Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MESH PROLOOP PLUG XL

Facility

$1,333.80

Service Code	HCPCS C1781
Hospital Charge Code	270655388
Hospital Revenue Code	278
Min. Negotiated Rate	$200.07
Max. Negotiated Rate	$322.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$293.44
Rate for Payer: Qualcare PPO/HMO/WC	$200.07

MESH PROLOOP PLUG XL

Facility

$1,333.80

Service Code	HCPCS C1781
Hospital Charge Code	270655388
Hospital Revenue Code	278
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$666.90
Rate for Payer: Aetna Commercial	$506.84
Rate for Payer: Aetna Medicare Advantage	$400.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.12
Rate for Payer: Cigna Commercial	$666.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$293.44
Rate for Payer: Qualcare PPO/HMO/WC	$200.07
Rate for Payer: UnitedHealthcare Community & State	$32.14
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

MESH PROLOOP PLUG X-LG 2/BOX

Facility

$722.75

Service Code	HCPCS C1781
Hospital Charge Code	270654230
Hospital Revenue Code	278
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$361.38
Rate for Payer: Aetna Commercial	$274.64
Rate for Payer: Aetna Medicare Advantage	$216.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.30
Rate for Payer: Cigna Commercial	$361.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.41
Rate for Payer: UnitedHealthcare Community & State	$17.42
Rate for Payer: Wellpoint Medicaid Managed Care	$19.15

MESH PROLOOP PLUG X-LG 2/BOX

Facility

$722.75

Service Code	HCPCS C1781
Hospital Charge Code	270654230
Hospital Revenue Code	278
Min. Negotiated Rate	$108.41
Max. Negotiated Rate	$174.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.41

MESH PROLOOP X-LG 30903

Facility

$666.90

Hospital Charge Code	270660258
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$333.45
Rate for Payer: Aetna Commercial	$253.42
Rate for Payer: Aetna Medicare Advantage	$200.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.06
Rate for Payer: Cigna Commercial	$333.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.07
Rate for Payer: Oxford Commercial	$133.38
Rate for Payer: Qualcare PPO/HMO/WC	$100.03
Rate for Payer: UnitedHealthcare Commercial	$133.38
Rate for Payer: UnitedHealthcare Community & State	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.67

MESH PROLOOP X-LG 30903

Facility

$666.90

Hospital Charge Code	270660258
Hospital Revenue Code	272
Min. Negotiated Rate	$100.03
Max. Negotiated Rate	$100.03
Rate for Payer: Qualcare PPO/HMO/WC	$100.03

MESH PROMOCOL 20*40

Facility

$96,387.00

Hospital Charge Code	270667627
Hospital Revenue Code	278
Min. Negotiated Rate	$14,458.05
Max. Negotiated Rate	$23,325.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19,277.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23,325.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21,205.14
Rate for Payer: Qualcare PPO/HMO/WC	$14,458.05

MESH PROMOCOL 20*40

Facility

$96,387.00

Hospital Charge Code	270667627
Hospital Revenue Code	278
Min. Negotiated Rate	$2,322.93
Max. Negotiated Rate	$48,193.50
Rate for Payer: Aetna Commercial	$36,627.06
Rate for Payer: Aetna Medicare Advantage	$28,916.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,578.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,578.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19,277.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,578.69
Rate for Payer: Cigna Commercial	$48,193.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23,325.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21,205.14
Rate for Payer: Qualcare PPO/HMO/WC	$14,458.05
Rate for Payer: UnitedHealthcare Community & State	$2,322.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2,554.26

MESH PTEX PCOX 12CM 4.8 ROUND

Facility

$2,533.05

Service Code	HCPCS C1781
Hospital Charge Code	270655028
Hospital Revenue Code	278
Min. Negotiated Rate	$379.96
Max. Negotiated Rate	$613.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$613.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$557.27
Rate for Payer: Qualcare PPO/HMO/WC	$379.96

