Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT KYPHOPLASTY FIRST FRACTURE

Facility

$14,968.80

Service Code	HCPCS C1713
Hospital Charge Code	270679165
Hospital Revenue Code	278
Min. Negotiated Rate	$2,245.32
Max. Negotiated Rate	$3,622.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,993.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,622.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,293.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,245.32

KIT KYPHOPLASTY FIRST FRACTURE

Facility

$14,968.80

Service Code	HCPCS C1713
Hospital Charge Code	270679165
Hospital Revenue Code	278
Min. Negotiated Rate	$360.75
Max. Negotiated Rate	$7,484.40
Rate for Payer: Aetna Commercial	$5,688.14
Rate for Payer: Aetna Medicare Advantage	$4,490.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,817.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,817.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,993.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,817.04
Rate for Payer: Cigna Commercial	$7,484.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,622.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,293.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,245.32
Rate for Payer: UnitedHealthcare Community & State	$360.75
Rate for Payer: Wellpoint Medicaid Managed Care	$396.67

KIT KYPHOPLASTY KPX153

Facility

$14,968.80

Hospital Charge Code	270647891C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,245.32
Max. Negotiated Rate	$2,245.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,245.32

KIT KYPHOPLASTY KPX153

Facility

$14,968.80

Hospital Charge Code	270647891C
Hospital Revenue Code	272
Min. Negotiated Rate	$360.75
Max. Negotiated Rate	$7,484.40
Rate for Payer: Aetna Commercial	$5,688.14
Rate for Payer: Aetna Medicare Advantage	$4,490.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,817.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,817.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,817.04
Rate for Payer: Cigna Commercial	$7,484.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.64
Rate for Payer: Oxford Commercial	$2,993.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,245.32
Rate for Payer: UnitedHealthcare Commercial	$2,993.76
Rate for Payer: UnitedHealthcare Community & State	$360.75
Rate for Payer: Wellpoint Medicaid Managed Care	$396.67

KIT LAPAROSC CHOLE CUSTOM****

Facility

$2,174.00

Hospital Charge Code	1606060
Hospital Revenue Code	272
Min. Negotiated Rate	$52.39
Max. Negotiated Rate	$1,087.00
Rate for Payer: Aetna Commercial	$826.12
Rate for Payer: Aetna Medicare Advantage	$652.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.37
Rate for Payer: Cigna Commercial	$1,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.20
Rate for Payer: Oxford Commercial	$434.80
Rate for Payer: Qualcare PPO/HMO/WC	$326.10
Rate for Payer: UnitedHealthcare Commercial	$434.80
Rate for Payer: UnitedHealthcare Community & State	$52.39
Rate for Payer: Wellpoint Medicaid Managed Care	$57.61

KIT LAPAROSC CHOLE CUSTOM****

Facility

$2,174.00

Hospital Charge Code	1606060
Hospital Revenue Code	272
Min. Negotiated Rate	$326.10
Max. Negotiated Rate	$326.10
Rate for Payer: Qualcare PPO/HMO/WC	$326.10

KIT LAPAROSC HERNIA CUSTOM****

Facility

$4,236.00

Hospital Charge Code	1606052
Hospital Revenue Code	272
Min. Negotiated Rate	$635.40
Max. Negotiated Rate	$635.40
Rate for Payer: Qualcare PPO/HMO/WC	$635.40

KIT LAPAROSC HERNIA CUSTOM****

Facility

$4,236.00

Hospital Charge Code	1606052
Hospital Revenue Code	272
Min. Negotiated Rate	$102.09
Max. Negotiated Rate	$2,118.00
Rate for Payer: Aetna Commercial	$1,609.68
Rate for Payer: Aetna Medicare Advantage	$1,270.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,080.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,080.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,080.18
Rate for Payer: Cigna Commercial	$2,118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.80
Rate for Payer: Oxford Commercial	$847.20
Rate for Payer: Qualcare PPO/HMO/WC	$635.40
Rate for Payer: UnitedHealthcare Commercial	$847.20
Rate for Payer: UnitedHealthcare Community & State	$102.09
Rate for Payer: Wellpoint Medicaid Managed Care	$112.25

KIT LAP CHOLE CUSTOM 6/ST

Facility

$1,712.05

Hospital Charge Code	270658611
Hospital Revenue Code	272
Min. Negotiated Rate	$41.26
Max. Negotiated Rate	$856.02
Rate for Payer: Aetna Commercial	$650.58
Rate for Payer: Aetna Medicare Advantage	$513.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.57
Rate for Payer: Cigna Commercial	$856.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.62
Rate for Payer: Oxford Commercial	$342.41
Rate for Payer: Qualcare PPO/HMO/WC	$256.81
Rate for Payer: UnitedHealthcare Commercial	$342.41
Rate for Payer: UnitedHealthcare Community & State	$41.26
Rate for Payer: Wellpoint Medicaid Managed Care	$45.37

KIT LAP CHOLE CUSTOM 6/ST

Facility

$1,712.05

Hospital Charge Code	270658611
Hospital Revenue Code	272
Min. Negotiated Rate	$256.81
Max. Negotiated Rate	$256.81
Rate for Payer: Qualcare PPO/HMO/WC	$256.81

