Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BARTONELLA ANTIBODY PROFILE II

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3038535B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

BARTONELLA ANTIBODY PROFILE II

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3038535B
Hospital Revenue Code	302
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$35.33
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

BARTONELLA DNA,PCR

Facility

$390.00

Service Code	HCPCS 87471
Hospital Charge Code	39900291
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BARTONELLA DNA,PCR

Facility

$390.00

Service Code	HCPCS 87471
Hospital Charge Code	39900291
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BARTONELLA, DNA PCR

Facility

$241.20

Service Code	HCPCS 87471
Hospital Charge Code	3038095
Hospital Revenue Code	306
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

BARTONELLA, DNA PCR

Facility

$241.20

Service Code	HCPCS 87471
Hospital Charge Code	3038095
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

BASALJEL/400MG/5ML

Facility

$28.00

Hospital Charge Code	60632531
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

BASALJEL/400MG/5ML

Facility

$28.00

Hospital Charge Code	60632531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

BASALJEL/500MG/CAP

Facility

$3.00

Hospital Charge Code	60632532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BASALJEL/500MG/CAP

Facility

$3.00

Hospital Charge Code	60632532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

BASALJEL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

BASALJEL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$290.59
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$2,719.50
Max. Negotiated Rate	$4,387.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,988.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$436.93
Max. Negotiated Rate	$9,065.00
Rate for Payer: Aetna Commercial	$6,889.40
Rate for Payer: Aetna Medicare Advantage	$5,439.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,623.15
Rate for Payer: Cigna Commercial	$9,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,988.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50
Rate for Payer: UnitedHealthcare Community & State	$436.93
Rate for Payer: Wellpoint Medicaid Managed Care	$480.44

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$206.66
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$206.66
Rate for Payer: Wellpoint Medicaid Managed Care	$227.24

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$206.66
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$206.66
Rate for Payer: Wellpoint Medicaid Managed Care	$227.24

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$290.59
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

Know your out-of-pocket cost for care.

All Charges