Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERLOCK 18MM X50CM

Facility

$4,777.50

Hospital Charge Code	270680002
Hospital Revenue Code	278
Min. Negotiated Rate	$115.14
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.05
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$115.14
Rate for Payer: Wellpoint Medicaid Managed Care	$126.60

INTERLOCK 20MM X50CM

Facility

$4,777.50

Hospital Charge Code	270679996
Hospital Revenue Code	278
Min. Negotiated Rate	$115.14
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.05
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$115.14
Rate for Payer: Wellpoint Medicaid Managed Care	$126.60

INTERLOCK 20MM X50CM

Facility

$4,777.50

Hospital Charge Code	270679996
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.05
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

INTERLOCK 22MM X30CM

Facility

$4,777.50

Hospital Charge Code	270679995
Hospital Revenue Code	278
Min. Negotiated Rate	$115.14
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.05
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$115.14
Rate for Payer: Wellpoint Medicaid Managed Care	$126.60

INTERLOCK 22MM X30CM

Facility

$4,777.50

Hospital Charge Code	270679995
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.05
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

Interlock 2D 4mm x 8cm

Facility

$2,572.50

Hospital Charge Code	270679431
Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.75
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

Interlock 2D 4mm x 8cm

Facility

$2,572.50

Hospital Charge Code	270679431
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK (3 WAY STOP COCK****

Facility

$4.00

Hospital Charge Code	8003154
Hospital Revenue Code	279
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

INTERLOCK (3 WAY STOP COCK****

Facility

$4.00

Hospital Charge Code	8003154
Hospital Revenue Code	279
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INTERLOCK 8MM X 20CM

Facility

$2,499.00

Hospital Charge Code	270662971
Hospital Revenue Code	278
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial	$949.62
Rate for Payer: Aetna Medicare Advantage	$749.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.25
Rate for Payer: Cigna Commercial	$1,249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$549.78
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Community & State	$60.23
Rate for Payer: Wellpoint Medicaid Managed Care	$66.22

INTERLOCK 8MM X 20CM

Facility

$2,499.00

Hospital Charge Code	270662971
Hospital Revenue Code	278
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$604.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$549.78
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	2680390
Hospital Revenue Code	272
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	2680390
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	7412025
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	7412025
Hospital Revenue Code	272
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

INTERLOCK OCLUSION SYSTEM 10 M

Facility

$2,697.50

Hospital Charge Code	270679435
Hospital Revenue Code	272
Min. Negotiated Rate	$404.62
Max. Negotiated Rate	$404.62
Rate for Payer: Qualcare PPO/HMO/WC	$404.62

INTERLOCK OCLUSION SYSTEM 10 M

Facility

$2,697.50

Hospital Charge Code	270679435
Hospital Revenue Code	272
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$1,348.75
Rate for Payer: Aetna Commercial	$1,025.05
Rate for Payer: Aetna Medicare Advantage	$809.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.86
Rate for Payer: Cigna Commercial	$1,348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$809.25
Rate for Payer: Oxford Commercial	$539.50
Rate for Payer: Qualcare PPO/HMO/WC	$404.62
Rate for Payer: UnitedHealthcare Commercial	$539.50
Rate for Payer: UnitedHealthcare Community & State	$65.01
Rate for Payer: Wellpoint Medicaid Managed Care	$71.48

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430O
Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.75
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430
Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.75
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430O
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 5 MM

Facility

$2,572.50

Hospital Charge Code	270679432
Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.75
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

INTERLOCK OCLUSION SYSTEM 5 MM

Facility

$2,572.50

Hospital Charge Code	270679432
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 6 MM

Facility

$2,572.50

Hospital Charge Code	270679433
Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.75
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

INTERLOCK OCLUSION SYSTEM 6 MM

Facility

$2,572.50

Hospital Charge Code	270679433
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

Know your out-of-pocket cost for care.

All Charges