KIT LATERAL SUPPORT

Facility

$3,250.00

Hospital Charge Code	270703547
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

KIT LATERAL SUPPORT

Facility

$3,250.00

Hospital Charge Code	270703547
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

KIT LEAD

Facility

$6,950.00

Service Code	HCPCS C1778
Hospital Charge Code	270665617
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$3,475.00
Rate for Payer: Aetna Commercial	$2,641.00
Rate for Payer: Aetna Medicare Advantage	$2,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,772.25
Rate for Payer: Cigna Commercial	$3,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,529.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50
Rate for Payer: UnitedHealthcare Community & State	$167.50
Rate for Payer: Wellpoint Medicaid Managed Care	$184.18

KIT LEAD

Facility

$32,550.00

Service Code	HCPCS C1767
Hospital Charge Code	270663408
Hospital Revenue Code	278
Min. Negotiated Rate	$784.46
Max. Negotiated Rate	$16,275.00
Rate for Payer: Aetna Commercial	$12,369.00
Rate for Payer: Aetna Medicare Advantage	$9,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,300.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,300.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,300.25
Rate for Payer: Cigna Commercial	$16,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,877.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,161.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,882.50
Rate for Payer: UnitedHealthcare Community & State	$784.46
Rate for Payer: Wellpoint Medicaid Managed Care	$862.58

KIT LEAD

Facility

$6,950.00

Service Code	HCPCS C1778
Hospital Charge Code	270665617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$1,681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,529.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50

KIT LEAD

Facility

$12,800.00

Service Code	HCPCS C1897
Hospital Charge Code	270665899
Hospital Revenue Code	278
Min. Negotiated Rate	$308.48
Max. Negotiated Rate	$6,400.00
Rate for Payer: Aetna Commercial	$4,864.00
Rate for Payer: Aetna Medicare Advantage	$3,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,264.00
Rate for Payer: Cigna Commercial	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00
Rate for Payer: UnitedHealthcare Community & State	$308.48
Rate for Payer: Wellpoint Medicaid Managed Care	$339.20

KIT LEAD

Facility

$12,800.00

Service Code	HCPCS C1897
Hospital Charge Code	270665899
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$3,097.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00

KIT LEAD

Facility

$32,550.00

Service Code	HCPCS C1767
Hospital Charge Code	270663408
Hospital Revenue Code	278
Min. Negotiated Rate	$4,882.50
Max. Negotiated Rate	$7,877.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,877.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,161.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,882.50

KIT LEAD 3778-45

Facility

$11,950.00

Hospital Charge Code	270639468
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

KIT LEAD 3778-45

Facility

$11,950.00

Hospital Charge Code	270639468
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

KIT LEAD 90 CM LENGTH

Facility

$16,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270672151
Hospital Revenue Code	278
Min. Negotiated Rate	$387.41
Max. Negotiated Rate	$8,037.50
Rate for Payer: Aetna Commercial	$6,108.50
Rate for Payer: Aetna Medicare Advantage	$4,822.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,099.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,099.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,099.12
Rate for Payer: Cigna Commercial	$8,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,890.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,536.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,411.25
Rate for Payer: UnitedHealthcare Community & State	$387.41
Rate for Payer: Wellpoint Medicaid Managed Care	$425.99

KIT LEAD 90 CM LENGTH

Facility

$16,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270672151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,411.25
Max. Negotiated Rate	$3,890.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,890.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,536.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,411.25

KIT LEAD MEDTRONIC

Facility

$11,300.00

Hospital Charge Code	270648828
Hospital Revenue Code	272
Min. Negotiated Rate	$1,695.00
Max. Negotiated Rate	$1,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,695.00

KIT LEAD MEDTRONIC

Facility

$11,300.00

Hospital Charge Code	270648828
Hospital Revenue Code	272
Min. Negotiated Rate	$272.33
Max. Negotiated Rate	$5,650.00
Rate for Payer: Aetna Commercial	$4,294.00
Rate for Payer: Aetna Medicare Advantage	$3,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,881.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,881.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,881.50
Rate for Payer: Cigna Commercial	$5,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,390.00
Rate for Payer: Oxford Commercial	$2,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,695.00
Rate for Payer: UnitedHealthcare Commercial	$2,260.00
Rate for Payer: UnitedHealthcare Community & State	$272.33
Rate for Payer: Wellpoint Medicaid Managed Care	$299.45

KIT LEAD (MEDTRONIC) 3778-60

Facility

$12,547.50

Hospital Charge Code	270640282
Hospital Revenue Code	278
Min. Negotiated Rate	$302.39
Max. Negotiated Rate	$6,273.75
Rate for Payer: Aetna Commercial	$4,768.05
Rate for Payer: Aetna Medicare Advantage	$3,764.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,199.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,199.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,509.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,199.61
Rate for Payer: Cigna Commercial	$6,273.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,036.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,760.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,882.12
Rate for Payer: UnitedHealthcare Community & State	$302.39
Rate for Payer: Wellpoint Medicaid Managed Care	$332.51

Know your out-of-pocket cost for care.

All Charges