MESH PTEX PCOX 12CM 4.8 ROUND

Facility

$2,533.05

Service Code	HCPCS C1781
Hospital Charge Code	270655028
Hospital Revenue Code	278
Min. Negotiated Rate	$61.05
Max. Negotiated Rate	$1,266.53
Rate for Payer: Aetna Commercial	$962.56
Rate for Payer: Aetna Medicare Advantage	$759.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.93
Rate for Payer: Cigna Commercial	$1,266.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$613.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$557.27
Rate for Payer: Qualcare PPO/HMO/WC	$379.96
Rate for Payer: UnitedHealthcare Community & State	$61.05
Rate for Payer: Wellpoint Medicaid Managed Care	$67.13

MESH PTEX PCOX 15x10CM STR

Facility

$2,166.40

Service Code	HCPCS C1781
Hospital Charge Code	270655625
Hospital Revenue Code	278
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$1,083.20
Rate for Payer: Aetna Commercial	$823.23
Rate for Payer: Aetna Medicare Advantage	$649.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.43
Rate for Payer: Cigna Commercial	$1,083.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$476.61
Rate for Payer: Qualcare PPO/HMO/WC	$324.96
Rate for Payer: UnitedHealthcare Community & State	$52.21
Rate for Payer: Wellpoint Medicaid Managed Care	$57.41

MESH PTEX PCOX 15x10CM STR

Facility

$2,166.40

Service Code	HCPCS C1781
Hospital Charge Code	270655625
Hospital Revenue Code	278
Min. Negotiated Rate	$324.96
Max. Negotiated Rate	$524.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$476.61
Rate for Payer: Qualcare PPO/HMO/WC	$324.96

MESH PTEX PCOX 20X15CM 8X6 STE

Facility

$3,492.20

Service Code	HCPCS C1781
Hospital Charge Code	270655623
Hospital Revenue Code	278
Min. Negotiated Rate	$523.83
Max. Negotiated Rate	$845.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.28
Rate for Payer: Qualcare PPO/HMO/WC	$523.83

MESH PTEX PCOX 20X15CM 8X6 STE

Facility

$3,492.20

Service Code	HCPCS C1781
Hospital Charge Code	270655623
Hospital Revenue Code	278
Min. Negotiated Rate	$84.16
Max. Negotiated Rate	$1,746.10
Rate for Payer: Aetna Commercial	$1,327.04
Rate for Payer: Aetna Medicare Advantage	$1,047.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$890.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$890.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$890.51
Rate for Payer: Cigna Commercial	$1,746.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.28
Rate for Payer: Qualcare PPO/HMO/WC	$523.83
Rate for Payer: UnitedHealthcare Community & State	$84.16
Rate for Payer: Wellpoint Medicaid Managed Care	$92.54

MESH PTEX PCOX ROUND 12CM STR

Facility

$2,155.80

Service Code	HCPCS C1781
Hospital Charge Code	270656033
Hospital Revenue Code	278
Min. Negotiated Rate	$323.37
Max. Negotiated Rate	$521.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$431.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$474.28
Rate for Payer: Qualcare PPO/HMO/WC	$323.37

MESH PTEX PCOX ROUND 12CM STR

Facility

$2,155.80

Service Code	HCPCS C1781
Hospital Charge Code	270656033
Hospital Revenue Code	278
Min. Negotiated Rate	$51.95
Max. Negotiated Rate	$1,077.90
Rate for Payer: Aetna Commercial	$819.20
Rate for Payer: Aetna Medicare Advantage	$646.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$549.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$549.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$431.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$549.73
Rate for Payer: Cigna Commercial	$1,077.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$474.28
Rate for Payer: Qualcare PPO/HMO/WC	$323.37
Rate for Payer: UnitedHealthcare Community & State	$51.95
Rate for Payer: Wellpoint Medicaid Managed Care	$57.13

MESH PTEX PCOX ROUND 15CM 6ST

Facility

$3,315.45

Service Code	HCPCS C1781
Hospital Charge Code	270655628
Hospital Revenue Code	278
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$1,657.72
Rate for Payer: Aetna Commercial	$1,259.87
Rate for Payer: Aetna Medicare Advantage	$994.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$845.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$845.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$663.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$845.44
Rate for Payer: Cigna Commercial	$1,657.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$802.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$729.40
Rate for Payer: Qualcare PPO/HMO/WC	$497.32
Rate for Payer: UnitedHealthcare Community & State	$79.90
Rate for Payer: Wellpoint Medicaid Managed Care	$87.86

