Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CUP M2A MAGNUM 54x48 US157854

Facility

$16,195.00

Hospital Charge Code	270635322
Hospital Revenue Code	278
Min. Negotiated Rate	$390.30
Max. Negotiated Rate	$8,097.50
Rate for Payer: Aetna Commercial	$6,154.10
Rate for Payer: Aetna Medicare Advantage	$4,858.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,129.73
Rate for Payer: Cigna Commercial	$8,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,562.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25
Rate for Payer: UnitedHealthcare Community & State	$390.30
Rate for Payer: Wellpoint Medicaid Managed Care	$429.17

CUP M2A MAGNUM 54x48 US157854

Facility

$16,195.00

Hospital Charge Code	270635322
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$3,919.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,562.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

CUP M2A MAGNUM PF 52x46mm

Facility

$18,555.00

Hospital Charge Code	270642989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.25
Max. Negotiated Rate	$4,490.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,082.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25

CUP M2A MAGNUM PF 52x46mm

Facility

$18,555.00

Hospital Charge Code	270642989
Hospital Revenue Code	278
Min. Negotiated Rate	$447.18
Max. Negotiated Rate	$9,277.50
Rate for Payer: Aetna Commercial	$7,050.90
Rate for Payer: Aetna Medicare Advantage	$5,566.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,731.52
Rate for Payer: Cigna Commercial	$9,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,082.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25
Rate for Payer: UnitedHealthcare Community & State	$447.18
Rate for Payer: Wellpoint Medicaid Managed Care	$491.71

CUP M2A MAGNUM PF 56mmX50mm

Facility

$16,065.50

Hospital Charge Code	270636167
Hospital Revenue Code	278
Min. Negotiated Rate	$387.18
Max. Negotiated Rate	$8,032.75
Rate for Payer: Aetna Commercial	$6,104.89
Rate for Payer: Aetna Medicare Advantage	$4,819.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,096.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,096.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,213.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,096.70
Rate for Payer: Cigna Commercial	$8,032.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,887.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,534.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.82
Rate for Payer: UnitedHealthcare Community & State	$387.18
Rate for Payer: Wellpoint Medicaid Managed Care	$425.74

CUP M2A MAGNUM PF 56mmX50mm

Facility

$16,065.50

Hospital Charge Code	270636167
Hospital Revenue Code	278
Min. Negotiated Rate	$2,409.82
Max. Negotiated Rate	$3,887.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,213.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,887.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,534.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.82

CUP M2A MAG PF 58x52 US157858

Facility

$6,110.00

Hospital Charge Code	270638449
Hospital Revenue Code	278
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$3,055.00
Rate for Payer: Aetna Commercial	$2,321.80
Rate for Payer: Aetna Medicare Advantage	$1,833.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,558.05
Rate for Payer: Cigna Commercial	$3,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,344.20
Rate for Payer: Qualcare PPO/HMO/WC	$916.50
Rate for Payer: UnitedHealthcare Community & State	$147.25
Rate for Payer: Wellpoint Medicaid Managed Care	$161.91

CUP M2A MAG PF 58x52 US157858

Facility

$6,110.00

Hospital Charge Code	270638449
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,344.20
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

CUP MEDICINE 1 OZ

Facility

$4.00

Hospital Charge Code	270300770
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CUP MEDICINE 1 OZ

Facility

$4.00

Hospital Charge Code	270300770
Hospital Revenue Code	270
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CUP MOD TM CLUS 48mm6202-48-22

Facility

$9,392.50

Hospital Charge Code	270635054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.88
Max. Negotiated Rate	$2,272.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.88

CUP MOD TM CLUS 48mm6202-48-22

Facility

$9,392.50

Hospital Charge Code	270635054
Hospital Revenue Code	278
Min. Negotiated Rate	$226.36
Max. Negotiated Rate	$4,696.25
Rate for Payer: Aetna Commercial	$3,569.15
Rate for Payer: Aetna Medicare Advantage	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.09
Rate for Payer: Cigna Commercial	$4,696.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.88
Rate for Payer: UnitedHealthcare Community & State	$226.36
Rate for Payer: Wellpoint Medicaid Managed Care	$248.90

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$107.37
Max. Negotiated Rate	$2,227.50
Rate for Payer: Aetna Commercial	$1,692.90
Rate for Payer: Aetna Medicare Advantage	$1,336.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.03
Rate for Payer: Cigna Commercial	$2,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$668.25
Rate for Payer: UnitedHealthcare Community & State	$107.37
Rate for Payer: Wellpoint Medicaid Managed Care	$118.06

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$668.25
Max. Negotiated Rate	$1,078.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$668.25

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$164.87

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

CUP MODU TM CLUS 48m 062024820

Facility

$12,377.80

Hospital Charge Code	270637224
Hospital Revenue Code	278
Min. Negotiated Rate	$298.30
Max. Negotiated Rate	$6,188.90
Rate for Payer: Aetna Commercial	$4,703.56
Rate for Payer: Aetna Medicare Advantage	$3,713.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,156.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,156.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,156.34
Rate for Payer: Cigna Commercial	$6,188.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,995.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,723.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.67
Rate for Payer: UnitedHealthcare Community & State	$298.30
Rate for Payer: Wellpoint Medicaid Managed Care	$328.01

CUP MODU TM CLUS 48m 062024820

Facility

$12,377.80

Hospital Charge Code	270637224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.67
Max. Negotiated Rate	$2,995.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,995.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,723.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.67

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

Know your out-of-pocket cost for care.

All Charges