Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT IMPLANT BRCE SYST AR1638CP

Facility

$8,099.00

Service Code	HCPCS C1713
Hospital Charge Code	270698671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,214.85
Max. Negotiated Rate	$1,959.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,619.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,959.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,781.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,214.85

KIT IMPLANT TOE SGARLATO B

Facility

$3,218.45

Hospital Charge Code	270608799
Hospital Revenue Code	278
Min. Negotiated Rate	$77.56
Max. Negotiated Rate	$1,609.22
Rate for Payer: Aetna Commercial	$1,223.01
Rate for Payer: Aetna Medicare Advantage	$965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$820.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$820.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$820.70
Rate for Payer: Cigna Commercial	$1,609.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$708.06
Rate for Payer: Qualcare PPO/HMO/WC	$482.77
Rate for Payer: UnitedHealthcare Community & State	$77.56
Rate for Payer: Wellpoint Medicaid Managed Care	$85.29

KIT IMPLANT TOE SGARLATO B

Facility

$3,218.45

Hospital Charge Code	270608799
Hospital Revenue Code	278
Min. Negotiated Rate	$482.77
Max. Negotiated Rate	$778.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$708.06
Rate for Payer: Qualcare PPO/HMO/WC	$482.77

KIT INFLATION SYRINGE 3-WAY

Facility

$225.00

Hospital Charge Code	270658333
Hospital Revenue Code	271
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

KIT INFLATION SYRINGE 3-WAY

Facility

$225.00

Hospital Charge Code	270658333
Hospital Revenue Code	271
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

KIT INFUSAID REFILL ******

Facility

$78.00

Hospital Charge Code	7000870
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$15.60
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

KIT INFUSAID REFILL ******

Facility

$78.00

Hospital Charge Code	7000870
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

KIT INFUSAID REFILL 40820

Facility

$37.65

Hospital Charge Code	270600825
Hospital Revenue Code	272
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

KIT INFUSAID REFILL 40820

Facility

$37.65

Hospital Charge Code	270600825
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.29
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$7.53
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

KIT IN-SITU BENDR CUT 530.521S

Facility

$387.25

Hospital Charge Code	270635021
Hospital Revenue Code	272
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.62
Rate for Payer: Aetna Commercial	$147.16
Rate for Payer: Aetna Medicare Advantage	$116.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.75
Rate for Payer: Cigna Commercial	$193.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.17
Rate for Payer: Oxford Commercial	$77.45
Rate for Payer: Qualcare PPO/HMO/WC	$58.09
Rate for Payer: UnitedHealthcare Commercial	$77.45
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

KIT IN-SITU BENDR CUT 530.521S

Facility

$387.25

Hospital Charge Code	270635021
Hospital Revenue Code	272
Min. Negotiated Rate	$58.09
Max. Negotiated Rate	$58.09
Rate for Payer: Qualcare PPO/HMO/WC	$58.09

KIT INSTRMT T1 GRT TOE2483KIT1

Facility

$2,455.25

Hospital Charge Code	270611663
Hospital Revenue Code	272
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$1,227.62
Rate for Payer: Aetna Commercial	$933.00
Rate for Payer: Aetna Medicare Advantage	$736.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.09
Rate for Payer: Cigna Commercial	$1,227.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$736.58
Rate for Payer: Oxford Commercial	$491.05
Rate for Payer: Qualcare PPO/HMO/WC	$368.29
Rate for Payer: UnitedHealthcare Commercial	$491.05
Rate for Payer: UnitedHealthcare Community & State	$59.17
Rate for Payer: Wellpoint Medicaid Managed Care	$65.06

KIT INSTRMT T1 GRT TOE2483KIT1

Facility

$2,455.25

Hospital Charge Code	270611663
Hospital Revenue Code	272
Min. Negotiated Rate	$368.29
Max. Negotiated Rate	$368.29
Rate for Payer: Qualcare PPO/HMO/WC	$368.29

KIT INTERNAL BRACE IMPLANT

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270676522
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

KIT INTERNAL BRACE IMPLANT

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270676522
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

KIT INTERNAL BRACE LIS ANC

Facility

$7,475.00

Hospital Charge Code	270684906
Hospital Revenue Code	272
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

KIT INTERNAL BRACE LIS ANC

Facility

$7,475.00

Hospital Charge Code	270684906
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

KIT INTRAGASTRIC ORBERA

Facility

$500.00

Hospital Charge Code	270693543
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

KIT INTRAGASTRIC ORBERA

Facility

$500.00

Hospital Charge Code	270693543
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

KIT INTROD BILIARY STENT 3391

Facility

$616.00

Hospital Charge Code	270600935
Hospital Revenue Code	272
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

KIT INTROD BILIARY STENT 3391

Facility

$616.00

Hospital Charge Code	270600935
Hospital Revenue Code	272
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$234.08
Rate for Payer: Aetna Medicare Advantage	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.08
Rate for Payer: Cigna Commercial	$308.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.80
Rate for Payer: Oxford Commercial	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$92.40
Rate for Payer: UnitedHealthcare Commercial	$123.20
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$16.32

KIT INTRODUCER

Facility

$990.35

Hospital Charge Code	270670059
Hospital Revenue Code	272
Min. Negotiated Rate	$148.55
Max. Negotiated Rate	$148.55
Rate for Payer: Qualcare PPO/HMO/WC	$148.55

KIT INTRODUCER

Facility

$990.35

Hospital Charge Code	270670059
Hospital Revenue Code	272
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$495.18
Rate for Payer: Aetna Commercial	$376.33
Rate for Payer: Aetna Medicare Advantage	$297.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.54
Rate for Payer: Cigna Commercial	$495.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.11
Rate for Payer: Oxford Commercial	$198.07
Rate for Payer: Qualcare PPO/HMO/WC	$148.55
Rate for Payer: UnitedHealthcare Commercial	$198.07
Rate for Payer: UnitedHealthcare Community & State	$23.87
Rate for Payer: Wellpoint Medicaid Managed Care	$26.24

KIT INTRODUCER 10FR

Facility

$180.00

Hospital Charge Code	270605534
Hospital Revenue Code	272
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

KIT INTRODUCER 10FR

Facility

$180.00

Hospital Charge Code	270605534
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

Know your out-of-pocket cost for care.

All Charges