Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COVER SNAP KAP DOME 26 DEPTH

Facility

$7.39

Hospital Charge Code	270667869
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

COVER SNAP KAP DOME 26 DEPTH

Facility

$7.39

Hospital Charge Code	270667869
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.69
Rate for Payer: Aetna Commercial	$2.81
Rate for Payer: Aetna Medicare Advantage	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.88
Rate for Payer: Cigna Commercial	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.22
Rate for Payer: Oxford Commercial	$1.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$1.48
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

COVER STENT VBX ENDOPRO 10X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683405N
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER STENT VBX ENDOPRO 10X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 10X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683405N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 10X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683405
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER STENT VBX ENDOPRO 8X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270679679
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 8X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270679679N
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER STENT VBX ENDOPRO 8X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270679679N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 8X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270679679
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER STENT VBX ENDOPRO 9X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683404
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 9X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683404N
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER STENT VBX ENDOPRO 9X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683404N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

COVER STENT VBX ENDOPRO 9X79

Facility

$18,295.00

Service Code	HCPCS C1874
Hospital Charge Code	270683404
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

COVER TABLE OEC E9100AL

Facility

$28.00

Hospital Charge Code	270625310
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

COVER TABLE OEC E9100AL

Facility

$28.00

Hospital Charge Code	270625310
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

COVER TIP MONOPOLAR CRVD SCISS

Facility

$100.00

Hospital Charge Code	270664000
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

COVER TIP MONOPOLAR CRVD SCISS

Facility

$100.00

Hospital Charge Code	270664000
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

COVER TRANDUCER NEOGUARD

Facility

$24.58

Hospital Charge Code	270663366
Hospital Revenue Code	270
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$3.69

COVER TRANDUCER NEOGUARD

Facility

$24.58

Hospital Charge Code	270663366
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.29
Rate for Payer: Aetna Commercial	$9.34
Rate for Payer: Aetna Medicare Advantage	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.27
Rate for Payer: Cigna Commercial	$12.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.37
Rate for Payer: Oxford Commercial	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.69
Rate for Payer: UnitedHealthcare Commercial	$4.92
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

COVER TRANSDUCER GEN PURPOSE

Facility

$52.00

Service Code	HCPCS E1575
Hospital Charge Code	2008155
Hospital Revenue Code	271
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

COVER TRANSDUCER GEN PURPOSE

Facility

$52.00

Service Code	HCPCS E1575
Hospital Charge Code	2008155
Hospital Revenue Code	271
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

COVER TRANSDUC INTRAOP 610367

Facility

$29.58

Hospital Charge Code	270626733
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.79
Rate for Payer: Aetna Commercial	$11.24
Rate for Payer: Aetna Medicare Advantage	$8.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.54
Rate for Payer: Cigna Commercial	$14.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.87
Rate for Payer: Oxford Commercial	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.44
Rate for Payer: UnitedHealthcare Commercial	$5.92
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

COVER TRANSDUC INTRAOP 610367

Facility

$29.58

Hospital Charge Code	270626733
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.44

COVER ULTRASOUND PROBE 63-0174

Facility

$8.85

Hospital Charge Code	270600434
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

Know your out-of-pocket cost for care.

All Charges