Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILL BONE VOID 20c THER0101020

Facility

$3,918.45

Hospital Charge Code	270635017
Hospital Revenue Code	272
Min. Negotiated Rate	$94.43
Max. Negotiated Rate	$1,959.22
Rate for Payer: Aetna Commercial	$1,489.01
Rate for Payer: Aetna Medicare Advantage	$1,175.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.20
Rate for Payer: Cigna Commercial	$1,959.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,175.54
Rate for Payer: Oxford Commercial	$783.69
Rate for Payer: Qualcare PPO/HMO/WC	$587.77
Rate for Payer: UnitedHealthcare Commercial	$783.69
Rate for Payer: UnitedHealthcare Community & State	$94.43
Rate for Payer: Wellpoint Medicaid Managed Care	$103.84

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.00
Rate for Payer: Oxford Commercial	$112.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Commercial	$112.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$278.36
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$278.36
Rate for Payer: Wellpoint Medicaid Managed Care	$306.07

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$278.36
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$278.36
Rate for Payer: Wellpoint Medicaid Managed Care	$306.07

FILLER VTS BONE CANC 200502

Facility

$6,222.45

Hospital Charge Code	270628653
Hospital Revenue Code	272
Min. Negotiated Rate	$933.37
Max. Negotiated Rate	$933.37
Rate for Payer: Qualcare PPO/HMO/WC	$933.37

FILLER VTS BONE CANC 200502

Facility

$6,222.45

Hospital Charge Code	270628653
Hospital Revenue Code	272
Min. Negotiated Rate	$149.96
Max. Negotiated Rate	$3,111.22
Rate for Payer: Aetna Commercial	$2,364.53
Rate for Payer: Aetna Medicare Advantage	$1,866.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.72
Rate for Payer: Cigna Commercial	$3,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.73
Rate for Payer: Oxford Commercial	$1,244.49
Rate for Payer: Qualcare PPO/HMO/WC	$933.37
Rate for Payer: UnitedHealthcare Commercial	$1,244.49
Rate for Payer: UnitedHealthcare Community & State	$149.96
Rate for Payer: Wellpoint Medicaid Managed Care	$164.89

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILM CURIX ORTHO HTG 24X24

Facility

$116.75

Hospital Charge Code	270654382
Hospital Revenue Code	272
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$17.51

FILM CURIX ORTHO HTG 24X24

Facility

$116.75

Hospital Charge Code	270654382
Hospital Revenue Code	272
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$58.38
Rate for Payer: Aetna Commercial	$44.37
Rate for Payer: Aetna Medicare Advantage	$35.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.77
Rate for Payer: Cigna Commercial	$58.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.02
Rate for Payer: Oxford Commercial	$23.35
Rate for Payer: Qualcare PPO/HMO/WC	$17.51
Rate for Payer: UnitedHealthcare Commercial	$23.35
Rate for Payer: UnitedHealthcare Community & State	$2.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

FILM ENDO PICTURE UPC5010A

Facility

$1,189.17

Hospital Charge Code	270607072
Hospital Revenue Code	270
Min. Negotiated Rate	$178.38
Max. Negotiated Rate	$178.38
Rate for Payer: Qualcare PPO/HMO/WC	$178.38

FILM ENDO PICTURE UPC5010A

Facility

$1,189.17

Hospital Charge Code	270607072
Hospital Revenue Code	270
Min. Negotiated Rate	$28.66
Max. Negotiated Rate	$594.59
Rate for Payer: Aetna Commercial	$451.88
Rate for Payer: Aetna Medicare Advantage	$356.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.24
Rate for Payer: Cigna Commercial	$594.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.75
Rate for Payer: Oxford Commercial	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$178.38
Rate for Payer: UnitedHealthcare Commercial	$237.83
Rate for Payer: UnitedHealthcare Community & State	$28.66
Rate for Payer: Wellpoint Medicaid Managed Care	$31.51

FILM MEDT EPI 2.5X2.5 1417000

Facility

$768.85

Hospital Charge Code	270622520
Hospital Revenue Code	272
Min. Negotiated Rate	$115.33
Max. Negotiated Rate	$115.33
Rate for Payer: Qualcare PPO/HMO/WC	$115.33

FILM MEDT EPI 2.5X2.5 1417000

Facility

$768.85

Hospital Charge Code	270622520
Hospital Revenue Code	272
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$384.43
Rate for Payer: Aetna Commercial	$292.16
Rate for Payer: Aetna Medicare Advantage	$230.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.06
Rate for Payer: Cigna Commercial	$384.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.66
Rate for Payer: Oxford Commercial	$153.77
Rate for Payer: Qualcare PPO/HMO/WC	$115.33
Rate for Payer: UnitedHealthcare Commercial	$153.77
Rate for Payer: UnitedHealthcare Community & State	$18.53
Rate for Payer: Wellpoint Medicaid Managed Care	$20.37

FILM NO-STING BARRIER 3344****

Facility

$2.00

Hospital Charge Code	270611000
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

FILM NO-STING BARRIER 3344****

Facility

$2.00

Hospital Charge Code	270611000
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

FILTER

Facility

$2,190.40

Hospital Charge Code	270657245
Hospital Revenue Code	278
Min. Negotiated Rate	$328.56
Max. Negotiated Rate	$530.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$438.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.89
Rate for Payer: Qualcare PPO/HMO/WC	$328.56

FILTER

Facility

$2,190.40

Hospital Charge Code	270657245
Hospital Revenue Code	278
Min. Negotiated Rate	$52.79
Max. Negotiated Rate	$1,095.20
Rate for Payer: Aetna Commercial	$832.35
Rate for Payer: Aetna Medicare Advantage	$657.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$438.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.55
Rate for Payer: Cigna Commercial	$1,095.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.89
Rate for Payer: Qualcare PPO/HMO/WC	$328.56
Rate for Payer: UnitedHealthcare Community & State	$52.79
Rate for Payer: Wellpoint Medicaid Managed Care	$58.05

Know your out-of-pocket cost for care.

All Charges