Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OPTIMUS X FIBER PLUS 10CC

Facility

$11,625.00

Hospital Charge Code	270703477
Hospital Revenue Code	278
Min. Negotiated Rate	$280.16
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,557.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$280.16
Rate for Payer: Wellpoint Medicaid Managed Care	$308.06

OPTIMUS X FIBER PLUS 2.5CC

Facility

$3,625.00

Service Code	HCPCS C1765
Hospital Charge Code	270706190
Hospital Revenue Code	278
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

OPTIMUS X FIBER PLUS 2.5CC

Facility

$3,625.00

Service Code	HCPCS C1765
Hospital Charge Code	270706190
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

OPTIRAY 320

Facility

$249.60

Hospital Charge Code	60635840
Hospital Revenue Code	255
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna Commercial	$94.85
Rate for Payer: Aetna Medicare Advantage	$74.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.65
Rate for Payer: Cigna Commercial	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.88
Rate for Payer: Oxford Commercial	$49.92
Rate for Payer: Qualcare PPO/HMO/WC	$37.44
Rate for Payer: UnitedHealthcare Commercial	$49.92
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.61

OPTIRAY 320

Facility

$249.60

Hospital Charge Code	60635840
Hospital Revenue Code	255
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$37.44

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$188.13
Rate for Payer: Aetna Commercial	$142.98
Rate for Payer: Aetna Medicare Advantage	$112.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.95
Rate for Payer: Cigna Commercial	$188.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.88
Rate for Payer: Oxford Commercial	$75.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$75.25
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626S
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627N
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627S
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

OPTI VISOR MP300 MP300

Facility

$74.45

Hospital Charge Code	270635629
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$28.29
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$37.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.34
Rate for Payer: Oxford Commercial	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.17
Rate for Payer: UnitedHealthcare Commercial	$14.89
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.97

OPTI VISOR MP300 MP300

Facility

$74.45

Hospital Charge Code	270635629
Hospital Revenue Code	272
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

OP TX ACLAV DISLOC ACUTE/CHRON

Facility

$48,992.10

Service Code	HCPCS 23550
Hospital Charge Code	16000612
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OP TX ACLAV DISLOC ACUTE/CHRON

Facility

$48,992.10

Service Code	HCPCS 23550
Hospital Charge Code	16000612
Hospital Revenue Code	360
Min. Negotiated Rate	$1,180.71
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,697.63
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,180.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,298.29

OP TX COMPL CRAN NRV FX W INT

Facility

$20,756.28

Service Code	HCPCS 21365
Hospital Charge Code	1600000640
Hospital Revenue Code	360
Min. Negotiated Rate	$3,113.44
Max. Negotiated Rate	$3,113.44
Rate for Payer: Qualcare PPO/HMO/WC	$3,113.44

OP TX COMPL CRAN NRV FX W INT

Facility

$20,756.28

Service Code	HCPCS 21365
Hospital Charge Code	1600000640
Hospital Revenue Code	360
Min. Negotiated Rate	$500.23
Max. Negotiated Rate	$25,386.70
Rate for Payer: Aetna Commercial	$19,129.52
Rate for Payer: Aetna Medicare Advantage	$22,786.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,032.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,386.70
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: Cigna Medicare Advantage	$7,032.91
Rate for Payer: Clover Medicare Advantage	$6,681.26
Rate for Payer: EmblemHealth Commercial	$21,098.73
Rate for Payer: Humana Medicare Advantage	$7,243.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,032.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,226.88
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,113.44
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$500.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,032.91
Rate for Payer: Wellcare Medicare Advantage	$7,032.91
Rate for Payer: Wellpoint Medicaid Managed Care	$550.04

OP TX FEM SFT FX W US EXAM

Facility

$15,091.30

Service Code	HCPCS 27506
Hospital Charge Code	1600000326
Hospital Revenue Code	360
Min. Negotiated Rate	$2,263.70
Max. Negotiated Rate	$2,263.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,263.70

OP TX FEM SFT FX W US EXAM

Facility

$15,091.30

Service Code	HCPCS 27506
Hospital Charge Code	1600000326
Hospital Revenue Code	360
Min. Negotiated Rate	$363.70
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,527.39
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,263.70
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$363.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$399.92

OP TX HUMERS SHFT FX,PLT/SCRW

Facility

$63,943.60

Service Code	HCPCS 24515
Hospital Charge Code	1600000619
Hospital Revenue Code	360
Min. Negotiated Rate	$1,541.04
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,183.08
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,541.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,694.51

OP TX HUMERS SHFT FX,PLT/SCRW

Facility

$63,943.60

Service Code	HCPCS 24515
Hospital Charge Code	1600000619
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

Know your out-of-pocket cost for care.

All Charges