Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.00

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$306.65
Rate for Payer: Aetna Commercial	$233.05
Rate for Payer: Aetna Medicare Advantage	$183.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.39
Rate for Payer: Cigna Commercial	$306.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.99
Rate for Payer: Oxford Commercial	$122.66
Rate for Payer: Qualcare PPO/HMO/WC	$92.00
Rate for Payer: UnitedHealthcare Commercial	$122.66
Rate for Payer: UnitedHealthcare Community & State	$14.78
Rate for Payer: Wellpoint Medicaid Managed Care	$16.25

FILIFORM SPIRAL TIP 4Fr 022104

Facility

$355.00

Hospital Charge Code	270653445
Hospital Revenue Code	272
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

FILIFORM SPIRAL TIP 4Fr 022104

Facility

$355.00

Hospital Charge Code	270653445
Hospital Revenue Code	272
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.50
Rate for Payer: Oxford Commercial	$71.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Commercial	$71.00
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.52
Rate for Payer: Oxford Commercial	$27.01
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$27.01
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.52
Rate for Payer: Oxford Commercial	$27.01
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$27.01
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

FILIFORM STR TIP 18 6F

Facility

$211.25

Hospital Charge Code	270619887
Hospital Revenue Code	272
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$31.69

FILIFORM STR TIP 18 6F

Facility

$211.25

Hospital Charge Code	270619887
Hospital Revenue Code	272
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$105.62
Rate for Payer: Aetna Commercial	$80.28
Rate for Payer: Aetna Medicare Advantage	$63.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.87
Rate for Payer: Cigna Commercial	$105.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.38
Rate for Payer: Oxford Commercial	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$31.69
Rate for Payer: UnitedHealthcare Commercial	$42.25
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.60

FILIFORM STR TIP 5FR

Facility

$380.00

Hospital Charge Code	270600276
Hospital Revenue Code	272
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$144.40
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.00
Rate for Payer: Oxford Commercial	$76.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$76.00
Rate for Payer: UnitedHealthcare Community & State	$9.16
Rate for Payer: Wellpoint Medicaid Managed Care	$10.07

FILIFORM STR TIP 5FR

Facility

$380.00

Hospital Charge Code	270600276
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

FILIFORM STR TIP LNG 4FR

Facility

$414.45

Hospital Charge Code	270600277
Hospital Revenue Code	272
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$82.89
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$82.89
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

FILIFORM STR TIP LNG 4FR

Facility

$414.45

Hospital Charge Code	270600277
Hospital Revenue Code	272
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$97.88
Max. Negotiated Rate	$97.88
Rate for Payer: Qualcare PPO/HMO/WC	$97.88

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$326.25
Rate for Payer: Aetna Commercial	$247.95
Rate for Payer: Aetna Medicare Advantage	$195.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.39
Rate for Payer: Cigna Commercial	$326.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.75
Rate for Payer: Oxford Commercial	$130.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.88
Rate for Payer: UnitedHealthcare Commercial	$130.50
Rate for Payer: UnitedHealthcare Community & State	$15.73
Rate for Payer: Wellpoint Medicaid Managed Care	$17.29

FILIFORM ST TIP 12.5 4F 021904

Facility

$184.60

Hospital Charge Code	270619885
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$92.30
Rate for Payer: Aetna Commercial	$70.15
Rate for Payer: Aetna Medicare Advantage	$55.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.07
Rate for Payer: Cigna Commercial	$92.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.38
Rate for Payer: Oxford Commercial	$36.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.69
Rate for Payer: UnitedHealthcare Commercial	$36.92
Rate for Payer: UnitedHealthcare Community & State	$4.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.89

FILIFORM ST TIP 12.5 4F 021904

Facility

$184.60

Hospital Charge Code	270619885
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$27.69
Rate for Payer: Qualcare PPO/HMO/WC	$27.69

FILIFOR STR TIP 18 3FR 021803

Facility

$219.40

Hospital Charge Code	270613112
Hospital Revenue Code	272
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$109.70
Rate for Payer: Aetna Commercial	$83.37
Rate for Payer: Aetna Medicare Advantage	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.95
Rate for Payer: Cigna Commercial	$109.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.82
Rate for Payer: Oxford Commercial	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$32.91
Rate for Payer: UnitedHealthcare Commercial	$43.88
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$5.81

FILIFOR STR TIP 18 3FR 021803

Facility

$219.40

Hospital Charge Code	270613112
Hospital Revenue Code	272
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$32.91
Rate for Payer: Qualcare PPO/HMO/WC	$32.91

FILIF STR TIP 12.5 6FR 021906

Facility

$186.00

Hospital Charge Code	270619886
Hospital Revenue Code	272
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

FILIF STR TIP 12.5 6FR 021906

Facility

$186.00

Hospital Charge Code	270619886
Hospital Revenue Code	272
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$37.20
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

FILL BONE VOID 10c THER0101010

Facility

$2,504.85

Hospital Charge Code	270635016
Hospital Revenue Code	272
Min. Negotiated Rate	$375.73
Max. Negotiated Rate	$375.73
Rate for Payer: Qualcare PPO/HMO/WC	$375.73

FILL BONE VOID 10c THER0101010

Facility

$2,504.85

Hospital Charge Code	270635016
Hospital Revenue Code	272
Min. Negotiated Rate	$60.37
Max. Negotiated Rate	$1,252.42
Rate for Payer: Aetna Commercial	$951.84
Rate for Payer: Aetna Medicare Advantage	$751.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$638.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$638.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$638.74
Rate for Payer: Cigna Commercial	$1,252.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$751.46
Rate for Payer: Oxford Commercial	$500.97
Rate for Payer: Qualcare PPO/HMO/WC	$375.73
Rate for Payer: UnitedHealthcare Commercial	$500.97
Rate for Payer: UnitedHealthcare Community & State	$60.37
Rate for Payer: Wellpoint Medicaid Managed Care	$66.38

FILL BONE VOID 20c THER0101020

Facility

$3,918.45

Hospital Charge Code	270635017
Hospital Revenue Code	272
Min. Negotiated Rate	$587.77
Max. Negotiated Rate	$587.77
Rate for Payer: Qualcare PPO/HMO/WC	$587.77

Know your out-of-pocket cost for care.

All Charges