Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CUP TM MDLR 52mm CLSTR62025222

Facility

$12,308.65

Hospital Charge Code	270635416
Hospital Revenue Code	278
Min. Negotiated Rate	$296.64
Max. Negotiated Rate	$6,154.32
Rate for Payer: Aetna Commercial	$4,677.29
Rate for Payer: Aetna Medicare Advantage	$3,692.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,138.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,138.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,461.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,138.71
Rate for Payer: Cigna Commercial	$6,154.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,978.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,846.30
Rate for Payer: UnitedHealthcare Community & State	$296.64
Rate for Payer: Wellpoint Medicaid Managed Care	$326.18

CUP TM MDLR 52mm CLSTR62025222

Facility

$12,308.65

Hospital Charge Code	270635416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,846.30
Max. Negotiated Rate	$2,978.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,461.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,978.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,846.30

CUP TM MOD 50m CLUS 6202-50-22

Facility

$9,392.50

Hospital Charge Code	270636149
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 TM MOD 50m CLUS 6202-50-22

Facility

$9,392.50

Hospital Charge Code	270636149
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 TM MOD 54 MULTI 62025420

Facility

$11,901.75

Service Code	HCPCS C1776
Hospital Charge Code	270637123
Hospital Revenue Code	278
Min. Negotiated Rate	$286.83
Max. Negotiated Rate	$5,950.88
Rate for Payer: Aetna Commercial	$4,522.66
Rate for Payer: Aetna Medicare Advantage	$3,570.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,034.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,034.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,380.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,034.95
Rate for Payer: Cigna Commercial	$5,950.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,880.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,618.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,785.26
Rate for Payer: UnitedHealthcare Community & State	$286.83
Rate for Payer: Wellpoint Medicaid Managed Care	$315.40

CUP TM MOD 54 MULTI 62025420

Facility

$11,901.75

Service Code	HCPCS C1776
Hospital Charge Code	270637123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.26
Max. Negotiated Rate	$2,880.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,380.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,880.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,618.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,785.26

CUP TM MOD 58m CLUST 620205822

Facility

$10,240.80

Hospital Charge Code	270638658
Hospital Revenue Code	278
Min. Negotiated Rate	$1,536.12
Max. Negotiated Rate	$2,478.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,048.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,478.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.12

CUP TM MOD 58m CLUST 620205822

Facility

$10,240.80

Hospital Charge Code	270638658
Hospital Revenue Code	278
Min. Negotiated Rate	$246.80
Max. Negotiated Rate	$5,120.40
Rate for Payer: Aetna Commercial	$3,891.50
Rate for Payer: Aetna Medicare Advantage	$3,072.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,611.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,611.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,048.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,611.40
Rate for Payer: Cigna Commercial	$5,120.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,478.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.12
Rate for Payer: UnitedHealthcare Community & State	$246.80
Rate for Payer: Wellpoint Medicaid Managed Care	$271.38

CUP TM MODUAR 54 CLSR 62025422

Facility

$9,846.90

Hospital Charge Code	270634658
Hospital Revenue Code	278
Min. Negotiated Rate	$1,477.04
Max. Negotiated Rate	$2,382.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,969.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,382.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,166.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,477.04

CUP TM MODUAR 54 CLSR 62025422

Facility

$9,846.90

Hospital Charge Code	270634658
Hospital Revenue Code	278
Min. Negotiated Rate	$237.31
Max. Negotiated Rate	$4,923.45
Rate for Payer: Aetna Commercial	$3,741.82
Rate for Payer: Aetna Medicare Advantage	$2,954.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,510.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,510.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,969.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,510.96
Rate for Payer: Cigna Commercial	$4,923.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,382.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,166.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,477.04
Rate for Payer: UnitedHealthcare Community & State	$237.31
Rate for Payer: Wellpoint Medicaid Managed Care	$260.94

CUP TM MODULAR 46mm 6202-46-22

Facility

$9,392.45

Hospital Charge Code	270635648
Hospital Revenue Code	278
Min. Negotiated Rate	$226.36
Max. Negotiated Rate	$4,696.23
Rate for Payer: Aetna Commercial	$3,569.13
Rate for Payer: Aetna Medicare Advantage	$2,817.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.07
Rate for Payer: Cigna Commercial	$4,696.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.87
Rate for Payer: UnitedHealthcare Community & State	$226.36
Rate for Payer: Wellpoint Medicaid Managed Care	$248.90

CUP TM MODULAR 46mm 6202-46-22

Facility

$9,392.45

Hospital Charge Code	270635648
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.87
Max. Negotiated Rate	$2,272.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.87

CUP TM MODULAR 48MM MULTI-

Facility

$8,660.00

Hospital Charge Code	270663509
Hospital Revenue Code	278
Min. Negotiated Rate	$208.71
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$208.71
Rate for Payer: Wellpoint Medicaid Managed Care	$229.49

CUP TM MODULAR 48MM MULTI-

Facility

$8,660.00

Hospital Charge Code	270663509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

CUP TRILOCK HIP 44MM SP

Facility

$4,750.00

Hospital Charge Code	270655469
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 TRILOCK HIP 44MM SP

Facility

$4,750.00

Hospital Charge Code	270655469
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 TRILOCK HIP 46MM SP

Facility

$4,750.00

Hospital Charge Code	270655470
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 TRILOCK HIP 46MM SP

Facility

$4,750.00

Hospital Charge Code	270655470
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 TRILOCK HIP 48MM SP

Facility

$4,750.00

Hospital Charge Code	270655471
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 TRILOCK HIP 48MM SP

Facility

$4,750.00

Hospital Charge Code	270655471
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 TRILOCK HIP 50MM SP

Facility

$4,750.00

Hospital Charge Code	270655473
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 TRILOCK HIP 50MM SP

Facility

$4,750.00

Hospital Charge Code	270655473
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 TRILOCK HIP 52MM SP

Facility

$4,750.00

Hospital Charge Code	270655474
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 TRILOCK HIP 52MM SP

Facility

$4,750.00

Hospital Charge Code	270655474
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 TRILOCK HIP 54MM SP

Facility

$4,750.00

Hospital Charge Code	270655476
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

Know your out-of-pocket cost for care.

All Charges