Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

T.L.S.O. BRACE CUSTOM

Facility

$4,798.45

Hospital Charge Code	270610014
Hospital Revenue Code	274
Min. Negotiated Rate	$719.77
Max. Negotiated Rate	$1,161.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.66
Rate for Payer: Qualcare PPO/HMO/WC	$719.77

T.L.S.O. BRACE CUSTOM

Facility

$4,798.45

Hospital Charge Code	270610014
Hospital Revenue Code	274
Min. Negotiated Rate	$115.64
Max. Negotiated Rate	$2,399.22
Rate for Payer: Aetna Commercial	$1,823.41
Rate for Payer: Aetna Medicare Advantage	$1,439.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.60
Rate for Payer: Cigna Commercial	$2,399.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.66
Rate for Payer: Qualcare PPO/HMO/WC	$719.77
Rate for Payer: UnitedHealthcare Community & State	$115.64
Rate for Payer: Wellpoint Medicaid Managed Care	$127.16

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$1,358.42
Max. Negotiated Rate	$2,191.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,992.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$218.25
Max. Negotiated Rate	$4,528.07
Rate for Payer: Aetna Commercial	$3,441.34
Rate for Payer: Aetna Medicare Advantage	$2,716.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,309.32
Rate for Payer: Cigna Commercial	$4,528.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,992.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42
Rate for Payer: UnitedHealthcare Community & State	$218.25
Rate for Payer: Wellpoint Medicaid Managed Care	$239.99

T.L.S.O. BRACE (OFF THE SHELF)

Facility

$3,981.65

Hospital Charge Code	270612938
Hospital Revenue Code	274
Min. Negotiated Rate	$95.96
Max. Negotiated Rate	$1,990.83
Rate for Payer: Aetna Commercial	$1,513.03
Rate for Payer: Aetna Medicare Advantage	$1,194.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,015.32
Rate for Payer: Cigna Commercial	$1,990.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$875.96
Rate for Payer: Qualcare PPO/HMO/WC	$597.25
Rate for Payer: UnitedHealthcare Community & State	$95.96
Rate for Payer: Wellpoint Medicaid Managed Care	$105.51

T.L.S.O. BRACE (OFF THE SHELF)

Facility

$3,981.65

Hospital Charge Code	270612938
Hospital Revenue Code	274
Min. Negotiated Rate	$597.25
Max. Negotiated Rate	$963.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$875.96
Rate for Payer: Qualcare PPO/HMO/WC	$597.25

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

TMJ - LT

Facility

$204.00

Hospital Charge Code	2009220
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

TMJ - LT

Facility

$204.00

Hospital Charge Code	2009220
Hospital Revenue Code	320
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

TMJ - RT

Facility

$204.00

Hospital Charge Code	2009225
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

TMJ - RT

Facility

$204.00

Hospital Charge Code	2009225
Hospital Revenue Code	320
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$3,291.05
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10
Rate for Payer: UnitedHealthcare Community & State	$208.72
Rate for Payer: Wellpoint Medicaid Managed Care	$229.51

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$516.46
Max. Negotiated Rate	$10,715.00
Rate for Payer: Aetna Commercial	$8,143.40
Rate for Payer: Aetna Medicare Advantage	$6,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.65
Rate for Payer: Cigna Commercial	$10,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,714.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50
Rate for Payer: UnitedHealthcare Community & State	$516.46
Rate for Payer: Wellpoint Medicaid Managed Care	$567.89

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$5,186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,714.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$372.64
Rate for Payer: Aetna Medicare Advantage	$443.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.53
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$137.00
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$109.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Medicare Advantage	$137.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
Hospital Revenue Code	360
Min. Negotiated Rate	$469.18
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,840.37
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$469.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$515.90

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$141.11
Max. Negotiated Rate	$2,927.50
Rate for Payer: Aetna Commercial	$2,224.90
Rate for Payer: Aetna Medicare Advantage	$1,756.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.03
Rate for Payer: Cigna Commercial	$2,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.10
Rate for Payer: Qualcare PPO/HMO/WC	$878.25
Rate for Payer: UnitedHealthcare Community & State	$141.11
Rate for Payer: Wellpoint Medicaid Managed Care	$155.16

Know your out-of-pocket cost for care.

All Charges