Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EX TAB 56.5X40MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705052
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

EX TAB 6.5X35MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705053
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

EX TAB 6.5X35MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705053
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

EXTEN AFX LIMB 120-20/C55F SA

Facility

$13,825.00

Hospital Charge Code	270659266C
Hospital Revenue Code	278
Min. Negotiated Rate	$333.18
Max. Negotiated Rate	$6,912.50
Rate for Payer: Aetna Commercial	$5,253.50
Rate for Payer: Aetna Medicare Advantage	$4,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,525.38
Rate for Payer: Cigna Commercial	$6,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75
Rate for Payer: UnitedHealthcare Community & State	$333.18
Rate for Payer: Wellpoint Medicaid Managed Care	$366.36

EXTEN AFX LIMB 120-20/C55F SA

Facility

$13,825.00

Hospital Charge Code	270659266C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,073.75
Max. Negotiated Rate	$3,345.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75

EXTEN AORTIC AFXA25-25/C95-O20

Facility

$19,450.00

Hospital Charge Code	270659261C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,917.50
Max. Negotiated Rate	$4,706.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,279.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50

EXTEN AORTIC AFXA25-25/C95-O20

Facility

$19,450.00

Hospital Charge Code	270659261C
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$9,725.00
Rate for Payer: Aetna Commercial	$7,391.00
Rate for Payer: Aetna Medicare Advantage	$5,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,959.75
Rate for Payer: Cigna Commercial	$9,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,279.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50
Rate for Payer: UnitedHealthcare Community & State	$468.75
Rate for Payer: Wellpoint Medicaid Managed Care	$515.42

EXTENDED GROUP SESSION

Facility

$563.20

Service Code	HCPCS 90853
Hospital Charge Code	9310082
Hospital Revenue Code	915
Min. Negotiated Rate	$84.48
Max. Negotiated Rate	$84.48
Rate for Payer: Qualcare PPO/HMO/WC	$84.48

EXTENDED GROUP SESSION

Facility

$563.20

Service Code	HCPCS 90853
Hospital Charge Code	9310082
Hospital Revenue Code	915
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.96
Rate for Payer: Qualcare PPO/HMO/WC	$84.48
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

EXTENDED GROUP SESSION IOTP***

Facility

$275.00

Service Code	HCPCS 90853
Hospital Charge Code	9310046
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

EXTENDED GROUP SESSION IOTP***

Facility

$275.00

Service Code	HCPCS 90853
Hospital Charge Code	9310046
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

EXTENDER REAR TIP 2.0CM

Facility

$1,272.60

Hospital Charge Code	270661190
Hospital Revenue Code	278
Min. Negotiated Rate	$190.89
Max. Negotiated Rate	$307.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.97
Rate for Payer: Qualcare PPO/HMO/WC	$190.89

EXTENDER REAR TIP 2.0CM

Facility

$1,272.60

Hospital Charge Code	270661190
Hospital Revenue Code	278
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$636.30
Rate for Payer: Aetna Commercial	$483.59
Rate for Payer: Aetna Medicare Advantage	$381.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.51
Rate for Payer: Cigna Commercial	$636.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.97
Rate for Payer: Qualcare PPO/HMO/WC	$190.89
Rate for Payer: UnitedHealthcare Community & State	$30.67
Rate for Payer: Wellpoint Medicaid Managed Care	$33.72

EXTENDER TAB 6642007

Facility

$3,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270696284
Hospital Revenue Code	278
Min. Negotiated Rate	$76.04
Max. Negotiated Rate	$1,577.50
Rate for Payer: Aetna Commercial	$1,198.90
Rate for Payer: Aetna Medicare Advantage	$946.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$804.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$804.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$804.52
Rate for Payer: Cigna Commercial	$1,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.10
Rate for Payer: Qualcare PPO/HMO/WC	$473.25
Rate for Payer: UnitedHealthcare Community & State	$76.04
Rate for Payer: Wellpoint Medicaid Managed Care	$83.61

