Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACK CUSTOM EYE AVIBMBM00706

Facility

$192.50

Hospital Charge Code	270642266
Hospital Revenue Code	272
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$28.88
Rate for Payer: Qualcare PPO/HMO/WC	$28.88

PACK CUSTOM EYE AVIBMBM00706

Facility

$192.50

Hospital Charge Code	270642266
Hospital Revenue Code	272
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$96.25
Rate for Payer: Aetna Commercial	$73.15
Rate for Payer: Aetna Medicare Advantage	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$96.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.75
Rate for Payer: Oxford Commercial	$38.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.88
Rate for Payer: UnitedHealthcare Commercial	$38.50
Rate for Payer: UnitedHealthcare Community & State	$4.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.10

PACK CUSTOM EYE PPK1468-02

Facility

$1,069.65

Hospital Charge Code	270623323
Hospital Revenue Code	272
Min. Negotiated Rate	$160.45
Max. Negotiated Rate	$160.45
Rate for Payer: Qualcare PPO/HMO/WC	$160.45

PACK CUSTOM EYE PPK1468-02

Facility

$1,069.65

Hospital Charge Code	270623323
Hospital Revenue Code	272
Min. Negotiated Rate	$25.78
Max. Negotiated Rate	$534.83
Rate for Payer: Aetna Commercial	$406.47
Rate for Payer: Aetna Medicare Advantage	$320.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.76
Rate for Payer: Cigna Commercial	$534.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.89
Rate for Payer: Oxford Commercial	$213.93
Rate for Payer: Qualcare PPO/HMO/WC	$160.45
Rate for Payer: UnitedHealthcare Commercial	$213.93
Rate for Payer: UnitedHealthcare Community & State	$25.78
Rate for Payer: Wellpoint Medicaid Managed Care	$28.35

PACK CUSTOM EYE PPK1469-02

Facility

$959.00

Hospital Charge Code	270623324
Hospital Revenue Code	272
Min. Negotiated Rate	$23.11
Max. Negotiated Rate	$479.50
Rate for Payer: Aetna Commercial	$364.42
Rate for Payer: Aetna Medicare Advantage	$287.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.54
Rate for Payer: Cigna Commercial	$479.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.70
Rate for Payer: Oxford Commercial	$191.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.85
Rate for Payer: UnitedHealthcare Commercial	$191.80
Rate for Payer: UnitedHealthcare Community & State	$23.11
Rate for Payer: Wellpoint Medicaid Managed Care	$25.41

PACK CUSTOM EYE PPK1469-02

Facility

$959.00

Hospital Charge Code	270623324
Hospital Revenue Code	272
Min. Negotiated Rate	$143.85
Max. Negotiated Rate	$143.85
Rate for Payer: Qualcare PPO/HMO/WC	$143.85

PACK CUSTOM EYE SEY11EYBYA

Facility

$248.00

Hospital Charge Code	270622793
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$94.24
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: Oxford Commercial	$49.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$49.60
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

PACK CUSTOM EYE SEY11EYBYA

Facility

$248.00

Hospital Charge Code	270622793
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

PACK CUSTOM KIT LAP SMA11GLBYA

Facility

$285.85

Hospital Charge Code	270632133
Hospital Revenue Code	272
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$42.88
Rate for Payer: Qualcare PPO/HMO/WC	$42.88

PACK CUSTOM KIT LAP SMA11GLBYA

Facility

$285.85

Hospital Charge Code	270632133
Hospital Revenue Code	272
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$142.93
Rate for Payer: Aetna Commercial	$108.62
Rate for Payer: Aetna Medicare Advantage	$85.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.89
Rate for Payer: Cigna Commercial	$142.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.75
Rate for Payer: Oxford Commercial	$57.17
Rate for Payer: Qualcare PPO/HMO/WC	$42.88
Rate for Payer: UnitedHealthcare Commercial	$57.17
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

PACK CUSTOM LAPAROSCOPY LPBYB

Facility

$309.65

Hospital Charge Code	270619914
Hospital Revenue Code	272
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$46.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

PACK CUSTOM LAPAROSCOPY LPBYB

Facility

$309.65

Hospital Charge Code	270619914
Hospital Revenue Code	272
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.89
Rate for Payer: Oxford Commercial	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Commercial	$61.93
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