MESH PTEX PCOX ROUND 15CM 6ST

Facility

$3,315.45

Service Code	HCPCS C1781
Hospital Charge Code	270655628
Hospital Revenue Code	278
Min. Negotiated Rate	$497.32
Max. Negotiated Rate	$802.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$663.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$802.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$729.40
Rate for Payer: Qualcare PPO/HMO/WC	$497.32

MESH PTEX PCOX ROUND 15CM STR

Facility

$3,288.05

Service Code	HCPCS C1781
Hospital Charge Code	270655030
Hospital Revenue Code	278
Min. Negotiated Rate	$79.24
Max. Negotiated Rate	$1,644.03
Rate for Payer: Aetna Commercial	$1,249.46
Rate for Payer: Aetna Medicare Advantage	$986.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$838.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$838.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$657.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$838.45
Rate for Payer: Cigna Commercial	$1,644.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.37
Rate for Payer: Qualcare PPO/HMO/WC	$493.21
Rate for Payer: UnitedHealthcare Community & State	$79.24
Rate for Payer: Wellpoint Medicaid Managed Care	$87.13

MESH PTEX PCOX ROUND 15CM STR

Facility

$3,288.05

Service Code	HCPCS C1781
Hospital Charge Code	270655030
Hospital Revenue Code	278
Min. Negotiated Rate	$493.21
Max. Negotiated Rate	$795.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$657.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.37
Rate for Payer: Qualcare PPO/HMO/WC	$493.21

MESH PTEX PCOX ROUND 20CM STR

Facility

$4,169.95

Service Code	HCPCS C1781
Hospital Charge Code	270655624
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$2,084.97
Rate for Payer: Aetna Commercial	$1,584.58
Rate for Payer: Aetna Medicare Advantage	$1,250.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$833.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.34
Rate for Payer: Cigna Commercial	$2,084.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.39
Rate for Payer: Qualcare PPO/HMO/WC	$625.49
Rate for Payer: UnitedHealthcare Community & State	$100.50
Rate for Payer: Wellpoint Medicaid Managed Care	$110.50

MESH PTEX PCOX ROUND 20CM STR

Facility

$4,169.95

Service Code	HCPCS C1781
Hospital Charge Code	270655624
Hospital Revenue Code	278
Min. Negotiated Rate	$625.49
Max. Negotiated Rate	$1,009.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$833.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.39
Rate for Payer: Qualcare PPO/HMO/WC	$625.49

MESH PTEX PCOX ROUND 9CM STR

Facility

$1,579.65

Service Code	HCPCS C1781
Hospital Charge Code	270655630
Hospital Revenue Code	278
Min. Negotiated Rate	$38.07
Max. Negotiated Rate	$789.83
Rate for Payer: Aetna Commercial	$600.27
Rate for Payer: Aetna Medicare Advantage	$473.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.81
Rate for Payer: Cigna Commercial	$789.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$347.52
Rate for Payer: Qualcare PPO/HMO/WC	$236.95
Rate for Payer: UnitedHealthcare Community & State	$38.07
Rate for Payer: Wellpoint Medicaid Managed Care	$41.86

MESH PTEX PCOX ROUND 9CM STR

Facility

$1,579.65

Service Code	HCPCS C1781
Hospital Charge Code	270655630
Hospital Revenue Code	278
Min. Negotiated Rate	$236.95
Max. Negotiated Rate	$382.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$347.52
Rate for Payer: Qualcare PPO/HMO/WC	$236.95

MESH PTEX PCOX SKIRT 20X15CM

Facility

$4,919.50

Service Code	HCPCS C1781
Hospital Charge Code	270656079
Hospital Revenue Code	278
Min. Negotiated Rate	$118.56
Max. Negotiated Rate	$2,459.75
Rate for Payer: Aetna Commercial	$1,869.41
Rate for Payer: Aetna Medicare Advantage	$1,475.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,254.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,254.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$983.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,254.47
Rate for Payer: Cigna Commercial	$2,459.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,190.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,082.29
Rate for Payer: Qualcare PPO/HMO/WC	$737.92
Rate for Payer: UnitedHealthcare Community & State	$118.56
Rate for Payer: Wellpoint Medicaid Managed Care	$130.37

Know your out-of-pocket cost for care.

All Charges