Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ENDCAP SYN SPIR BLDE 457.010S

Facility

$907.25

Hospital Charge Code	270611968
Hospital Revenue Code	278
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$453.62
Rate for Payer: Aetna Commercial	$344.75
Rate for Payer: Aetna Medicare Advantage	$272.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.35
Rate for Payer: Cigna Commercial	$453.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.59
Rate for Payer: Qualcare PPO/HMO/WC	$136.09
Rate for Payer: UnitedHealthcare Community & State	$21.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

END CAP T2 10MM 182200108

Facility

$910.00

Hospital Charge Code	270639018
Hospital Revenue Code	272
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$345.80
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$182.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.50
Rate for Payer: UnitedHealthcare Commercial	$182.00
Rate for Payer: UnitedHealthcare Community & State	$21.93
Rate for Payer: Wellpoint Medicaid Managed Care	$24.11

END CAP T2 10MM 182200108

Facility

$910.00

Hospital Charge Code	270639018
Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$136.50
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

ENDCAP T25 STAR DRIVE

Facility

$828.00

Hospital Charge Code	270662829
Hospital Revenue Code	278
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$200.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$182.16
Rate for Payer: Qualcare PPO/HMO/WC	$124.20

ENDCAP T25 STAR DRIVE

Facility

$828.00

Hospital Charge Code	270662829
Hospital Revenue Code	278
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna Commercial	$314.64
Rate for Payer: Aetna Medicare Advantage	$248.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.14
Rate for Payer: Cigna Commercial	$414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$182.16
Rate for Payer: Qualcare PPO/HMO/WC	$124.20
Rate for Payer: UnitedHealthcare Community & State	$19.95
Rate for Payer: Wellpoint Medicaid Managed Care	$21.94

END CAP T2 PROX, 6MM

Facility

$1,460.00

Hospital Charge Code	270671183
Hospital Revenue Code	278
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$353.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$321.20
Rate for Payer: Qualcare PPO/HMO/WC	$219.00

END CAP T2 PROX, 6MM

Facility

$1,460.00

Hospital Charge Code	270671183
Hospital Revenue Code	278
Min. Negotiated Rate	$35.19
Max. Negotiated Rate	$730.00
Rate for Payer: Aetna Commercial	$554.80
Rate for Payer: Aetna Medicare Advantage	$438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.30
Rate for Payer: Cigna Commercial	$730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$321.20
Rate for Payer: Qualcare PPO/HMO/WC	$219.00
Rate for Payer: UnitedHealthcare Community & State	$35.19
Rate for Payer: Wellpoint Medicaid Managed Care	$38.69

ENDCAP T40 STRDRV 0MM GRAY ST

Facility

$905.35

Hospital Charge Code	270677570
Hospital Revenue Code	278
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$452.68
Rate for Payer: Aetna Commercial	$344.03
Rate for Payer: Aetna Medicare Advantage	$271.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.86
Rate for Payer: Cigna Commercial	$452.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.18
Rate for Payer: Qualcare PPO/HMO/WC	$135.80
Rate for Payer: UnitedHealthcare Community & State	$21.82
Rate for Payer: Wellpoint Medicaid Managed Care	$23.99

ENDCAP T40 STRDRV 0MM GRAY ST

Facility

$905.35

Hospital Charge Code	270677570
Hospital Revenue Code	278
Min. Negotiated Rate	$135.80
Max. Negotiated Rate	$219.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.18
Rate for Payer: Qualcare PPO/HMO/WC	$135.80

ENDCAP T40 STRDRV 0MM TIBIA ST

Facility

$905.35

Service Code	HCPCS C1713
Hospital Charge Code	270669791
Hospital Revenue Code	278
Min. Negotiated Rate	$135.80
Max. Negotiated Rate	$219.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.18
Rate for Payer: Qualcare PPO/HMO/WC	$135.80

ENDCAP T40 STRDRV 0MM TIBIA ST

Facility

$905.35

Service Code	HCPCS C1713
Hospital Charge Code	270669791
Hospital Revenue Code	278
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$452.68
Rate for Payer: Aetna Commercial	$344.03
Rate for Payer: Aetna Medicare Advantage	$271.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.86
Rate for Payer: Cigna Commercial	$452.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.18
Rate for Payer: Qualcare PPO/HMO/WC	$135.80
Rate for Payer: UnitedHealthcare Community & State	$21.82
Rate for Payer: Wellpoint Medicaid Managed Care	$23.99

ENDCAP TI MULTILOC 0MM

Facility

$911.55

Hospital Charge Code	270650156
Hospital Revenue Code	272
Min. Negotiated Rate	$136.73
Max. Negotiated Rate	$136.73
Rate for Payer: Qualcare PPO/HMO/WC	$136.73

ENDCAP TI MULTILOC 0MM

Facility

$911.55

Hospital Charge Code	270650156
Hospital Revenue Code	272
Min. Negotiated Rate	$21.97
Max. Negotiated Rate	$455.77
Rate for Payer: Aetna Commercial	$346.39
Rate for Payer: Aetna Medicare Advantage	$273.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.45
Rate for Payer: Cigna Commercial	$455.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.46
Rate for Payer: Oxford Commercial	$182.31
Rate for Payer: Qualcare PPO/HMO/WC	$136.73
Rate for Payer: UnitedHealthcare Commercial	$182.31
Rate for Payer: UnitedHealthcare Community & State	$21.97
Rate for Payer: Wellpoint Medicaid Managed Care	$24.16

