Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	412311103
Hospital Revenue Code	361
Min. Negotiated Rate	$77.59
Max. Negotiated Rate	$77.59
Rate for Payer: Qualcare PPO/HMO/WC	$77.59

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	412311103
Hospital Revenue Code	361
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$155.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.90
Rate for Payer: Cigna Commercial	$258.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.18
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.59
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.71

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	395011103
Hospital Revenue Code	761
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$258.62
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$155.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.90
Rate for Payer: Cigna Commercial	$258.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.18
Rate for Payer: Oxford Commercial	$103.45
Rate for Payer: Qualcare PPO/HMO/WC	$77.59
Rate for Payer: UnitedHealthcare Commercial	$103.45
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.71

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	395011103
Hospital Revenue Code	761
Min. Negotiated Rate	$77.59
Max. Negotiated Rate	$77.59
Rate for Payer: Qualcare PPO/HMO/WC	$77.59

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	303511103
Hospital Revenue Code	510
Min. Negotiated Rate	$77.59
Max. Negotiated Rate	$77.59
Rate for Payer: Qualcare PPO/HMO/WC	$77.59

TANGENTIAL BX SKIN EA ADD LES

Facility

$517.25

Service Code	HCPCS 11103
Hospital Charge Code	303511103
Hospital Revenue Code	510
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$258.62
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$155.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.90
Rate for Payer: Cigna Commercial	$258.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.18
Rate for Payer: Qualcare PPO/HMO/WC	$77.59
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.71

TAP

Facility

$484.00

Hospital Charge Code	270335104
Hospital Revenue Code	272
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

TAP

Facility

$484.00

Hospital Charge Code	270335104
Hospital Revenue Code	272
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Oxford Commercial	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$96.80
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

TAP 2.7mm 2346-028

Facility

$249.00

Service Code	HCPCS C1713
Hospital Charge Code	270610165
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$94.62
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.78
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

TAP 2.7mm 2346-028

Facility

$249.00

Service Code	HCPCS C1713
Hospital Charge Code	270610165
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.78
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

TAP 3.5MM 18MM

Facility

$773.65

Hospital Charge Code	270697902
Hospital Revenue Code	272
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$386.82
Rate for Payer: Aetna Commercial	$293.99
Rate for Payer: Aetna Medicare Advantage	$232.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.28
Rate for Payer: Cigna Commercial	$386.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.09
Rate for Payer: Oxford Commercial	$154.73
Rate for Payer: Qualcare PPO/HMO/WC	$116.05
Rate for Payer: UnitedHealthcare Commercial	$154.73
Rate for Payer: UnitedHealthcare Community & State	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$20.50

TAP 3.5MM 18MM

Facility

$773.65

Hospital Charge Code	270697902
Hospital Revenue Code	272
Min. Negotiated Rate	$116.05
Max. Negotiated Rate	$116.05
Rate for Payer: Qualcare PPO/HMO/WC	$116.05

TAP 3.5mm CORTEX SCREWS

Facility

$491.30

Service Code	HCPCS C1713
Hospital Charge Code	270604141
Hospital Revenue Code	278
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$245.65
Rate for Payer: Aetna Commercial	$186.69
Rate for Payer: Aetna Medicare Advantage	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.28
Rate for Payer: Cigna Commercial	$245.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.09
Rate for Payer: Qualcare PPO/HMO/WC	$73.69
Rate for Payer: UnitedHealthcare Community & State	$11.84
Rate for Payer: Wellpoint Medicaid Managed Care	$13.02

TAP 3.5mm CORTEX SCREWS

Facility

$491.30

Service Code	HCPCS C1713
Hospital Charge Code	270604141
Hospital Revenue Code	278
Min. Negotiated Rate	$73.69
Max. Negotiated Rate	$118.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.09
Rate for Payer: Qualcare PPO/HMO/WC	$73.69

TAP 3.5 QUICK RELEASE PLATE

Facility

$970.00

Hospital Charge Code	270638091
Hospital Revenue Code	278
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$234.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$213.40
Rate for Payer: Qualcare PPO/HMO/WC	$145.50

TAP 3.5 QUICK RELEASE PLATE

Facility

$970.00

Hospital Charge Code	270638091
Hospital Revenue Code	278
Min. Negotiated Rate	$23.38
Max. Negotiated Rate	$485.00
Rate for Payer: Aetna Commercial	$368.60
Rate for Payer: Aetna Medicare Advantage	$291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.35
Rate for Payer: Cigna Commercial	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$213.40
Rate for Payer: Qualcare PPO/HMO/WC	$145.50
Rate for Payer: UnitedHealthcare Community & State	$23.38
Rate for Payer: Wellpoint Medicaid Managed Care	$25.70

TAP 3.5 X 45 FOR LOCKING SCREW

Facility

$500.00

Hospital Charge Code	270638100
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TAP 3.5 X 45 FOR LOCKING SCREW

Facility

$500.00

Hospital Charge Code	270638100
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

TAP 3MM 20-35MM

Facility

$1,895.00

Hospital Charge Code	270693360
Hospital Revenue Code	272
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.50
Rate for Payer: Oxford Commercial	$379.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$379.00
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$50.22

TAP 3MM 20-35MM

Facility

$1,895.00

Hospital Charge Code	270693360
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

TAP 4.0mm CANCELLOUS SCREW

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	270604464
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

TAP 4.0mm CANCELLOUS SCREW

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	270604464
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

TAP 4.0mm DISPOSABLE 702805

Facility

$855.00

Hospital Charge Code	270640259
Hospital Revenue Code	272
Min. Negotiated Rate	$128.25
Max. Negotiated Rate	$128.25
Rate for Payer: Qualcare PPO/HMO/WC	$128.25

TAP 4.0mm DISPOSABLE 702805

Facility

$855.00

Hospital Charge Code	270640259
Hospital Revenue Code	272
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$324.90
Rate for Payer: Aetna Medicare Advantage	$256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.03
Rate for Payer: Cigna Commercial	$427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.50
Rate for Payer: Oxford Commercial	$171.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.25
Rate for Payer: UnitedHealthcare Commercial	$171.00
Rate for Payer: UnitedHealthcare Community & State	$20.61
Rate for Payer: Wellpoint Medicaid Managed Care	$22.66

TAP 4 5MM CANNULATED

Facility

$1,000.00

Hospital Charge Code	270680219
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

Know your out-of-pocket cost for care.

All Charges