Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

X LONG ANGLED ATTACHMENT

Facility

$8,106.10

Hospital Charge Code	270657079
Hospital Revenue Code	278
Min. Negotiated Rate	$195.36
Max. Negotiated Rate	$4,053.05
Rate for Payer: Aetna Commercial	$3,080.32
Rate for Payer: Aetna Medicare Advantage	$2,431.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,067.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,067.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,621.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,067.06
Rate for Payer: Cigna Commercial	$4,053.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,961.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,783.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.91
Rate for Payer: UnitedHealthcare Community & State	$195.36
Rate for Payer: Wellpoint Medicaid Managed Care	$214.81

X LONG ANGLED ATTACHMENT

Facility

$8,106.10

Hospital Charge Code	270657079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.91
Max. Negotiated Rate	$1,961.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,621.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,961.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,783.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.91

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$319.32
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Community & State	$319.32
Rate for Payer: Wellpoint Medicaid Managed Care	$351.12

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
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	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

XOMED TUBING

Facility

$87.00

Hospital Charge Code	270335206
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.10
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

XOMED TUBING

Facility

$87.00

Hospital Charge Code	270335206
Hospital Revenue Code	272
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

XOPENEX HFA INH 15GM

Facility

$221.00

Hospital Charge Code	60635541
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$44.20
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

XOPENEX HFA INH 15GM

Facility

$221.00

Hospital Charge Code	60635541
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

XPAC TLIF 10X28MM PARALELL

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704189
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

XPAC TLIF 10X28MM PARALELL

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704189
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

XPANDER 10/3 1ST FRACTURE

Facility

$19,625.00

Hospital Charge Code	270638554C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,943.75
Max. Negotiated Rate	$2,943.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75

XPANDER 10/3 1ST FRACTURE

Facility

$19,625.00

Hospital Charge Code	270638554C
Hospital Revenue Code	272
Min. Negotiated Rate	$472.96
Max. Negotiated Rate	$9,812.50
Rate for Payer: Aetna Commercial	$7,457.50
Rate for Payer: Aetna Medicare Advantage	$5,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,004.38
Rate for Payer: Cigna Commercial	$9,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,887.50
Rate for Payer: Oxford Commercial	$3,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75
Rate for Payer: UnitedHealthcare Commercial	$3,925.00
Rate for Payer: UnitedHealthcare Community & State	$472.96
Rate for Payer: Wellpoint Medicaid Managed Care	$520.06

XPANDER 15/3 1ST FRAC KPT1503

Facility

$19,625.00

Hospital Charge Code	270635272
Hospital Revenue Code	272
Min. Negotiated Rate	$472.96
Max. Negotiated Rate	$9,812.50
Rate for Payer: Aetna Commercial	$7,457.50
Rate for Payer: Aetna Medicare Advantage	$5,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,004.38
Rate for Payer: Cigna Commercial	$9,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,887.50
Rate for Payer: Oxford Commercial	$3,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75
Rate for Payer: UnitedHealthcare Commercial	$3,925.00
Rate for Payer: UnitedHealthcare Community & State	$472.96
Rate for Payer: Wellpoint Medicaid Managed Care	$520.06

XPANDER 15/3 1ST FRAC KPT1503

Facility

$19,625.00

Hospital Charge Code	270635272
Hospital Revenue Code	272
Min. Negotiated Rate	$2,943.75
Max. Negotiated Rate	$2,943.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75

XPANDER 15/3 1ST FRAC KPT1503

Facility

$19,625.00

Hospital Charge Code	270635272V
Hospital Revenue Code	272
Min. Negotiated Rate	$472.96
Max. Negotiated Rate	$9,812.50
Rate for Payer: Aetna Commercial	$7,457.50
Rate for Payer: Aetna Medicare Advantage	$5,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,004.38
Rate for Payer: Cigna Commercial	$9,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,887.50
Rate for Payer: Oxford Commercial	$3,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75
Rate for Payer: UnitedHealthcare Commercial	$3,925.00
Rate for Payer: UnitedHealthcare Community & State	$472.96
Rate for Payer: Wellpoint Medicaid Managed Care	$520.06

XPANDER 15/3 1ST FRAC KPT1503

Facility

$19,625.00

Hospital Charge Code	270635272V
Hospital Revenue Code	272
Min. Negotiated Rate	$2,943.75
Max. Negotiated Rate	$2,943.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75

XPANDER 15/3 FIR FRAC KPT1505

Facility

$21,842.70

Hospital Charge Code	270636258
Hospital Revenue Code	272
Min. Negotiated Rate	$3,276.41
Max. Negotiated Rate	$3,276.41
Rate for Payer: Qualcare PPO/HMO/WC	$3,276.41

XPANDER 15/3 FIR FRAC KPT1505

Facility

$21,842.70

Hospital Charge Code	270636258
Hospital Revenue Code	272
Min. Negotiated Rate	$526.41
Max. Negotiated Rate	$10,921.35
Rate for Payer: Aetna Commercial	$8,300.23
Rate for Payer: Aetna Medicare Advantage	$6,552.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,569.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,569.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,569.89
Rate for Payer: Cigna Commercial	$10,921.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,552.81
Rate for Payer: Oxford Commercial	$4,368.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,276.41
Rate for Payer: UnitedHealthcare Commercial	$4,368.54
Rate for Payer: UnitedHealthcare Community & State	$526.41
Rate for Payer: Wellpoint Medicaid Managed Care	$578.83

XPANDER20/3 IST FRCR W/KPT2002

Facility

$17,985.00

Hospital Charge Code	270630734
Hospital Revenue Code	272
Min. Negotiated Rate	$433.44
Max. Negotiated Rate	$8,992.50
Rate for Payer: Aetna Commercial	$6,834.30
Rate for Payer: Aetna Medicare Advantage	$5,395.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,586.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,586.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,586.18
Rate for Payer: Cigna Commercial	$8,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,395.50
Rate for Payer: Oxford Commercial	$3,597.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,697.75
Rate for Payer: UnitedHealthcare Commercial	$3,597.00
Rate for Payer: UnitedHealthcare Community & State	$433.44
Rate for Payer: Wellpoint Medicaid Managed Care	$476.60

XPANDER20/3 IST FRCR W/KPT2002

Facility

$17,985.00

Hospital Charge Code	270630734
Hospital Revenue Code	272
Min. Negotiated Rate	$2,697.75
Max. Negotiated Rate	$2,697.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,697.75

XPANDER FRST FRAC 10/3 KPT1003

Facility

$19,625.00

Hospital Charge Code	270638554V
Hospital Revenue Code	272
Min. Negotiated Rate	$472.96
Max. Negotiated Rate	$9,812.50
Rate for Payer: Aetna Commercial	$7,457.50
Rate for Payer: Aetna Medicare Advantage	$5,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,004.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,004.38
Rate for Payer: Cigna Commercial	$9,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,887.50
Rate for Payer: Oxford Commercial	$3,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75
Rate for Payer: UnitedHealthcare Commercial	$3,925.00
Rate for Payer: UnitedHealthcare Community & State	$472.96
Rate for Payer: Wellpoint Medicaid Managed Care	$520.06

XPANDER FRST FRAC 10/3 KPT1003

Facility

$19,625.00

Hospital Charge Code	270638554V
Hospital Revenue Code	272
Min. Negotiated Rate	$2,943.75
Max. Negotiated Rate	$2,943.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,943.75

XP EXPANDABLE LUMBAR INTERBODY

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270704667
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

Know your out-of-pocket cost for care.

All Charges