Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACIFIC PLUS 5X40X180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683484S
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

PACIFIC PLUS 5X40X180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683484S
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

Pacific Plus 5x60x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683485
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 5x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683485N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 5x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683485N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 5x60x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683485
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

Pacific Plus 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

PACIFIER NUK W/HANDLE

Facility

$7.42

Hospital Charge Code	270652256
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.71
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.89
Rate for Payer: Cigna Commercial	$3.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$1.48
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PACIFIER NUK W/HANDLE

Facility

$7.42

Hospital Charge Code	270652256
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

PACIFIER SOOTHIE

Facility

$13.65

Hospital Charge Code	270600479
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

PACIFIER SOOTHIE

Facility

$13.65

Hospital Charge Code	270600479
Hospital Revenue Code	270
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

PACING CHANDLER TRNSLM 98100H

Facility

$1,228.85

Hospital Charge Code	270110040
Hospital Revenue Code	270
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$614.42
Rate for Payer: Aetna Commercial	$466.96
Rate for Payer: Aetna Medicare Advantage	$368.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$313.36
Rate for Payer: Cigna Commercial	$614.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.65
Rate for Payer: Oxford Commercial	$245.77
Rate for Payer: Qualcare PPO/HMO/WC	$184.33
Rate for Payer: UnitedHealthcare Commercial	$245.77
Rate for Payer: UnitedHealthcare Community & State	$29.62
Rate for Payer: Wellpoint Medicaid Managed Care	$32.56

PACING CHANDLER TRNSLM 98100H

Facility

$1,228.85

Hospital Charge Code	270110040
Hospital Revenue Code	270
Min. Negotiated Rate	$184.33
Max. Negotiated Rate	$184.33
Rate for Payer: Qualcare PPO/HMO/WC	$184.33

PACK 4.0MM CINCH ANCHOR

Facility

$1,342.45

Hospital Charge Code	270605121
Hospital Revenue Code	272
Min. Negotiated Rate	$32.35
Max. Negotiated Rate	$671.23
Rate for Payer: Aetna Commercial	$510.13
Rate for Payer: Aetna Medicare Advantage	$402.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.32
Rate for Payer: Cigna Commercial	$671.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.74
Rate for Payer: Oxford Commercial	$268.49
Rate for Payer: Qualcare PPO/HMO/WC	$201.37
Rate for Payer: UnitedHealthcare Commercial	$268.49
Rate for Payer: UnitedHealthcare Community & State	$32.35
Rate for Payer: Wellpoint Medicaid Managed Care	$35.57

PACK 4.0MM CINCH ANCHOR

Facility

$1,342.45

Hospital Charge Code	270605121
Hospital Revenue Code	272
Min. Negotiated Rate	$201.37
Max. Negotiated Rate	$201.37
Rate for Payer: Qualcare PPO/HMO/WC	$201.37

PACK ALCON PHACO EMULS 10530F

Facility

$1,068.00

Hospital Charge Code	270614706
Hospital Revenue Code	272
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.00
Rate for Payer: Aetna Commercial	$405.84
Rate for Payer: Aetna Medicare Advantage	$320.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.34
Rate for Payer: Cigna Commercial	$534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.40
Rate for Payer: Oxford Commercial	$213.60
Rate for Payer: Qualcare PPO/HMO/WC	$160.20
Rate for Payer: UnitedHealthcare Commercial	$213.60
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.30

PACK ALCON PHACO EMULS 10530F

Facility

$1,068.00

Hospital Charge Code	270614706
Hospital Revenue Code	272
Min. Negotiated Rate	$160.20
Max. Negotiated Rate	$160.20
Rate for Payer: Qualcare PPO/HMO/WC	$160.20

PACK ANTERIOR VITRECTOMY

Facility

$830.00

Hospital Charge Code	270653347
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.00
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$166.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

Know your out-of-pocket cost for care.

All Charges