PACK CUSTOM LAP CHOLE

Facility

$259.05

Hospital Charge Code	270642270
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$129.53
Rate for Payer: Aetna Commercial	$98.44
Rate for Payer: Aetna Medicare Advantage	$77.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.06
Rate for Payer: Cigna Commercial	$129.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.72
Rate for Payer: Oxford Commercial	$51.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.86
Rate for Payer: UnitedHealthcare Commercial	$51.81
Rate for Payer: UnitedHealthcare Community & State	$6.24
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

PACK CUSTOM LAP CHOLE

Facility

$259.05

Hospital Charge Code	270642270
Hospital Revenue Code	272
Min. Negotiated Rate	$38.86
Max. Negotiated Rate	$38.86
Rate for Payer: Qualcare PPO/HMO/WC	$38.86

PACK CUSTOM MAJOR

Facility

$720.00

Hospital Charge Code	270619913
Hospital Revenue Code	272
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$273.60
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.00
Rate for Payer: Oxford Commercial	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00
Rate for Payer: UnitedHealthcare Commercial	$144.00
Rate for Payer: UnitedHealthcare Community & State	$17.35
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

PACK CUSTOM MAJOR

Facility

$720.00

Hospital Charge Code	270619913
Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

PACK CUSTOM MAJR AVIBMBM005-10

Facility

$242.30

Hospital Charge Code	270642264
Hospital Revenue Code	272
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$121.15
Rate for Payer: Aetna Commercial	$92.07
Rate for Payer: Aetna Medicare Advantage	$72.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.79
Rate for Payer: Cigna Commercial	$121.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.69
Rate for Payer: Oxford Commercial	$48.46
Rate for Payer: Qualcare PPO/HMO/WC	$36.34
Rate for Payer: UnitedHealthcare Commercial	$48.46
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.42

PACK CUSTOM MAJR AVIBMBM005-10

Facility

$242.30

Hospital Charge Code	270642264
Hospital Revenue Code	272
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$36.34
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

PACK CUSTOM MINOR AVIBMBM00408

Facility

$139.75

Hospital Charge Code	270642263
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$69.88
Rate for Payer: Aetna Commercial	$53.10
Rate for Payer: Aetna Medicare Advantage	$41.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.64
Rate for Payer: Cigna Commercial	$69.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.92
Rate for Payer: Oxford Commercial	$27.95
Rate for Payer: Qualcare PPO/HMO/WC	$20.96
Rate for Payer: UnitedHealthcare Commercial	$27.95
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.70

PACK CUSTOM MINOR AVIBMBM00408

Facility

$139.75

Hospital Charge Code	270642263
Hospital Revenue Code	272
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$20.96
Rate for Payer: Qualcare PPO/HMO/WC	$20.96

PACK CUSTOM MINOR SBA11MIBYA

Facility

$415.00

Hospital Charge Code	270619912
Hospital Revenue Code	272
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$157.70
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.50
Rate for Payer: Oxford Commercial	$83.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Commercial	$83.00
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.00

PACK CUSTOM MINOR SBA11MIBYA

Facility

$415.00

Hospital Charge Code	270619912
Hospital Revenue Code	272
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$62.25
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

PACK CUSTOM NONVASC SBA11ANBYA

Facility

$254.45

Hospital Charge Code	270626894
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$127.22
Rate for Payer: Aetna Commercial	$96.69
Rate for Payer: Aetna Medicare Advantage	$76.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.88
Rate for Payer: Cigna Commercial	$127.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.33
Rate for Payer: Oxford Commercial	$50.89
Rate for Payer: Qualcare PPO/HMO/WC	$38.17
Rate for Payer: UnitedHealthcare Commercial	$50.89
Rate for Payer: UnitedHealthcare Community & State	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.74

PACK CUSTOM NONVASC SBA11ANBYA

Facility

$254.45

Hospital Charge Code	270626894
Hospital Revenue Code	272
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$38.17
Rate for Payer: Qualcare PPO/HMO/WC	$38.17

PACK CUSTOM TOTAL JOINT

Facility

$898.15

Hospital Charge Code	270653777
Hospital Revenue Code	272
Min. Negotiated Rate	$134.72
Max. Negotiated Rate	$134.72
Rate for Payer: Qualcare PPO/HMO/WC	$134.72

Know your out-of-pocket cost for care.

All Charges