Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EVASC VEN ARTLZ TIBL/PRNL VN

Facility

$98,874.75

Service Code	HCPCS 0620T
Hospital Charge Code	41100620T
Hospital Revenue Code	360
Min. Negotiated Rate	$14,831.21
Max. Negotiated Rate	$14,831.21
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74116014
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74116015
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74116014
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$993.21
Rate for Payer: Aetna Medicare Advantage	$784.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.49
Rate for Payer: Cigna Commercial	$1,306.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74115015
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74116015
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74117014
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$993.21
Rate for Payer: Aetna Medicare Advantage	$784.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.49
Rate for Payer: Cigna Commercial	$1,306.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74117015
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74115014
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74117015
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93229
Hospital Charge Code	74115015
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74115014
Hospital Revenue Code	731
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$993.21
Rate for Payer: Aetna Medicare Advantage	$784.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.49
Rate for Payer: Cigna Commercial	$1,306.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.11
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.06
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: Wellpoint Medicaid Managed Care	$69.26

EVENT MONITORING

Facility

$2,613.70

Service Code	HCPCS 93228
Hospital Charge Code	74117014
Hospital Revenue Code	731
Min. Negotiated Rate	$392.06
Max. Negotiated Rate	$392.06
Rate for Payer: Qualcare PPO/HMO/WC	$392.06

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304N
Hospital Revenue Code	278
Min. Negotiated Rate	$177.13
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$177.13
Rate for Payer: Wellpoint Medicaid Managed Care	$194.78

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304
Hospital Revenue Code	278
Min. Negotiated Rate	$177.13
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$177.13
Rate for Payer: Wellpoint Medicaid Managed Care	$194.78

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302S
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302N
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERLAST CROSS LINKED POLY INS

Facility

$24,859.05

Service Code	HCPCS C1713
Hospital Charge Code	270704973
Hospital Revenue Code	278
Min. Negotiated Rate	$3,728.86
Max. Negotiated Rate	$6,015.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,971.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,015.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,468.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,728.86

EVERLAST CROSS LINKED POLY INS

Facility

$24,859.05

Service Code	HCPCS C1713
Hospital Charge Code	270704973
Hospital Revenue Code	278
Min. Negotiated Rate	$599.10
Max. Negotiated Rate	$12,429.52
Rate for Payer: Aetna Commercial	$9,446.44
Rate for Payer: Aetna Medicare Advantage	$7,457.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,339.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,339.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,971.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,339.06
Rate for Payer: Cigna Commercial	$12,429.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,015.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,468.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,728.86
Rate for Payer: UnitedHealthcare Community & State	$599.10
Rate for Payer: Wellpoint Medicaid Managed Care	$658.76

Know your out-of-pocket cost for care.

All Charges