Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COVER BURR TI LP MATRIX 12MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698158
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

COVER BURR TI LP MATRIX 12MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698158
Hospital Revenue Code	278
Min. Negotiated Rate	$55.43
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$55.43
Rate for Payer: Wellpoint Medicaid Managed Care	$60.95

COVER CLAMP STER WHITE 2/10X5

Facility

$9.48

Hospital Charge Code	270656636
Hospital Revenue Code	270
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.42

COVER CLAMP STER WHITE 2/10X5

Facility

$9.48

Hospital Charge Code	270656636
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.74
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.42
Rate for Payer: Cigna Commercial	$4.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.84
Rate for Payer: Oxford Commercial	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.42
Rate for Payer: UnitedHealthcare Commercial	$1.90
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

COVER CLMP BLU STER 4860061013

Facility

$5.00

Hospital Charge Code	270634413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

COVER CLMP BLU STER 4860061013

Facility

$5.00

Hospital Charge Code	270634413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

COVER CM TRANSDUC 14 61 610002

Facility

$59.25

Hospital Charge Code	270624204
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$8.89
Rate for Payer: Qualcare PPO/HMO/WC	$8.89

COVER CM TRANSDUC 14 61 610002

Facility

$59.25

Hospital Charge Code	270624204
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$29.62
Rate for Payer: Aetna Commercial	$22.52
Rate for Payer: Aetna Medicare Advantage	$17.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.11
Rate for Payer: Cigna Commercial	$29.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.77
Rate for Payer: Oxford Commercial	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.89
Rate for Payer: UnitedHealthcare Commercial	$11.85
Rate for Payer: UnitedHealthcare Community & State	$1.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1.57

COVER FOAM 12

Facility

$25.00

Hospital Charge Code	270672154
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

COVER FOAM 12

Facility

$25.00

Hospital Charge Code	270672154
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

COVER FOAM 14

Facility

$28.75

Hospital Charge Code	270672156
Hospital Revenue Code	272
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

COVER FOAM 14

Facility

$28.75

Hospital Charge Code	270672156
Hospital Revenue Code	272
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.38
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.33
Rate for Payer: Cigna Commercial	$14.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.62
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.31
Rate for Payer: UnitedHealthcare Commercial	$5.75
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

COVER FOAM 8

Facility

$21.25

Hospital Charge Code	270672153
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.62
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.38
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

COVER FOAM 8

Facility

$21.25

Hospital Charge Code	270672153
Hospital Revenue Code	272
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

COVER HYPOTHERMIA 30x60 351F

Facility

$50.45

Hospital Charge Code	270080050
Hospital Revenue Code	272
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

COVER HYPOTHERMIA 30x60 351F

Facility

$50.45

Hospital Charge Code	270080050
Hospital Revenue Code	272
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.13
Rate for Payer: Oxford Commercial	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

COVER KAPS STERILE 18 DEPTH

Facility

$250.75

Hospital Charge Code	270662662
Hospital Revenue Code	270
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$125.38
Rate for Payer: Aetna Commercial	$95.28
Rate for Payer: Aetna Medicare Advantage	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.94
Rate for Payer: Cigna Commercial	$125.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.22
Rate for Payer: Oxford Commercial	$50.15
Rate for Payer: Qualcare PPO/HMO/WC	$37.61
Rate for Payer: UnitedHealthcare Commercial	$50.15
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$6.64

COVER KAPS STERILE 18 DEPTH

Facility

$250.75

Hospital Charge Code	270662662
Hospital Revenue Code	270
Min. Negotiated Rate	$37.61
Max. Negotiated Rate	$37.61
Rate for Payer: Qualcare PPO/HMO/WC	$37.61

COVER LATERAL PLATE LOCKING 14

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693156
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

COVER LATERAL PLATE LOCKING 14

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693156
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

COVER LIGHT HANDLE STRL

Facility

$874.15

Hospital Charge Code	270665025
Hospital Revenue Code	270
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$437.07
Rate for Payer: Aetna Commercial	$332.18
Rate for Payer: Aetna Medicare Advantage	$262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.91
Rate for Payer: Cigna Commercial	$437.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.25
Rate for Payer: Oxford Commercial	$174.83
Rate for Payer: Qualcare PPO/HMO/WC	$131.12
Rate for Payer: UnitedHealthcare Commercial	$174.83
Rate for Payer: UnitedHealthcare Community & State	$21.07
Rate for Payer: Wellpoint Medicaid Managed Care	$23.16

COVER LIGHT HANDLE STRL

Facility

$874.15

Hospital Charge Code	270665025
Hospital Revenue Code	270
Min. Negotiated Rate	$131.12
Max. Negotiated Rate	$131.12
Rate for Payer: Qualcare PPO/HMO/WC	$131.12

COVER LITE OPER RM DISP 3/PK

Facility

$19.25

Hospital Charge Code	270608053
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

COVER LITE OPER RM DISP 3/PK

Facility

$19.25

Hospital Charge Code	270608053
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

COVER LITE SHIELD UNIVERSAL

Facility

$4.06

Hospital Charge Code	270649599
Hospital Revenue Code	270
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

Know your out-of-pocket cost for care.

All Charges