EXTENDER TAB 6642007

Facility

$3,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270696284
Hospital Revenue Code	278
Min. Negotiated Rate	$473.25
Max. Negotiated Rate	$763.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.10
Rate for Payer: Qualcare PPO/HMO/WC	$473.25

EXTEND TAB TULIP MODULAR MIS

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270696743
Hospital Revenue Code	278
Min. Negotiated Rate	$162.43
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,482.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$162.43
Rate for Payer: Wellpoint Medicaid Managed Care	$178.61

EXTEND TAB TULIP MODULAR MIS

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270696743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,482.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

EXTENSION AORTIC

Facility

$20,175.00

Hospital Charge Code	270666591
Hospital Revenue Code	278
Min. Negotiated Rate	$3,026.25
Max. Negotiated Rate	$4,882.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,882.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,438.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,026.25

EXTENSION AORTIC

Facility

$20,175.00

Hospital Charge Code	270666591
Hospital Revenue Code	278
Min. Negotiated Rate	$486.22
Max. Negotiated Rate	$10,087.50
Rate for Payer: Aetna Commercial	$7,666.50
Rate for Payer: Aetna Medicare Advantage	$6,052.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,144.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,144.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,144.62
Rate for Payer: Cigna Commercial	$10,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,882.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,438.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,026.25
Rate for Payer: UnitedHealthcare Community & State	$486.22
Rate for Payer: Wellpoint Medicaid Managed Care	$534.64

EXTENSION AORTIC A28-28/C55

Facility

$15,350.00

Hospital Charge Code	270666864
Hospital Revenue Code	278
Min. Negotiated Rate	$369.94
Max. Negotiated Rate	$7,675.00
Rate for Payer: Aetna Commercial	$5,833.00
Rate for Payer: Aetna Medicare Advantage	$4,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,914.25
Rate for Payer: Cigna Commercial	$7,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,377.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50
Rate for Payer: UnitedHealthcare Community & State	$369.94
Rate for Payer: Wellpoint Medicaid Managed Care	$406.77

EXTENSION AORTIC A28-28/C55

Facility

$15,350.00

Hospital Charge Code	270666864
Hospital Revenue Code	278
Min. Negotiated Rate	$2,302.50
Max. Negotiated Rate	$3,714.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,377.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50

EXTENSION BMT ENDCAP 5 345905

Facility

$813.65

Hospital Charge Code	270617175
Hospital Revenue Code	278
Min. Negotiated Rate	$122.05
Max. Negotiated Rate	$196.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.05

EXTENSION BMT ENDCAP 5 345905

Facility

$813.65

Hospital Charge Code	270617175
Hospital Revenue Code	278
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$406.82
Rate for Payer: Aetna Commercial	$309.19
Rate for Payer: Aetna Medicare Advantage	$244.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.48
Rate for Payer: Cigna Commercial	$406.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.05
Rate for Payer: UnitedHealthcare Community & State	$19.61
Rate for Payer: Wellpoint Medicaid Managed Care	$21.56

EXTENSION LEAD 10cm 7489-10

Facility

$2,251.90

Hospital Charge Code	270632004
Hospital Revenue Code	272
Min. Negotiated Rate	$337.79
Max. Negotiated Rate	$337.79
Rate for Payer: Qualcare PPO/HMO/WC	$337.79

EXTENSION LEAD 10cm 7489-10

Facility

$2,251.90

Hospital Charge Code	270632004
Hospital Revenue Code	272
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$1,125.95
Rate for Payer: Aetna Commercial	$855.72
Rate for Payer: Aetna Medicare Advantage	$675.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$574.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$574.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$574.23
Rate for Payer: Cigna Commercial	$1,125.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.57
Rate for Payer: Oxford Commercial	$450.38
Rate for Payer: Qualcare PPO/HMO/WC	$337.79
Rate for Payer: UnitedHealthcare Commercial	$450.38
Rate for Payer: UnitedHealthcare Community & State	$54.27
Rate for Payer: Wellpoint Medicaid Managed Care	$59.68

Know your out-of-pocket cost for care.

All Charges