Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPL DEL SYS DIST BIOCOM BICEP

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681458
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

IMPLNT TESTCLR OVL SZ 3210-023

Facility

$2,976.00

Hospital Charge Code	270612829
Hospital Revenue Code	272
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$1,130.88
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.80
Rate for Payer: Oxford Commercial	$595.20
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$595.20
Rate for Payer: UnitedHealthcare Community & State	$71.72
Rate for Payer: Wellpoint Medicaid Managed Care	$78.86

IMPLNT TESTCLR OVL SZ 3210-023

Facility

$2,976.00

Hospital Charge Code	270612829
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-034

Facility

$2,976.00

Hospital Charge Code	270612830
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-034

Facility

$2,976.00

Hospital Charge Code	270612830
Hospital Revenue Code	272
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$1,130.88
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.80
Rate for Payer: Oxford Commercial	$595.20
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$595.20
Rate for Payer: UnitedHealthcare Community & State	$71.72
Rate for Payer: Wellpoint Medicaid Managed Care	$78.86

IMPLNT TESTCLR OVL SZ 3210-042

Facility

$2,976.00

Hospital Charge Code	270612831
Hospital Revenue Code	272
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$1,130.88
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.80
Rate for Payer: Oxford Commercial	$595.20
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$595.20
Rate for Payer: UnitedHealthcare Community & State	$71.72
Rate for Payer: Wellpoint Medicaid Managed Care	$78.86

IMPLNT TESTCLR OVL SZ 3210-042

Facility

$2,976.00

Hospital Charge Code	270612831
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-047

Facility

$2,976.00

Hospital Charge Code	270612832
Hospital Revenue Code	272
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$1,130.88
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.80
Rate for Payer: Oxford Commercial	$595.20
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$595.20
Rate for Payer: UnitedHealthcare Community & State	$71.72
Rate for Payer: Wellpoint Medicaid Managed Care	$78.86

IMPLNT TESTCLR OVL SZ 3210-047

Facility

$2,976.00

Hospital Charge Code	270612832
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-050

Facility

$2,976.00

Hospital Charge Code	270612833
Hospital Revenue Code	272
Min. Negotiated Rate	$71.72
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$1,130.88
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.80
Rate for Payer: Oxford Commercial	$595.20
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$595.20
Rate for Payer: UnitedHealthcare Community & State	$71.72
Rate for Payer: Wellpoint Medicaid Managed Care	$78.86

IMPLNT TESTCLR OVL SZ 3210-050

Facility

$2,976.00

Hospital Charge Code	270612833
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPL SUBTALAR HYPROCURE II SZ8

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693926
Hospital Revenue Code	278
Min. Negotiated Rate	$481.40
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$7,590.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25
Rate for Payer: UnitedHealthcare Community & State	$481.40
Rate for Payer: Wellpoint Medicaid Managed Care	$529.34

IMPL SUBTALAR HYPROCURE II SZ8

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

IMPLT PORT 19X1 SAF WO Y PWRLC

Facility

$57.00

Service Code	HCPCS C1788
Hospital Charge Code	270668314
Hospital Revenue Code	278
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

IMPLT PORT 19X1 SAF WO Y PWRLC

Facility

$57.00

Service Code	HCPCS C1788
Hospital Charge Code	270668314
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$13.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

IMP METATARSAL PHAL SZ 30

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668131
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$1,519.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,381.60
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

IMP METATARSAL PHAL SZ 30

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668131
Hospital Revenue Code	278
Min. Negotiated Rate	$151.35
Max. Negotiated Rate	$3,140.00
Rate for Payer: Aetna Commercial	$2,386.40
Rate for Payer: Aetna Medicare Advantage	$1,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.40
Rate for Payer: Cigna Commercial	$3,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,381.60
Rate for Payer: Qualcare PPO/HMO/WC	$942.00
Rate for Payer: UnitedHealthcare Community & State	$151.35
Rate for Payer: Wellpoint Medicaid Managed Care	$166.42

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.50
Rate for Payer: Oxford Commercial	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Commercial	$975.00
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$72.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,145.40
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$904.26
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$72.64
Rate for Payer: Wellpoint Medicaid Managed Care	$79.88

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$72.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,145.40
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$904.26
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$72.64
Rate for Payer: Wellpoint Medicaid Managed Care	$79.88

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMV SET-UP***

Facility

$32.40

Hospital Charge Code	9500463
Hospital Revenue Code	279
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

IMV SET-UP***

Facility

$32.40

Hospital Charge Code	9500463
Hospital Revenue Code	279
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna Commercial	$12.31
Rate for Payer: Aetna Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.72
Rate for Payer: Oxford Commercial	$6.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$6.48
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

Know your out-of-pocket cost for care.

All Charges