END CAP TI T40

Facility

$1,212.65

Service Code	HCPCS C1713
Hospital Charge Code	270691607
Hospital Revenue Code	278
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$293.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$266.78
Rate for Payer: Qualcare PPO/HMO/WC	$181.90

END CAP TI T40

Facility

$1,212.65

Service Code	HCPCS C1713
Hospital Charge Code	270691607
Hospital Revenue Code	278
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$606.33
Rate for Payer: Aetna Commercial	$460.81
Rate for Payer: Aetna Medicare Advantage	$363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.23
Rate for Payer: Cigna Commercial	$606.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$266.78
Rate for Payer: Qualcare PPO/HMO/WC	$181.90
Rate for Payer: UnitedHealthcare Community & State	$29.22
Rate for Payer: Wellpoint Medicaid Managed Care	$32.14

END CAP TI T40 STARDRIVE

Facility

$879.00

Service Code	HCPCS C1713
Hospital Charge Code	270671812
Hospital Revenue Code	278
Min. Negotiated Rate	$131.85
Max. Negotiated Rate	$212.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.38
Rate for Payer: Qualcare PPO/HMO/WC	$131.85

END CAP TI T40 STARDRIVE

Facility

$879.00

Service Code	HCPCS C1713
Hospital Charge Code	270671812
Hospital Revenue Code	278
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$439.50
Rate for Payer: Aetna Commercial	$334.02
Rate for Payer: Aetna Medicare Advantage	$263.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.15
Rate for Payer: Cigna Commercial	$439.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.38
Rate for Payer: Qualcare PPO/HMO/WC	$131.85
Rate for Payer: UnitedHealthcare Community & State	$21.18
Rate for Payer: Wellpoint Medicaid Managed Care	$23.29

END CAP TI W T25 SD FOR NAIL

Facility

$1,106.15

Service Code	HCPCS C1713
Hospital Charge Code	270693261
Hospital Revenue Code	278
Min. Negotiated Rate	$165.92
Max. Negotiated Rate	$267.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.35
Rate for Payer: Qualcare PPO/HMO/WC	$165.92

END CAP TI W T25 SD FOR NAIL

Facility

$1,106.15

Service Code	HCPCS C1713
Hospital Charge Code	270693261
Hospital Revenue Code	278
Min. Negotiated Rate	$26.66
Max. Negotiated Rate	$553.08
Rate for Payer: Aetna Commercial	$420.34
Rate for Payer: Aetna Medicare Advantage	$331.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.07
Rate for Payer: Cigna Commercial	$553.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.35
Rate for Payer: Qualcare PPO/HMO/WC	$165.92
Rate for Payer: UnitedHealthcare Community & State	$26.66
Rate for Payer: Wellpoint Medicaid Managed Care	$29.31

END CAP VALOR

Facility

$1,060.00

Hospital Charge Code	270677452
Hospital Revenue Code	272
Min. Negotiated Rate	$159.00
Max. Negotiated Rate	$159.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.00

END CAP VALOR

Facility

$1,060.00

Hospital Charge Code	270677452
Hospital Revenue Code	272
Min. Negotiated Rate	$25.55
Max. Negotiated Rate	$530.00
Rate for Payer: Aetna Commercial	$402.80
Rate for Payer: Aetna Medicare Advantage	$318.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.30
Rate for Payer: Cigna Commercial	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.00
Rate for Payer: Oxford Commercial	$212.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.00
Rate for Payer: UnitedHealthcare Commercial	$212.00
Rate for Payer: UnitedHealthcare Community & State	$25.55
Rate for Payer: Wellpoint Medicaid Managed Care	$28.09

ENDCAP ZIM FOR NAIL 2252-01

Facility

$1,035.25

Hospital Charge Code	270619866
Hospital Revenue Code	278
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$517.62
Rate for Payer: Aetna Commercial	$393.39
Rate for Payer: Aetna Medicare Advantage	$310.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.99
Rate for Payer: Cigna Commercial	$517.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$227.75
Rate for Payer: Qualcare PPO/HMO/WC	$155.29
Rate for Payer: UnitedHealthcare Community & State	$24.95
Rate for Payer: Wellpoint Medicaid Managed Care	$27.43

ENDCAP ZIM FOR NAIL 2252-01

Facility

$1,035.25

Hospital Charge Code	270619866
Hospital Revenue Code	278
Min. Negotiated Rate	$155.29
Max. Negotiated Rate	$250.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$227.75
Rate for Payer: Qualcare PPO/HMO/WC	$155.29

ENDO 5 ML APPLIER

Facility

$8,900.00

Hospital Charge Code	270665369
Hospital Revenue Code	270
Min. Negotiated Rate	$214.49
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$3,382.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.00
Rate for Payer: Oxford Commercial	$1,780.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00
Rate for Payer: UnitedHealthcare Commercial	$1,780.00
Rate for Payer: UnitedHealthcare Community & State	$214.49
Rate for Payer: Wellpoint Medicaid Managed Care	$235.85

ENDO 5 ML APPLIER

Facility

$8,900.00

Hospital Charge Code	270665369
Hospital Revenue Code	270
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$1,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

Know your out-of-pocket cost for care.

All Charges