Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CUP VERSAFITCUP 46MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684248
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

CUP VERSAFITCUP 46MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684248
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

CUP WONDER-FLO FEEDING

Facility

$65.65

Hospital Charge Code	270300745
Hospital Revenue Code	270
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

CUP WONDER-FLO FEEDING

Facility

$65.65

Hospital Charge Code	270300745
Hospital Revenue Code	270
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$13.13
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

CUP ZIM BIPOL 28 50 5001-50-28

Facility

$1,589.70

Hospital Charge Code	270626237
Hospital Revenue Code	278
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$794.85
Rate for Payer: Aetna Commercial	$604.09
Rate for Payer: Aetna Medicare Advantage	$476.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$405.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$405.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$405.37
Rate for Payer: Cigna Commercial	$794.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$384.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$349.73
Rate for Payer: Qualcare PPO/HMO/WC	$238.46
Rate for Payer: UnitedHealthcare Community & State	$38.31
Rate for Payer: Wellpoint Medicaid Managed Care	$42.13

CUP ZIM BIPOL 28 50 5001-50-28

Facility

$1,589.70

Hospital Charge Code	270626237
Hospital Revenue Code	278
Min. Negotiated Rate	$238.46
Max. Negotiated Rate	$384.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$384.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$349.73
Rate for Payer: Qualcare PPO/HMO/WC	$238.46

CUP ZIM BIPOL 41MM 5000-41-22

Facility

$3,205.65

Hospital Charge Code	270601272
Hospital Revenue Code	278
Min. Negotiated Rate	$480.85
Max. Negotiated Rate	$775.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.24
Rate for Payer: Qualcare PPO/HMO/WC	$480.85

CUP ZIM BIPOL 41MM 5000-41-22

Facility

$3,205.65

Hospital Charge Code	270601272
Hospital Revenue Code	278
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$1,602.83
Rate for Payer: Aetna Commercial	$1,218.15
Rate for Payer: Aetna Medicare Advantage	$961.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$817.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$817.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$817.44
Rate for Payer: Cigna Commercial	$1,602.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.24
Rate for Payer: Qualcare PPO/HMO/WC	$480.85
Rate for Payer: UnitedHealthcare Community & State	$77.26
Rate for Payer: Wellpoint Medicaid Managed Care	$84.95

CUP ZIM BIPOL 42MM 5000-42-22

Facility

$3,029.65

Hospital Charge Code	270616590
Hospital Revenue Code	278
Min. Negotiated Rate	$73.01
Max. Negotiated Rate	$1,514.83
Rate for Payer: Aetna Commercial	$1,151.27
Rate for Payer: Aetna Medicare Advantage	$908.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$772.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$772.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$772.56
Rate for Payer: Cigna Commercial	$1,514.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$733.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$666.52
Rate for Payer: Qualcare PPO/HMO/WC	$454.45
Rate for Payer: UnitedHealthcare Community & State	$73.01
Rate for Payer: Wellpoint Medicaid Managed Care	$80.29

CUP ZIM BIPOL 42MM 5000-42-22

Facility

$3,029.65

Hospital Charge Code	270616590
Hospital Revenue Code	278
Min. Negotiated Rate	$454.45
Max. Negotiated Rate	$733.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$733.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$666.52
Rate for Payer: Qualcare PPO/HMO/WC	$454.45

CUP ZIM BIPOL 43MM 5000-43-22

Facility

$3,121.65

Hospital Charge Code	270609350
Hospital Revenue Code	278
Min. Negotiated Rate	$75.23
Max. Negotiated Rate	$1,560.83
Rate for Payer: Aetna Commercial	$1,186.23
Rate for Payer: Aetna Medicare Advantage	$936.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.02
Rate for Payer: Cigna Commercial	$1,560.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$686.76
Rate for Payer: Qualcare PPO/HMO/WC	$468.25
Rate for Payer: UnitedHealthcare Community & State	$75.23
Rate for Payer: Wellpoint Medicaid Managed Care	$82.72

CUP ZIM BIPOL 43MM 5000-43-22

Facility

$3,121.65

Hospital Charge Code	270609350
Hospital Revenue Code	278
Min. Negotiated Rate	$468.25
Max. Negotiated Rate	$755.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$686.76
Rate for Payer: Qualcare PPO/HMO/WC	$468.25

CUP ZIM BIPOL 44MM 5000-44-28

Facility

$3,121.65

Hospital Charge Code	270616916
Hospital Revenue Code	278
Min. Negotiated Rate	$75.23
Max. Negotiated Rate	$1,560.83
Rate for Payer: Aetna Commercial	$1,186.23
Rate for Payer: Aetna Medicare Advantage	$936.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.02
Rate for Payer: Cigna Commercial	$1,560.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$686.76
Rate for Payer: Qualcare PPO/HMO/WC	$468.25
Rate for Payer: UnitedHealthcare Community & State	$75.23
Rate for Payer: Wellpoint Medicaid Managed Care	$82.72

CUP ZIM BIPOL 44MM 5000-44-28

Facility

$3,121.65

Hospital Charge Code	270616916
Hospital Revenue Code	278
Min. Negotiated Rate	$468.25
Max. Negotiated Rate	$755.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$686.76
Rate for Payer: Qualcare PPO/HMO/WC	$468.25

