Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STYLET SPINAL INVICTUS 40MM

Facility

$1,625.00

Hospital Charge Code	270698064
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

STYLET SPINAL INVICTUS 40MM

Facility

$1,625.00

Hospital Charge Code	270698064
Hospital Revenue Code	272
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

STYLET SPINAL INVICTUS 45MM

Facility

$1,625.00

Hospital Charge Code	270698065
Hospital Revenue Code	272
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

STYLET SPINAL INVICTUS 45MM

Facility

$1,625.00

Hospital Charge Code	270698065
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

STYLOS BA PUTTY 10

Facility

$16,125.00

Hospital Charge Code	270702356
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

STYLOS BA PUTTY 10

Facility

$16,125.00

Hospital Charge Code	270702356
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

STYYLET 45 CM CM

Facility

$200.00

Hospital Charge Code	270688562
Hospital Revenue Code	270
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

STYYLET 45 CM CM

Facility

$200.00

Hospital Charge Code	270688562
Hospital Revenue Code	270
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SUBARACHNOID INJ (NEUORLYTIC)

Facility

$3,107.20

Service Code	HCPCS 62280
Hospital Charge Code	84506015
Hospital Revenue Code	361
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$932.16
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$74.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$82.34

SUBARACHNOID INJ (NEUORLYTIC)

Facility

$3,107.20

Service Code	HCPCS 62280
Hospital Charge Code	84506015
Hospital Revenue Code	361
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

SUBC/IM INF ADDNL PUMP-NEW SIT

Facility

$206.86

Service Code	HCPCS 96371
Hospital Charge Code	3408030
Hospital Revenue Code	260
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.06
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.03
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$4.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$5.48

SUBC/IM INF ADDNL PUMP-NEW SIT

Facility

$206.86

Service Code	HCPCS 96371
Hospital Charge Code	3408030
Hospital Revenue Code	260
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$31.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.03

SUBC/IM INF@ADDTN'L HR AFTR 91

Facility

$219.00

Service Code	HCPCS 96370
Hospital Charge Code	3408025
Hospital Revenue Code	260
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$32.85
Rate for Payer: Qualcare PPO/HMO/WC	$32.85

SUBC/IM INF@ADDTN'L HR AFTR 91

Facility

$219.00

Service Code	HCPCS 96370
Hospital Charge Code	3408025
Hospital Revenue Code	260
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.70
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.85
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.80

SUBC INF/IM THERAPY,INT UP 1HR

Facility

$762.00

Service Code	HCPCS 96369
Hospital Charge Code	3408020
Hospital Revenue Code	260
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.60
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$18.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$20.19

SUBC INF/IM THERAPY,INT UP 1HR

Facility

$762.00

Service Code	HCPCS 96369
Hospital Charge Code	3408020
Hospital Revenue Code	260
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.30

SUBDUAL EVACUATING PORT SYSTEM

Facility

$9,192.40

Hospital Charge Code	270671362
Hospital Revenue Code	272
Min. Negotiated Rate	$221.54
Max. Negotiated Rate	$4,596.20
Rate for Payer: Aetna Commercial	$3,493.11
Rate for Payer: Aetna Medicare Advantage	$2,757.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,344.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,344.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,344.06
Rate for Payer: Cigna Commercial	$4,596.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,757.72
Rate for Payer: Oxford Commercial	$1,838.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.86
Rate for Payer: UnitedHealthcare Commercial	$1,838.48
Rate for Payer: UnitedHealthcare Community & State	$221.54
Rate for Payer: Wellpoint Medicaid Managed Care	$243.60

SUBDUAL EVACUATING PORT SYSTEM

Facility

$9,192.40

Hospital Charge Code	270671362
Hospital Revenue Code	272
Min. Negotiated Rate	$1,378.86
Max. Negotiated Rate	$1,378.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.86

SUBFIX IMPLANT 8MM

Facility

$10,381.00

Service Code	HCPCS C1713
Hospital Charge Code	270675857
Hospital Revenue Code	278
Min. Negotiated Rate	$250.18
Max. Negotiated Rate	$5,190.50
Rate for Payer: Aetna Commercial	$3,944.78
Rate for Payer: Aetna Medicare Advantage	$3,114.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.16
Rate for Payer: Cigna Commercial	$5,190.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,283.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.15
Rate for Payer: UnitedHealthcare Community & State	$250.18
Rate for Payer: Wellpoint Medicaid Managed Care	$275.10

SUBFIX IMPLANT 8MM

Facility

$10,381.00

Service Code	HCPCS C1713
Hospital Charge Code	270675857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.15
Max. Negotiated Rate	$2,512.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,283.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.15

SUB OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	9109155
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	9109155
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB OT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GO
Hospital Charge Code	9109157
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB OT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GO
Hospital Charge Code	9109157
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB OT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GO
Hospital Charge Code	9109156
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Know your out-of-pocket cost for care.

All Charges