Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STIMULATOR SPINAL

Facility

$38,430.00

Service Code	HCPCS C1767
Hospital Charge Code	270665833
Hospital Revenue Code	278
Min. Negotiated Rate	$5,764.50
Max. Negotiated Rate	$9,300.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,686.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,300.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,454.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,764.50

STIMULATOR SPINAL FUSN 101385W

Facility

$10,617.65

Hospital Charge Code	270607674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,592.65
Max. Negotiated Rate	$2,569.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,123.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,569.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,335.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,592.65

STIMULATOR SPINAL FUSN 101385W

Facility

$10,617.65

Hospital Charge Code	270607674
Hospital Revenue Code	278
Min. Negotiated Rate	$255.89
Max. Negotiated Rate	$5,308.82
Rate for Payer: Aetna Commercial	$4,034.71
Rate for Payer: Aetna Medicare Advantage	$3,185.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,123.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,707.50
Rate for Payer: Cigna Commercial	$5,308.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,569.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,335.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,592.65
Rate for Payer: UnitedHealthcare Community & State	$255.89
Rate for Payer: Wellpoint Medicaid Managed Care	$281.37

STIMULATOR SPNAL IMPT 10-1385M

Facility

$23,312.00

Hospital Charge Code	270628786
Hospital Revenue Code	272
Min. Negotiated Rate	$3,496.80
Max. Negotiated Rate	$3,496.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,496.80

STIMULATOR SPNAL IMPT 10-1385M

Facility

$23,312.00

Hospital Charge Code	270628786
Hospital Revenue Code	272
Min. Negotiated Rate	$561.82
Max. Negotiated Rate	$11,656.00
Rate for Payer: Aetna Commercial	$8,858.56
Rate for Payer: Aetna Medicare Advantage	$6,993.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,944.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,944.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,944.56
Rate for Payer: Cigna Commercial	$11,656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,993.60
Rate for Payer: Oxford Commercial	$4,662.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,496.80
Rate for Payer: UnitedHealthcare Commercial	$4,662.40
Rate for Payer: UnitedHealthcare Community & State	$561.82
Rate for Payer: Wellpoint Medicaid Managed Care	$617.77

STIMULATOR TEST TS8R

Facility

$1,736.00

Hospital Charge Code	270633799
Hospital Revenue Code	272
Min. Negotiated Rate	$41.84
Max. Negotiated Rate	$868.00
Rate for Payer: Aetna Commercial	$659.68
Rate for Payer: Aetna Medicare Advantage	$520.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$442.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$442.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$442.68
Rate for Payer: Cigna Commercial	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.80
Rate for Payer: Oxford Commercial	$347.20
Rate for Payer: Qualcare PPO/HMO/WC	$260.40
Rate for Payer: UnitedHealthcare Commercial	$347.20
Rate for Payer: UnitedHealthcare Community & State	$41.84
Rate for Payer: Wellpoint Medicaid Managed Care	$46.00

STIMULATOR TEST TS8R

Facility

$1,736.00

Hospital Charge Code	270633799
Hospital Revenue Code	272
Min. Negotiated Rate	$260.40
Max. Negotiated Rate	$260.40
Rate for Payer: Qualcare PPO/HMO/WC	$260.40

STIMULATOR VARI-STIM

Facility

$292.00

Hospital Charge Code	270600307
Hospital Revenue Code	272
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

STIMULATOR VARI-STIM

Facility

$292.00

Hospital Charge Code	270600307
Hospital Revenue Code	272
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$110.96
Rate for Payer: Aetna Medicare Advantage	$87.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.46
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.60
Rate for Payer: Oxford Commercial	$58.40
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$58.40
Rate for Payer: UnitedHealthcare Community & State	$7.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

STIMUL BN GROWTH OSTEOG 40M

Facility

$57,700.00

Service Code	HCPCS E0749
Hospital Charge Code	270693961
Hospital Revenue Code	278
Min. Negotiated Rate	$8,655.00
Max. Negotiated Rate	$13,963.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,963.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,655.00

