Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

T-15 TAPERED DRIVER

Facility

$2,090.00

Hospital Charge Code	270686087
Hospital Revenue Code	272
Min. Negotiated Rate	$313.50
Max. Negotiated Rate	$313.50
Rate for Payer: Qualcare PPO/HMO/WC	$313.50

T-15 TAPERED DRIVER

Facility

$2,090.00

Hospital Charge Code	270686087
Hospital Revenue Code	272
Min. Negotiated Rate	$50.37
Max. Negotiated Rate	$1,045.00
Rate for Payer: Aetna Commercial	$794.20
Rate for Payer: Aetna Medicare Advantage	$627.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.95
Rate for Payer: Cigna Commercial	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.00
Rate for Payer: Oxford Commercial	$418.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.50
Rate for Payer: UnitedHealthcare Commercial	$418.00
Rate for Payer: UnitedHealthcare Community & State	$50.37
Rate for Payer: Wellpoint Medicaid Managed Care	$55.38

T1 CANN TFNA

Facility

$7,919.65

Service Code	HCPCS C1713
Hospital Charge Code	270686307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.95
Max. Negotiated Rate	$1,916.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.95

T1 CANN TFNA

Facility

$7,919.65

Service Code	HCPCS C1713
Hospital Charge Code	270686307
Hospital Revenue Code	278
Min. Negotiated Rate	$190.86
Max. Negotiated Rate	$3,959.82
Rate for Payer: Aetna Commercial	$3,009.47
Rate for Payer: Aetna Medicare Advantage	$2,375.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.51
Rate for Payer: Cigna Commercial	$3,959.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.95
Rate for Payer: UnitedHealthcare Community & State	$190.86
Rate for Payer: Wellpoint Medicaid Managed Care	$209.87

T1 LAG SCREW 10.5X90MM

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270656563
Hospital Revenue Code	278
Min. Negotiated Rate	$664.50
Max. Negotiated Rate	$1,072.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,072.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$974.60
Rate for Payer: Qualcare PPO/HMO/WC	$664.50

T1 LAG SCREW 10.5X90MM

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270656563
Hospital Revenue Code	278
Min. Negotiated Rate	$106.76
Max. Negotiated Rate	$2,215.00
Rate for Payer: Aetna Commercial	$1,683.40
Rate for Payer: Aetna Medicare Advantage	$1,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,129.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,129.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,129.65
Rate for Payer: Cigna Commercial	$2,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,072.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$974.60
Rate for Payer: Qualcare PPO/HMO/WC	$664.50
Rate for Payer: UnitedHealthcare Community & State	$106.76
Rate for Payer: Wellpoint Medicaid Managed Care	$117.39

T2 F/T LOCKING SCREW 4X45MM

Facility

$1,220.00

Hospital Charge Code	270656556
Hospital Revenue Code	278
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$610.00
Rate for Payer: Aetna Commercial	$463.60
Rate for Payer: Aetna Medicare Advantage	$366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.10
Rate for Payer: Cigna Commercial	$610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.40
Rate for Payer: Qualcare PPO/HMO/WC	$183.00
Rate for Payer: UnitedHealthcare Community & State	$29.40
Rate for Payer: Wellpoint Medicaid Managed Care	$32.33

T2 F/T LOCKING SCREW 4X45MM

Facility

$1,220.00

Hospital Charge Code	270656556
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$295.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.40
Rate for Payer: Qualcare PPO/HMO/WC	$183.00

T30 LOCK SCREW

Facility

$925.00

Service Code	HCPCS C1713
Hospital Charge Code	270695751
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

T30 LOCK SCREW

Facility

$925.00

Service Code	HCPCS C1713
Hospital Charge Code	270695751
Hospital Revenue Code	278
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

T3 FREE

Facility

$261.00

Service Code	HCPCS 84481
Hospital Charge Code	38472801
Hospital Revenue Code	301
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
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	$61.15
Rate for Payer: Cigna Commercial	$130.50
Rate for Payer: Cigna Medicare Advantage	$16.94
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Medicare Advantage	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

T3 FREE

Facility

$261.00

Service Code	HCPCS 84481
Hospital Charge Code	38472801
Hospital Revenue Code	301
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$39.15
Rate for Payer: Qualcare PPO/HMO/WC	$39.15

T3 HEMODIALYS 15X5F 15CM CT ST

Facility

$700.00

Hospital Charge Code	270680502
Hospital Revenue Code	272
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

T3 HEMODIALYS 15X5F 15CM CT ST

Facility

$700.00

Hospital Charge Code	270680502
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

T3 REVERSE

Facility

$160.85

Service Code	HCPCS 84482
Hospital Charge Code	3030400
Hospital Revenue Code	301
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.87
Rate for Payer: Aetna Medicare Advantage	$51.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.89
Rate for Payer: Cigna Commercial	$80.42
Rate for Payer: Cigna Medicare Advantage	$15.76
Rate for Payer: Clover Medicare Advantage	$14.97
Rate for Payer: EmblemHealth Commercial	$47.28
Rate for Payer: Humana Medicare Advantage	$16.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.76
Rate for Payer: Wellcare Medicare Advantage	$15.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

T3 REVERSE

Facility

$160.85

Service Code	HCPCS 84482
Hospital Charge Code	3030400
Hospital Revenue Code	301
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$24.13
Rate for Payer: Qualcare PPO/HMO/WC	$24.13

T3,REVERSE,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 84482
Hospital Charge Code	39900145
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

T3,REVERSE,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 84482
Hospital Charge Code	39900145
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.87
Rate for Payer: Aetna Medicare Advantage	$51.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.89
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.76
Rate for Payer: Clover Medicare Advantage	$14.97
Rate for Payer: EmblemHealth Commercial	$47.28
Rate for Payer: Humana Medicare Advantage	$16.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.76
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	$12.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.76
Rate for Payer: Wellcare Medicare Advantage	$15.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

T3 TOTAL

Facility

$667.59

Service Code	HCPCS 84480
Hospital Charge Code	3003712
Hospital Revenue Code	301
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$38.57
Rate for Payer: Aetna Medicare Advantage	$45.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
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	$51.19
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.18
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Medicare Advantage	$14.18
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

T3 TOTAL

Facility

$667.59

Service Code	HCPCS 84480
Hospital Charge Code	3003712
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

T3 (TRIIODOTHYRONINE)

Facility

$295.00

Service Code	HCPCS 84480
Hospital Charge Code	38472623
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

T3 (TRIIODOTHYRONINE)

Facility

$295.00

Service Code	HCPCS 84480
Hospital Charge Code	38472623
Hospital Revenue Code	301
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$38.57
Rate for Payer: Aetna Medicare Advantage	$45.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
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	$51.19
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: Cigna Medicare Advantage	$14.18
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Medicare Advantage	$14.18
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

Know your out-of-pocket cost for care.

All Charges