

$39.25

Hospital Charge Code	270608884
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$7.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.85
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SPHERE EYE 20MM E561420

Facility

$39.25

Hospital Charge Code	270608884
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

Know your out-of-pocket cost for care.

All Charges