STIMUL BN GROWTH OSTEOG 40M

Facility

$57,700.00

Service Code	HCPCS E0749
Hospital Charge Code	270693961
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.57
Max. Negotiated Rate	$28,850.00
Rate for Payer: Aetna Commercial	$21,926.00
Rate for Payer: Aetna Medicare Advantage	$17,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,713.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,713.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,713.50
Rate for Payer: Cigna Commercial	$28,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,963.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,655.00
Rate for Payer: UnitedHealthcare Community & State	$1,390.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,529.05

STIMUPLEX A 22Gx2

Facility

$580.18

Hospital Charge Code	270655697
Hospital Revenue Code	271
Min. Negotiated Rate	$87.03
Max. Negotiated Rate	$87.03
Rate for Payer: Qualcare PPO/HMO/WC	$87.03

STIMUPLEX A 22Gx2

Facility

$580.18

Hospital Charge Code	270655697
Hospital Revenue Code	271
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.09
Rate for Payer: Aetna Commercial	$220.47
Rate for Payer: Aetna Medicare Advantage	$174.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.95
Rate for Payer: Cigna Commercial	$290.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.05
Rate for Payer: Oxford Commercial	$116.04
Rate for Payer: Qualcare PPO/HMO/WC	$87.03
Rate for Payer: UnitedHealthcare Commercial	$116.04
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

STITCH PK ULTAFIX RC 10170A

Facility

$868.00

Hospital Charge Code	270633956
Hospital Revenue Code	272
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$130.20
Rate for Payer: Qualcare PPO/HMO/WC	$130.20

STITCH PK ULTAFIX RC 10170A

Facility

$868.00

Hospital Charge Code	270633956
Hospital Revenue Code	272
Min. Negotiated Rate	$20.92
Max. Negotiated Rate	$434.00
Rate for Payer: Aetna Commercial	$329.84
Rate for Payer: Aetna Medicare Advantage	$260.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.34
Rate for Payer: Cigna Commercial	$434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.40
Rate for Payer: Oxford Commercial	$173.60
Rate for Payer: Qualcare PPO/HMO/WC	$130.20
Rate for Payer: UnitedHealthcare Commercial	$173.60
Rate for Payer: UnitedHealthcare Community & State	$20.92
Rate for Payer: Wellpoint Medicaid Managed Care	$23.00

STITCH PK ULTRAFIX 2.9 10215A

Facility

$768.85

Hospital Charge Code	270633955
Hospital Revenue Code	272
Min. Negotiated Rate	$115.33
Max. Negotiated Rate	$115.33
Rate for Payer: Qualcare PPO/HMO/WC	$115.33

STITCH PK ULTRAFIX 2.9 10215A

Facility

$768.85

Hospital Charge Code	270633955
Hospital Revenue Code	272
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$384.43
Rate for Payer: Aetna Commercial	$292.16
Rate for Payer: Aetna Medicare Advantage	$230.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.06
Rate for Payer: Cigna Commercial	$384.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.66
Rate for Payer: Oxford Commercial	$153.77
Rate for Payer: Qualcare PPO/HMO/WC	$115.33
Rate for Payer: UnitedHealthcare Commercial	$153.77
Rate for Payer: UnitedHealthcare Community & State	$18.53
Rate for Payer: Wellpoint Medicaid Managed Care	$20.37

ST LARYNGEAL FUNCTION STUDIES

Facility

$2,400.00

Service Code	HCPCS 92520GN
Hospital Charge Code	74204015
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

ST LARYNGEAL FUNCTION STUDIES

Facility

$2,400.00

Service Code	HCPCS 92520GN
Hospital Charge Code	74204015
Hospital Revenue Code	444
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

ST LIBE MONO 4.0x28m 389342840

Facility

$4,375.00

Hospital Charge Code	270639382
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

ST LIBE MONO 4.0x28m 389342840

Facility

$4,375.00

Hospital Charge Code	270639382
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBER MONO 3.0x12m389341230

Facility

$1,250.00

Hospital Charge Code	270638462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 3.0x12m389341230

Facility

$1,250.00

Hospital Charge Code	270638462
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

ST LIBER MONO 3.0x28m389342830

Facility

$1,250.00

Hospital Charge Code	270638598
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 3.0x28m389342830

Facility

$1,250.00

Hospital Charge Code	270638598
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

Know your out-of-pocket cost for care.

All Charges