Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD MODULA 32mm-3 NECK 163668

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270640278
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$661.10
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD MODULAR 28mm +3 NECK

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270605342
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

HEAD MODULAR 28mm +3 NECK

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270605342
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

HEAD MODULAR 28MM STD NECK

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270605405
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

HEAD MODULAR 28MM STD NECK

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270605405
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

HEAD MODULAR 32MM-3 NCK 163608

Facility

$2,673.50

Hospital Charge Code	270634777
Hospital Revenue Code	278
Min. Negotiated Rate	$64.43
Max. Negotiated Rate	$1,336.75
Rate for Payer: Aetna Commercial	$1,015.93
Rate for Payer: Aetna Medicare Advantage	$802.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$681.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$681.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$681.74
Rate for Payer: Cigna Commercial	$1,336.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$646.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$588.17
Rate for Payer: Qualcare PPO/HMO/WC	$401.02
Rate for Payer: UnitedHealthcare Community & State	$64.43
Rate for Payer: Wellpoint Medicaid Managed Care	$70.85

HEAD MODULAR 32MM-3 NCK 163608

Facility

$2,673.50

Hospital Charge Code	270634777
Hospital Revenue Code	278
Min. Negotiated Rate	$401.02
Max. Negotiated Rate	$646.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$534.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$646.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$588.17
Rate for Payer: Qualcare PPO/HMO/WC	$401.02

HEAD MODULAR 32MM STD NECK

Facility

$2,780.00

Hospital Charge Code	270637436
Hospital Revenue Code	278
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$672.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$672.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$611.60
Rate for Payer: Qualcare PPO/HMO/WC	$417.00

HEAD MODULAR 32MM STD NECK

Facility

$2,780.00

Hospital Charge Code	270637436
Hospital Revenue Code	278
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$1,390.00
Rate for Payer: Aetna Commercial	$1,056.40
Rate for Payer: Aetna Medicare Advantage	$834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$708.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$708.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$556.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$708.90
Rate for Payer: Cigna Commercial	$1,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$672.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$611.60
Rate for Payer: Qualcare PPO/HMO/WC	$417.00
Rate for Payer: UnitedHealthcare Community & State	$67.00
Rate for Payer: Wellpoint Medicaid Managed Care	$73.67

HEAD MODULAR 40mm +3 NECK

Facility

$7,045.00

Hospital Charge Code	270645621
Hospital Revenue Code	278
Min. Negotiated Rate	$169.78
Max. Negotiated Rate	$3,522.50
Rate for Payer: Aetna Commercial	$2,677.10
Rate for Payer: Aetna Medicare Advantage	$2,113.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,796.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,796.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,796.47
Rate for Payer: Cigna Commercial	$3,522.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,704.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,549.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,056.75
Rate for Payer: UnitedHealthcare Community & State	$169.78
Rate for Payer: Wellpoint Medicaid Managed Care	$186.69

HEAD MODULAR 40mm +3 NECK

Facility

$7,045.00

Hospital Charge Code	270645621
Hospital Revenue Code	278
Min. Negotiated Rate	$1,056.75
Max. Negotiated Rate	$1,704.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,704.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,549.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,056.75

HEAD MODULAR 44mm M2A MAGNUM

Facility

$6,090.95

Hospital Charge Code	270636873
Hospital Revenue Code	278
Min. Negotiated Rate	$913.64
Max. Negotiated Rate	$1,474.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.01
Rate for Payer: Qualcare PPO/HMO/WC	$913.64

HEAD MODULAR 44mm M2A MAGNUM

Facility

$6,090.95

Hospital Charge Code	270636873
Hospital Revenue Code	278
Min. Negotiated Rate	$146.79
Max. Negotiated Rate	$3,045.47
Rate for Payer: Aetna Commercial	$2,314.56
Rate for Payer: Aetna Medicare Advantage	$1,827.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,553.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,553.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,553.19
Rate for Payer: Cigna Commercial	$3,045.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.01
Rate for Payer: Qualcare PPO/HMO/WC	$913.64
Rate for Payer: UnitedHealthcare Community & State	$146.79
Rate for Payer: Wellpoint Medicaid Managed Care	$161.41

HEAD MODULAR 46mm M2A MAGNUM

Facility

$7,040.00

Hospital Charge Code	270642990
Hospital Revenue Code	278
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$3,520.00
Rate for Payer: Aetna Commercial	$2,675.20
Rate for Payer: Aetna Medicare Advantage	$2,112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,795.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,795.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,795.20
Rate for Payer: Cigna Commercial	$3,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,703.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,056.00
Rate for Payer: UnitedHealthcare Community & State	$169.66
Rate for Payer: Wellpoint Medicaid Managed Care	$186.56

HEAD MODULAR 46mm M2A MAGNUM

Facility

$7,040.00

Hospital Charge Code	270642990
Hospital Revenue Code	278
Min. Negotiated Rate	$1,056.00
Max. Negotiated Rate	$1,703.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,703.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,056.00

HEAD MODULAR 48 M2A MAG 157448

Facility

$6,140.00

Hospital Charge Code	270635324
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

HEAD MODULAR 48 M2A MAG 157448

Facility

$6,140.00

Hospital Charge Code	270635324
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

HEAD MODULAR 50mm M2A MAGNUM

Facility

$6,090.95

Hospital Charge Code	270636166
Hospital Revenue Code	278
Min. Negotiated Rate	$146.79
Max. Negotiated Rate	$3,045.47
Rate for Payer: Aetna Commercial	$2,314.56
Rate for Payer: Aetna Medicare Advantage	$1,827.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,553.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,553.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,553.19
Rate for Payer: Cigna Commercial	$3,045.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.01
Rate for Payer: Qualcare PPO/HMO/WC	$913.64
Rate for Payer: UnitedHealthcare Community & State	$146.79
Rate for Payer: Wellpoint Medicaid Managed Care	$161.41

HEAD MODULAR 50mm M2A MAGNUM

Facility

$6,090.95

Hospital Charge Code	270636166
Hospital Revenue Code	278
Min. Negotiated Rate	$913.64
Max. Negotiated Rate	$1,474.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.01
Rate for Payer: Qualcare PPO/HMO/WC	$913.64

HEAD MODULAR 54mm M2A 157454

Facility

$6,140.00

Hospital Charge Code	270638623
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

HEAD MODULAR 54mm M2A 157454

Facility

$6,140.00

Hospital Charge Code	270638623
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

HEAD MODULAR CONSTRAIN 36/-9m

Facility

$8,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270686596
Hospital Revenue Code	278
Min. Negotiated Rate	$215.57
Max. Negotiated Rate	$4,472.50
Rate for Payer: Aetna Commercial	$3,399.10
Rate for Payer: Aetna Medicare Advantage	$2,683.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,280.97
Rate for Payer: Cigna Commercial	$4,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,967.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75
Rate for Payer: UnitedHealthcare Community & State	$215.57
Rate for Payer: Wellpoint Medicaid Managed Care	$237.04

HEAD MODULAR CONSTRAIN 36/-9m

Facility

$8,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270686596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,341.75
Max. Negotiated Rate	$2,164.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,967.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75

HEAD MODULAR FEM 36 MM

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270632967
Hospital Revenue Code	278
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$661.10
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$72.42
Rate for Payer: Wellpoint Medicaid Managed Care	$79.63

HEAD MODULAR FEM 36 MM

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270632967
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$661.10
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

Know your out-of-pocket cost for care.

All Charges