Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXTENSION LLIAC

Facility

$16,900.00

Hospital Charge Code	270666863
Hospital Revenue Code	278
Min. Negotiated Rate	$407.29
Max. Negotiated Rate	$8,450.00
Rate for Payer: Aetna Commercial	$6,422.00
Rate for Payer: Aetna Medicare Advantage	$5,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,309.50
Rate for Payer: Cigna Commercial	$8,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00
Rate for Payer: UnitedHealthcare Community & State	$407.29
Rate for Payer: Wellpoint Medicaid Managed Care	$447.85

EXTENSION LLIAC

Facility

$16,900.00

Hospital Charge Code	270666863
Hospital Revenue Code	278
Min. Negotiated Rate	$2,535.00
Max. Negotiated Rate	$4,089.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00

EXTENSION MODULAR 13x10MM

Facility

$2,140.00

Hospital Charge Code	270677208
Hospital Revenue Code	278
Min. Negotiated Rate	$321.00
Max. Negotiated Rate	$517.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00

EXTENSION MODULAR 13x10MM

Facility

$2,140.00

Hospital Charge Code	270677208
Hospital Revenue Code	278
Min. Negotiated Rate	$51.57
Max. Negotiated Rate	$1,070.00
Rate for Payer: Aetna Commercial	$813.20
Rate for Payer: Aetna Medicare Advantage	$642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.70
Rate for Payer: Cigna Commercial	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00
Rate for Payer: UnitedHealthcare Community & State	$51.57
Rate for Payer: Wellpoint Medicaid Managed Care	$56.71

EXTENSION SET ADULT EXPANDABLE

Facility

$20.88

Hospital Charge Code	270640484
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna Commercial	$7.93
Rate for Payer: Aetna Medicare Advantage	$6.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.26
Rate for Payer: Oxford Commercial	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.18
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

EXTENSION SET ADULT EXPANDABLE

Facility

$20.88

Hospital Charge Code	270640484
Hospital Revenue Code	270
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

EXTENSION S/J 17G

Facility

$2,710.00

Hospital Charge Code	270642400
Hospital Revenue Code	278
Min. Negotiated Rate	$65.31
Max. Negotiated Rate	$1,355.00
Rate for Payer: Aetna Commercial	$1,029.80
Rate for Payer: Aetna Medicare Advantage	$813.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$691.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$691.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$691.05
Rate for Payer: Cigna Commercial	$1,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$596.20
Rate for Payer: Qualcare PPO/HMO/WC	$406.50
Rate for Payer: UnitedHealthcare Community & State	$65.31
Rate for Payer: Wellpoint Medicaid Managed Care	$71.81

EXTENSION S/J 17G

Facility

$2,710.00

Hospital Charge Code	270642400
Hospital Revenue Code	278
Min. Negotiated Rate	$406.50
Max. Negotiated Rate	$655.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$596.20
Rate for Payer: Qualcare PPO/HMO/WC	$406.50

EXTENSION STEM INSTRUMENT SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689819
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

EXTENSION STEM INSTRUMENT SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689819
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

EXTENSION STEM SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688396
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

EXTENSION STEM SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688396
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

EXTENSION TUBE FR EPIDURAL INJ

Facility

$182.00

Hospital Charge Code	270325400
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$69.16
Rate for Payer: Aetna Medicare Advantage	$54.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.41
Rate for Payer: Cigna Commercial	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$36.40
Rate for Payer: Qualcare PPO/HMO/WC	$27.30
Rate for Payer: UnitedHealthcare Commercial	$36.40
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

EXTENSION TUBE FR EPIDURAL INJ

Facility

$182.00

Hospital Charge Code	270325400
Hospital Revenue Code	272
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$27.30
Rate for Payer: Qualcare PPO/HMO/WC	$27.30

EXTENSION TUBING

Facility

$39.75

Hospital Charge Code	270654298
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.96

EXTENSION TUBING

Facility

$39.75

Hospital Charge Code	270654298
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.88
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: Aetna Medicare Advantage	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.14
Rate for Payer: Cigna Commercial	$19.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.93
Rate for Payer: Oxford Commercial	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.96
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

EXTENSION TUBING SET #4429****

Facility

$15.00

Hospital Charge Code	1810076
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

EXTENSION TUBING SET #4429****

Facility

$15.00

Hospital Charge Code	1810076
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

EXTENSION ZIM KNEE 5988-10-15

Facility

$2,426.45

Hospital Charge Code	270625221
Hospital Revenue Code	272
Min. Negotiated Rate	$363.97
Max. Negotiated Rate	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$363.97

EXTENSION ZIM KNEE 5988-10-15

Facility

$2,426.45

Hospital Charge Code	270625221
Hospital Revenue Code	272
Min. Negotiated Rate	$58.48
Max. Negotiated Rate	$1,213.22
Rate for Payer: Aetna Commercial	$922.05
Rate for Payer: Aetna Medicare Advantage	$727.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$618.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$618.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$618.74
Rate for Payer: Cigna Commercial	$1,213.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.93
Rate for Payer: Oxford Commercial	$485.29
Rate for Payer: Qualcare PPO/HMO/WC	$363.97
Rate for Payer: UnitedHealthcare Commercial	$485.29
Rate for Payer: UnitedHealthcare Community & State	$58.48
Rate for Payer: Wellpoint Medicaid Managed Care	$64.30

EXTENSION ZIM KNEE 5988-10-18

Facility

$2,426.45

Hospital Charge Code	270625222
Hospital Revenue Code	272
Min. Negotiated Rate	$58.48
Max. Negotiated Rate	$1,213.22
Rate for Payer: Aetna Commercial	$922.05
Rate for Payer: Aetna Medicare Advantage	$727.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$618.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$618.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$618.74
Rate for Payer: Cigna Commercial	$1,213.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.93
Rate for Payer: Oxford Commercial	$485.29
Rate for Payer: Qualcare PPO/HMO/WC	$363.97
Rate for Payer: UnitedHealthcare Commercial	$485.29
Rate for Payer: UnitedHealthcare Community & State	$58.48
Rate for Payer: Wellpoint Medicaid Managed Care	$64.30

EXTENSION ZIM KNEE 5988-10-18

Facility

$2,426.45

Hospital Charge Code	270625222
Hospital Revenue Code	272
Min. Negotiated Rate	$363.97
Max. Negotiated Rate	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$363.97

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$18,788.05

Service Code	APR-DRG 9111
Min. Negotiated Rate	$18,419.66
Max. Negotiated Rate	$18,788.05
Rate for Payer: UnitedHealthcare Community & State	$18,419.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,788.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18,419.66

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$26,853.05

Service Code	APR-DRG 9112
Min. Negotiated Rate	$26,326.52
Max. Negotiated Rate	$26,853.05
Rate for Payer: UnitedHealthcare Community & State	$26,326.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,853.05
Rate for Payer: Wellpoint Medicaid Managed Care	$26,326.52

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$35,526.96

Service Code	APR-DRG 9113
Min. Negotiated Rate	$34,830.35
Max. Negotiated Rate	$35,526.96
Rate for Payer: UnitedHealthcare Community & State	$34,830.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,526.96
Rate for Payer: Wellpoint Medicaid Managed Care	$34,830.35

Know your out-of-pocket cost for care.

All Charges