Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALEUTAIN 28X36MM 15DG LOR 19MM

Facility

$23,515.00

Hospital Charge Code	270670135
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 15DG LOR 19MM

Facility

$23,515.00

Hospital Charge Code	270670135
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 11MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670105
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 5DEG LOR 11MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670105
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 13MM

Facility

$23,515.00

Hospital Charge Code	270670114
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 5DEG LOR 13MM

Facility

$23,515.00

Hospital Charge Code	270670114
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 15MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670122
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 5DEG LOR 15MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670122
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 17MM

Facility

$23,515.00

Hospital Charge Code	270670130
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 17MM

Facility

$23,515.00

Hospital Charge Code	270670130
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 5DEG LOR 19MM

Facility

$23,515.00

Hospital Charge Code	270670137
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN 28X36MM 5DEG LOR 19MM

Facility

$23,515.00

Hospital Charge Code	270670137
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 9MM

Facility

$23,515.00

Hospital Charge Code	270670097
Hospital Revenue Code	278
Min. Negotiated Rate	$566.71
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$566.71
Rate for Payer: Wellpoint Medicaid Managed Care	$623.15

ALEUTAIN 28X36MM 5DEG LOR 9MM

Facility

$23,515.00

Hospital Charge Code	270670097
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,173.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEUTAIN CX 11X11MM CON 10MM

Facility

$6,535.00

Hospital Charge Code	270670143
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

ALEUTAIN CX 11X11MM CON 10MM

Facility

$6,535.00

Hospital Charge Code	270670143
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X11MM CON 6MM

Facility

$6,535.00

Hospital Charge Code	270670138
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X11MM CON 6MM

Facility

$6,535.00

Hospital Charge Code	270670138
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

ALEUTAIN CX 11X11MM CON 7MM

Facility

$6,535.00

Hospital Charge Code	270670139
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X11MM CON 7MM

Facility

$6,535.00

Hospital Charge Code	270670139
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

ALEUTAIN CX 11X11MM CON 8MM

Facility

$6,535.00

Hospital Charge Code	270670140
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

ALEUTAIN CX 11X11MM CON 8MM

Facility

$6,535.00

Hospital Charge Code	270670140
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X11MM CON 9MM

Facility

$6,535.00

Hospital Charge Code	270670141
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X11MM CON 9MM

Facility

$6,535.00

Hospital Charge Code	270670141
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

ALEUTAIN CX 11X11MM LOR 10MM

Facility

$6,535.00

Hospital Charge Code	270670144
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

Know your out-of-pocket cost for care.

All Charges