Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FHC VISION REFERRAL

Facility

$220.00

Service Code	HCPCS 92499EP
Hospital Charge Code	9400097
Hospital Revenue Code	510
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

FHC VISION REFERRAL

Facility

$220.00

Service Code	HCPCS 92499EP
Hospital Charge Code	9400097
Hospital Revenue Code	510
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

FIBER BAR GLASS 11MM X 150MM

Facility

$887.75

Hospital Charge Code	270668709
Hospital Revenue Code	278
Min. Negotiated Rate	$21.39
Max. Negotiated Rate	$443.88
Rate for Payer: Aetna Commercial	$337.35
Rate for Payer: Aetna Medicare Advantage	$266.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.38
Rate for Payer: Cigna Commercial	$443.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.31
Rate for Payer: Qualcare PPO/HMO/WC	$133.16
Rate for Payer: UnitedHealthcare Community & State	$21.39
Rate for Payer: Wellpoint Medicaid Managed Care	$23.53

FIBER BAR GLASS 11MM X 150MM

Facility

$887.75

Hospital Charge Code	270668709
Hospital Revenue Code	278
Min. Negotiated Rate	$133.16
Max. Negotiated Rate	$214.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.31
Rate for Payer: Qualcare PPO/HMO/WC	$133.16

FIBER BAR GLASS 11MM X 350MM

Facility

$1,155.75

Hospital Charge Code	270668710
Hospital Revenue Code	278
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$279.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$254.26
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

FIBER BAR GLASS 11MM X 350MM

Facility

$1,155.75

Hospital Charge Code	270668710
Hospital Revenue Code	278
Min. Negotiated Rate	$27.85
Max. Negotiated Rate	$577.88
Rate for Payer: Aetna Commercial	$439.19
Rate for Payer: Aetna Medicare Advantage	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.72
Rate for Payer: Cigna Commercial	$577.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$254.26
Rate for Payer: Qualcare PPO/HMO/WC	$173.36
Rate for Payer: UnitedHealthcare Community & State	$27.85
Rate for Payer: Wellpoint Medicaid Managed Care	$30.63

FIBER BONE GRAFT STAGRAFT 5CC

Facility

$11,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270700039
Hospital Revenue Code	278
Min. Negotiated Rate	$273.54
Max. Negotiated Rate	$5,675.00
Rate for Payer: Aetna Commercial	$4,313.00
Rate for Payer: Aetna Medicare Advantage	$3,405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,894.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,894.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,894.25
Rate for Payer: Cigna Commercial	$5,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,746.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,497.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.50
Rate for Payer: UnitedHealthcare Community & State	$273.54
Rate for Payer: Wellpoint Medicaid Managed Care	$300.77

FIBER BONE GRAFT STAGRAFT 5CC

Facility

$11,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270700039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,702.50
Max. Negotiated Rate	$2,746.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,746.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,497.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.50

FIBER DISC

Facility

$10,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270692240
Hospital Revenue Code	278
Min. Negotiated Rate	$250.64
Max. Negotiated Rate	$5,200.00
Rate for Payer: Aetna Commercial	$3,952.00
Rate for Payer: Aetna Medicare Advantage	$3,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,652.00
Rate for Payer: Cigna Commercial	$5,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,288.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,560.00
Rate for Payer: UnitedHealthcare Community & State	$250.64
Rate for Payer: Wellpoint Medicaid Managed Care	$275.60

FIBER DISC

Facility

$10,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270692240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$2,516.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,288.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,560.00

FIBER GREENLIGHT

Facility

$5,000.00

Hospital Charge Code	270683514
Hospital Revenue Code	272
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

FIBER GREENLIGHT

Facility

$5,000.00

Hospital Charge Code	270683514
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

FIBER GREEN LIGHT MOXY REF#10

Facility

$5,000.00

Hospital Charge Code	270675695
Hospital Revenue Code	279
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

FIBER GREEN LIGHT MOXY REF#10

Facility

$5,000.00

Hospital Charge Code	270675695
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

FIBER HOLMION 356 MICRON

Facility

$5,250.00

Hospital Charge Code	270675974
Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FIBER HOLMION 356 MICRON

Facility

$5,250.00

Hospital Charge Code	270675974
Hospital Revenue Code	272
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,575.00
Rate for Payer: Oxford Commercial	$1,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

FIBER HOLMIUM

Facility

$1,985.00

Hospital Charge Code	270692104
Hospital Revenue Code	272
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$992.50
Rate for Payer: Aetna Commercial	$754.30
Rate for Payer: Aetna Medicare Advantage	$595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.18
Rate for Payer: Cigna Commercial	$992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.50
Rate for Payer: Oxford Commercial	$397.00
Rate for Payer: Qualcare PPO/HMO/WC	$297.75
Rate for Payer: UnitedHealthcare Commercial	$397.00
Rate for Payer: UnitedHealthcare Community & State	$47.84
Rate for Payer: Wellpoint Medicaid Managed Care	$52.60

FIBER HOLMIUM

Facility

$1,985.00

Hospital Charge Code	270692104
Hospital Revenue Code	272
Min. Negotiated Rate	$297.75
Max. Negotiated Rate	$297.75
Rate for Payer: Qualcare PPO/HMO/WC	$297.75

FIBERLASE 30X450MM(LASERFIBER)

Facility

$706.00

Hospital Charge Code	270335437
Hospital Revenue Code	272
Min. Negotiated Rate	$17.01
Max. Negotiated Rate	$353.00
Rate for Payer: Aetna Commercial	$268.28
Rate for Payer: Aetna Medicare Advantage	$211.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.03
Rate for Payer: Cigna Commercial	$353.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.80
Rate for Payer: Oxford Commercial	$141.20
Rate for Payer: Qualcare PPO/HMO/WC	$105.90
Rate for Payer: UnitedHealthcare Commercial	$141.20
Rate for Payer: UnitedHealthcare Community & State	$17.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.71

FIBERLASE 30X450MM(LASERFIBER)

Facility

$706.00

Hospital Charge Code	270335437
Hospital Revenue Code	272
Min. Negotiated Rate	$105.90
Max. Negotiated Rate	$105.90
Rate for Payer: Qualcare PPO/HMO/WC	$105.90

FIBER LASER

Facility

$2,337.50

Hospital Charge Code	270661301
Hospital Revenue Code	270
Min. Negotiated Rate	$350.62
Max. Negotiated Rate	$350.62
Rate for Payer: Qualcare PPO/HMO/WC	$350.62

FIBER LASER

Facility

$2,337.50

Hospital Charge Code	270661301
Hospital Revenue Code	270
Min. Negotiated Rate	$56.33
Max. Negotiated Rate	$1,168.75
Rate for Payer: Aetna Commercial	$888.25
Rate for Payer: Aetna Medicare Advantage	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$596.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$596.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$596.06
Rate for Payer: Cigna Commercial	$1,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.25
Rate for Payer: Oxford Commercial	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$350.62
Rate for Payer: UnitedHealthcare Commercial	$467.50
Rate for Payer: UnitedHealthcare Community & State	$56.33
Rate for Payer: Wellpoint Medicaid Managed Care	$61.94

FIBER LASER 1470

Facility

$3,500.00

Hospital Charge Code	270662161
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

FIBER LASER 1470

Facility

$3,500.00

Hospital Charge Code	270662161
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

FIBER LASER HOLMIUM 550

Facility

$1,340.00

Hospital Charge Code	270673456
Hospital Revenue Code	272
Min. Negotiated Rate	$201.00
Max. Negotiated Rate	$201.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.00

Know your out-of-pocket cost for care.

All Charges