Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ELECTROSURCICAL PROBE W/HNDL**

Facility

$86.00

Hospital Charge Code	1607027
Hospital Revenue Code	272
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

ELECTROSURCICAL PROBE W/HNDL**

Facility

$86.00

Hospital Charge Code	1607027
Hospital Revenue Code	272
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$32.68
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.93
Rate for Payer: Cigna Commercial	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$17.20
Rate for Payer: UnitedHealthcare Community & State	$2.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	1008165
Hospital Revenue Code	430
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	1008165
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	1008170
Hospital Revenue Code	420
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	1008170
Hospital Revenue Code	420
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$78.28
Rate for Payer: Aetna Medicare Advantage	$61.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.46

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

ELECT VAP 24FR X 5MM 27050RG/6

Facility

$595.25

Hospital Charge Code	270618274
Hospital Revenue Code	272
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$297.62
Rate for Payer: Aetna Commercial	$226.19
Rate for Payer: Aetna Medicare Advantage	$178.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.79
Rate for Payer: Cigna Commercial	$297.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.57
Rate for Payer: Oxford Commercial	$119.05
Rate for Payer: Qualcare PPO/HMO/WC	$89.29
Rate for Payer: UnitedHealthcare Commercial	$119.05
Rate for Payer: UnitedHealthcare Community & State	$14.35
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

ELECT VAP 24FR X 5MM 27050RG/6

Facility

$595.25

Hospital Charge Code	270618274
Hospital Revenue Code	272
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$89.29
Rate for Payer: Qualcare PPO/HMO/WC	$89.29

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$304.14
Max. Negotiated Rate	$6,310.00
Rate for Payer: Aetna Commercial	$4,795.60
Rate for Payer: Aetna Medicare Advantage	$3,786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,218.10
Rate for Payer: Cigna Commercial	$6,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,776.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00
Rate for Payer: UnitedHealthcare Community & State	$304.14
Rate for Payer: Wellpoint Medicaid Managed Care	$334.43

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.00
Max. Negotiated Rate	$3,054.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,776.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00

Elevate Apical and posterior

Facility

$11,895.00

Hospital Charge Code	270666115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,784.25
Max. Negotiated Rate	$2,878.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,379.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,878.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,616.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,784.25

Elevate Apical and posterior

Facility

$11,895.00

Hospital Charge Code	270666115
Hospital Revenue Code	278
Min. Negotiated Rate	$286.67
Max. Negotiated Rate	$5,947.50
Rate for Payer: Aetna Commercial	$4,520.10
Rate for Payer: Aetna Medicare Advantage	$3,568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,033.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,033.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,379.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,033.22
Rate for Payer: Cigna Commercial	$5,947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,878.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,616.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,784.25
Rate for Payer: UnitedHealthcare Community & State	$286.67
Rate for Payer: Wellpoint Medicaid Managed Care	$315.22

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$114.94

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$383.15
Rate for Payer: Aetna Commercial	$291.19
Rate for Payer: Aetna Medicare Advantage	$229.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.41
Rate for Payer: Cigna Commercial	$383.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.89
Rate for Payer: Oxford Commercial	$153.26
Rate for Payer: Qualcare PPO/HMO/WC	$114.94
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: UnitedHealthcare Community & State	$18.47
Rate for Payer: Wellpoint Medicaid Managed Care	$20.31

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$339.34
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.90
Rate for Payer: Oxford Commercial	$178.60
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$339.34
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.90
Rate for Payer: Oxford Commercial	$178.60
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$544.74
Max. Negotiated Rate	$878.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$87.52
Max. Negotiated Rate	$878.85
Rate for Payer: Aetna Commercial	$479.26
Rate for Payer: Aetna Medicare Advantage	$570.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$636.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$636.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$176.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$636.03
Rate for Payer: Cigna Medicare Advantage	$176.20
Rate for Payer: Clover Medicare Advantage	$167.39
Rate for Payer: EmblemHealth Commercial	$528.60
Rate for Payer: Humana Medicare Advantage	$181.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$176.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74
Rate for Payer: UnitedHealthcare Community & State	$87.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.20
Rate for Payer: Wellcare Medicare Advantage	$176.20
Rate for Payer: Wellpoint Medicaid Managed Care	$96.24

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,942.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,765.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$3,049.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,765.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75
Rate for Payer: UnitedHealthcare Community & State	$193.40
Rate for Payer: Wellpoint Medicaid Managed Care	$212.66

ELITE COMPRESS IMPLANT 18X18X1

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges