Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
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	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
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	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SSB LA ENA - SJORGEN'S AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006898
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SSB LA ENA - SJORGEN'S AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006898
Hospital Revenue Code	302
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$82.05
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$207.86
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.10
Rate for Payer: Oxford Commercial	$109.40
Rate for Payer: Qualcare PPO/HMO/WC	$82.05
Rate for Payer: UnitedHealthcare Commercial	$109.40
Rate for Payer: UnitedHealthcare Community & State	$13.18
Rate for Payer: Wellpoint Medicaid Managed Care	$14.50

SSD 1%/400GM

Facility

$87.00

Hospital Charge Code	60633918
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.10
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

SSD 1%/400GM

Facility

$87.00

Hospital Charge Code	60633918
Hospital Revenue Code	250
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

SSD 1%/50GM

Facility

$21.00

Hospital Charge Code	60633919
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

SSD 1%/50GM

Facility

$21.00

Hospital Charge Code	60633919
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$12.49

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.62
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

SSEP (LOWER)

Facility

$711.25

Service Code	HCPCS 95926
Hospital Charge Code	5500022
Hospital Revenue Code	922
Min. Negotiated Rate	$106.69
Max. Negotiated Rate	$106.69
Rate for Payer: Qualcare PPO/HMO/WC	$106.69

SSEP (LOWER)

Facility

$711.25

Service Code	HCPCS 95926
Hospital Charge Code	5500022
Hospital Revenue Code	922
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.38
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.69
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$17.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$18.85

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$465.37
Max. Negotiated Rate	$9,655.00
Rate for Payer: Aetna Commercial	$7,337.80
Rate for Payer: Aetna Medicare Advantage	$5,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,924.05
Rate for Payer: Cigna Commercial	$9,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,793.00
Rate for Payer: Oxford Commercial	$3,862.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50
Rate for Payer: UnitedHealthcare Commercial	$3,862.00
Rate for Payer: UnitedHealthcare Community & State	$465.37
Rate for Payer: Wellpoint Medicaid Managed Care	$511.71

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$2,896.50
Max. Negotiated Rate	$2,896.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50

SSEP (UPPER)

Facility

$638.45

Service Code	HCPCS 95925
Hospital Charge Code	5400106
Hospital Revenue Code	922
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

SSEP (UPPER)

Facility

$638.45

Service Code	HCPCS 95925
Hospital Charge Code	5400106
Hospital Revenue Code	922
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,326.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.53
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$15.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

Know your out-of-pocket cost for care.

All Charges