CUP ZIM BIPOL 44MM 50004428***

Facility

$2,322.00

Hospital Charge Code	270606987
Hospital Revenue Code	274
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$1,161.00
Rate for Payer: Aetna Commercial	$882.36
Rate for Payer: Aetna Medicare Advantage	$696.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.11
Rate for Payer: Cigna Commercial	$1,161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.84
Rate for Payer: Qualcare PPO/HMO/WC	$348.30
Rate for Payer: UnitedHealthcare Community & State	$55.96
Rate for Payer: Wellpoint Medicaid Managed Care	$61.53

CUP ZIM BIPOL 44MM 50004428***

Facility

$2,322.00

Hospital Charge Code	270606987
Hospital Revenue Code	274
Min. Negotiated Rate	$348.30
Max. Negotiated Rate	$561.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.84
Rate for Payer: Qualcare PPO/HMO/WC	$348.30

CUP ZIM BIPOL 45MM 5000-45-28

Facility

$3,208.00

Hospital Charge Code	270607081
Hospital Revenue Code	278
Min. Negotiated Rate	$77.31
Max. Negotiated Rate	$1,604.00
Rate for Payer: Aetna Commercial	$1,219.04
Rate for Payer: Aetna Medicare Advantage	$962.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$818.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$818.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$818.04
Rate for Payer: Cigna Commercial	$1,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.76
Rate for Payer: Qualcare PPO/HMO/WC	$481.20
Rate for Payer: UnitedHealthcare Community & State	$77.31
Rate for Payer: Wellpoint Medicaid Managed Care	$85.01

CUP ZIM BIPOL 45MM 5000-45-28

Facility

$3,208.00

Hospital Charge Code	270607081
Hospital Revenue Code	278
Min. Negotiated Rate	$481.20
Max. Negotiated Rate	$776.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.76
Rate for Payer: Qualcare PPO/HMO/WC	$481.20

CUP ZIM BIPOL 45MM 5000-45-28

Facility

$3,369.65

Hospital Charge Code	270605858
Hospital Revenue Code	278
Min. Negotiated Rate	$81.21
Max. Negotiated Rate	$1,684.83
Rate for Payer: Aetna Commercial	$1,280.47
Rate for Payer: Aetna Medicare Advantage	$1,010.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$859.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$859.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$673.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$859.26
Rate for Payer: Cigna Commercial	$1,684.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$741.32
Rate for Payer: Qualcare PPO/HMO/WC	$505.45
Rate for Payer: UnitedHealthcare Community & State	$81.21
Rate for Payer: Wellpoint Medicaid Managed Care	$89.30

CUP ZIM BIPOL 45MM 5000-45-28

Facility

$3,369.65

Hospital Charge Code	270605858
Hospital Revenue Code	278
Min. Negotiated Rate	$505.45
Max. Negotiated Rate	$815.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$673.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$741.32
Rate for Payer: Qualcare PPO/HMO/WC	$505.45

CUP ZIM BIPOL 46MM 5000-46

Facility

$2,706.20

Hospital Charge Code	270628127
Hospital Revenue Code	278
Min. Negotiated Rate	$65.22
Max. Negotiated Rate	$1,353.10
Rate for Payer: Aetna Commercial	$1,028.36
Rate for Payer: Aetna Medicare Advantage	$811.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$690.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$690.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$690.08
Rate for Payer: Cigna Commercial	$1,353.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.36
Rate for Payer: Qualcare PPO/HMO/WC	$405.93
Rate for Payer: UnitedHealthcare Community & State	$65.22
Rate for Payer: Wellpoint Medicaid Managed Care	$71.71

CUP ZIM BIPOL 46MM 5000-46

Facility

$2,706.20

Hospital Charge Code	270628127
Hospital Revenue Code	278
Min. Negotiated Rate	$405.93
Max. Negotiated Rate	$654.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.36
Rate for Payer: Qualcare PPO/HMO/WC	$405.93

CUP ZIM BIPOL 46MM 5000-46-28

Facility

$3,031.25

Hospital Charge Code	270601274
Hospital Revenue Code	278
Min. Negotiated Rate	$454.69
Max. Negotiated Rate	$733.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$606.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$733.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$666.88
Rate for Payer: Qualcare PPO/HMO/WC	$454.69

CUP ZIM BIPOL 46MM 5000-46-28

Facility

$3,031.25

Hospital Charge Code	270601274
Hospital Revenue Code	278
Min. Negotiated Rate	$73.05
Max. Negotiated Rate	$1,515.62
Rate for Payer: Aetna Commercial	$1,151.88
Rate for Payer: Aetna Medicare Advantage	$909.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$772.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$772.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$606.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$772.97
Rate for Payer: Cigna Commercial	$1,515.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$733.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$666.88
Rate for Payer: Qualcare PPO/HMO/WC	$454.69
Rate for Payer: UnitedHealthcare Community & State	$73.05
Rate for Payer: Wellpoint Medicaid Managed Care	$80.33

CUP ZIM BIPOL 47MM 5000-47-28

Facility

$3,067.25

Hospital Charge Code	270605478
Hospital Revenue Code	278
Min. Negotiated Rate	$460.09
Max. Negotiated Rate	$742.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$613.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$674.79
Rate for Payer: Qualcare PPO/HMO/WC	$460.09

Know your out-of-pocket cost for care.

All Charges