Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDANCE FOR NDL BRST-GL

Facility

$306.45

Service Code	HCPCS 19281
Hospital Charge Code	85000050
Hospital Revenue Code	361
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.94
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.97
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

GUIDANCE FOR NDL BRST-GL

Facility

$306.45

Service Code	HCPCS 19281
Hospital Charge Code	85000050
Hospital Revenue Code	361
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.97

GUIDANCE FOR NDL BRST-PC

Facility

$147.20

Service Code	HCPCS 7703226
Hospital Charge Code	85000060
Hospital Revenue Code	320
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$22.08
Rate for Payer: Qualcare PPO/HMO/WC	$22.08

GUIDANCE FOR NDL BRST-PC

Facility

$147.20

Service Code	HCPCS 7703226
Hospital Charge Code	85000060
Hospital Revenue Code	320
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$55.94
Rate for Payer: Aetna Medicare Advantage	$44.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.54
Rate for Payer: Cigna Commercial	$73.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

GUIDANCE FOR NDL BRST-TC

Facility

$159.20

Service Code	HCPCS 77032TC
Hospital Charge Code	85000055
Hospital Revenue Code	320
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$23.88
Rate for Payer: Qualcare PPO/HMO/WC	$23.88

GUIDANCE FOR NDL BRST-TC

Facility

$159.20

Service Code	HCPCS 77032TC
Hospital Charge Code	85000055
Hospital Revenue Code	320
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$60.50
Rate for Payer: Aetna Medicare Advantage	$47.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.60
Rate for Payer: Cigna Commercial	$79.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.76
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.22

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	85000896
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	85000896
Hospital Revenue Code	333
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	2309093
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	2309093
Hospital Revenue Code	333
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

GUID CATH MPAI 6F

Facility

$274.75

Hospital Charge Code	2709001203
Hospital Revenue Code	272
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$137.38
Rate for Payer: Aetna Commercial	$104.41
Rate for Payer: Aetna Medicare Advantage	$82.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.06
Rate for Payer: Cigna Commercial	$137.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.42
Rate for Payer: Oxford Commercial	$54.95
Rate for Payer: Qualcare PPO/HMO/WC	$41.21
Rate for Payer: UnitedHealthcare Commercial	$54.95
Rate for Payer: UnitedHealthcare Community & State	$6.62
Rate for Payer: Wellpoint Medicaid Managed Care	$7.28

GUID CATH MPAI 6F

Facility

$274.75

Hospital Charge Code	2709001203
Hospital Revenue Code	272
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$41.21
Rate for Payer: Qualcare PPO/HMO/WC	$41.21

GUID CHCE X/SPPRT 182cm1216101

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270639577
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

GUID CHCE X/SPPRT 182cm1216101

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270639577
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

GUIDE 035x180cm ROADRUNN

Facility

$239.70

Service Code	HCPCS C1769
Hospital Charge Code	270679802N
Hospital Revenue Code	278
Min. Negotiated Rate	$35.95
Max. Negotiated Rate	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.73
Rate for Payer: Qualcare PPO/HMO/WC	$35.95

GUIDE 035x180cm ROADRUNN

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270679802S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

GUIDE 035x180cm ROADRUNN

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270679802S
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

GUIDE 035x180cm ROADRUNN

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270679802
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

GUIDE 035x180cm ROADRUNN

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270679802
Hospital Revenue Code	278
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

GUIDE 035x180cm ROADRUNN

Facility

$239.70

Service Code	HCPCS C1769
Hospital Charge Code	270679802N
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$119.85
Rate for Payer: Aetna Commercial	$91.09
Rate for Payer: Aetna Medicare Advantage	$71.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$119.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.73
Rate for Payer: Qualcare PPO/HMO/WC	$35.95
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.35

GUIDE ACCU-CUT AUSTIN/CHEVRON

Facility

$375.00

Hospital Charge Code	270643491
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDE ACCU-CUT AUSTIN/CHEVRON

Facility

$375.00

Hospital Charge Code	270643491
Hospital Revenue Code	272
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDE ACCU-CUT OSTEOTOMY

Facility

$425.00

Hospital Charge Code	270644159
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

GUIDE ACCU-CUT OSTEOTOMY

Facility

$425.00

Hospital Charge Code	270644159
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

GUIDE ACCU-CUT YOUNGSWICK 1mm

Facility

$375.00

Hospital Charge Code	270643492
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

Know your out-of-pocket cost for care.

All Charges