Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACK KIT LAPAROSCOPY CHOLE I

Facility

$191.99

Hospital Charge Code	270688554
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$72.96
Rate for Payer: Aetna Medicare Advantage	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.96
Rate for Payer: Cigna Commercial	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.60
Rate for Payer: Oxford Commercial	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.80
Rate for Payer: UnitedHealthcare Commercial	$38.40
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.09

PACK KNEE ARTHROSCOPY

Facility

$305.10

Hospital Charge Code	270653776
Hospital Revenue Code	272
Min. Negotiated Rate	$45.77
Max. Negotiated Rate	$45.77
Rate for Payer: Qualcare PPO/HMO/WC	$45.77

PACK KNEE ARTHROSCOPY

Facility

$305.10

Hospital Charge Code	270653776
Hospital Revenue Code	272
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$152.55
Rate for Payer: Aetna Commercial	$115.94
Rate for Payer: Aetna Medicare Advantage	$91.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.80
Rate for Payer: Cigna Commercial	$152.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.53
Rate for Payer: Oxford Commercial	$61.02
Rate for Payer: Qualcare PPO/HMO/WC	$45.77
Rate for Payer: UnitedHealthcare Commercial	$61.02
Rate for Payer: UnitedHealthcare Community & State	$7.35
Rate for Payer: Wellpoint Medicaid Managed Care	$8.09

PACK KNEE ARTHROSCOPY 102448

Facility

$1,207.90

Hospital Charge Code	270653776V
Hospital Revenue Code	272
Min. Negotiated Rate	$181.19
Max. Negotiated Rate	$181.19
Rate for Payer: Qualcare PPO/HMO/WC	$181.19

PACK KNEE ARTHROSCOPY 102448

Facility

$1,207.90

Hospital Charge Code	270653776V
Hospital Revenue Code	272
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$603.95
Rate for Payer: Aetna Commercial	$459.00
Rate for Payer: Aetna Medicare Advantage	$362.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.01
Rate for Payer: Cigna Commercial	$603.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.37
Rate for Payer: Oxford Commercial	$241.58
Rate for Payer: Qualcare PPO/HMO/WC	$181.19
Rate for Payer: UnitedHealthcare Commercial	$241.58
Rate for Payer: UnitedHealthcare Community & State	$29.11
Rate for Payer: Wellpoint Medicaid Managed Care	$32.01

PACK LAPAROSCOPY GENERAL

Facility

$262.20

Hospital Charge Code	270653773
Hospital Revenue Code	272
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$131.10
Rate for Payer: Aetna Commercial	$99.64
Rate for Payer: Aetna Medicare Advantage	$78.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.86
Rate for Payer: Cigna Commercial	$131.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.66
Rate for Payer: Oxford Commercial	$52.44
Rate for Payer: Qualcare PPO/HMO/WC	$39.33
Rate for Payer: UnitedHealthcare Commercial	$52.44
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$6.95

PACK LAPAROSCOPY GENERAL

Facility

$262.20

Hospital Charge Code	270653773
Hospital Revenue Code	272
Min. Negotiated Rate	$39.33
Max. Negotiated Rate	$39.33
Rate for Payer: Qualcare PPO/HMO/WC	$39.33

PACK LAPAROSCOPY PELVI 89220

Facility

$72.85

Hospital Charge Code	270613257
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

PACK LAPAROSCOPY PELVI 89220

Facility

$72.85

Hospital Charge Code	270613257
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

PACK LAPAROTOMY XII 88094

Facility

$148.00

Hospital Charge Code	270609205
Hospital Revenue Code	272
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

PACK LAPAROTOMY XII 88094

Facility

$148.00

Hospital Charge Code	270609205
Hospital Revenue Code	272
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$74.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$29.60
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$29.60
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

PACK LAP/PELVISCOPY II 88222

Facility

$153.65

Hospital Charge Code	270609207
Hospital Revenue Code	272
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$30.73
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

PACK LAP/PELVISCOPY II 88222

Facility

$153.65

Hospital Charge Code	270609207
Hospital Revenue Code	272
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

PACK LINEN DISP *******

Facility

$50.00

Hospital Charge Code	1801059
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PACK LINEN DISP *******

Facility

$50.00

Hospital Charge Code	1801059
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

PACK LITHOTOMY II 88521

Facility

$72.85

Hospital Charge Code	270609206
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

PACK LITHOTOMY II 88521

Facility

$72.85

Hospital Charge Code	270609206
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

PACK LITHOTOMY II 9175 PERI/GY

Facility

$100.37

Hospital Charge Code	270653803
Hospital Revenue Code	272
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$50.19
Rate for Payer: Aetna Commercial	$38.14
Rate for Payer: Aetna Medicare Advantage	$30.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.59
Rate for Payer: Cigna Commercial	$50.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.11
Rate for Payer: Oxford Commercial	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$15.06
Rate for Payer: UnitedHealthcare Commercial	$20.07
Rate for Payer: UnitedHealthcare Community & State	$2.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

PACK LITHOTOMY II 9175 PERI/GY

Facility

$100.37

Hospital Charge Code	270653803
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$15.06
Rate for Payer: Qualcare PPO/HMO/WC	$15.06

PACK MAJOR LAPAROTOMY CUSTOM

Facility

$245.60

Hospital Charge Code	270653792
Hospital Revenue Code	272
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.80
Rate for Payer: Aetna Commercial	$93.33
Rate for Payer: Aetna Medicare Advantage	$73.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.63
Rate for Payer: Cigna Commercial	$122.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.68
Rate for Payer: Oxford Commercial	$49.12
Rate for Payer: Qualcare PPO/HMO/WC	$36.84
Rate for Payer: UnitedHealthcare Commercial	$49.12
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

PACK MAJOR LAPAROTOMY CUSTOM

Facility

$245.60

Hospital Charge Code	270653792
Hospital Revenue Code	272
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$36.84

PACK MCP TOT JT DISPOS

Facility

$2,680.00

Hospital Charge Code	270697844
Hospital Revenue Code	270
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$1,340.00
Rate for Payer: Aetna Commercial	$1,018.40
Rate for Payer: Aetna Medicare Advantage	$804.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.40
Rate for Payer: Cigna Commercial	$1,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$804.00
Rate for Payer: Oxford Commercial	$536.00
Rate for Payer: Qualcare PPO/HMO/WC	$402.00
Rate for Payer: UnitedHealthcare Commercial	$536.00
Rate for Payer: UnitedHealthcare Community & State	$64.59
Rate for Payer: Wellpoint Medicaid Managed Care	$71.02

PACK MCP TOT JT DISPOS

Facility

$2,680.00

Hospital Charge Code	270697844
Hospital Revenue Code	270
Min. Negotiated Rate	$402.00
Max. Negotiated Rate	$402.00
Rate for Payer: Qualcare PPO/HMO/WC	$402.00

PACK MINOR CUSTOMIZED

Facility

$223.05

Hospital Charge Code	270653794
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$111.53
Rate for Payer: Aetna Commercial	$84.76
Rate for Payer: Aetna Medicare Advantage	$66.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.88
Rate for Payer: Cigna Commercial	$111.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.92
Rate for Payer: Oxford Commercial	$44.61
Rate for Payer: Qualcare PPO/HMO/WC	$33.46
Rate for Payer: UnitedHealthcare Commercial	$44.61
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

PACK MINOR CUSTOMIZED

Facility

$223.05

Hospital Charge Code	270653794
Hospital Revenue Code	272
Min. Negotiated Rate	$33.46
Max. Negotiated Rate	$33.46
Rate for Payer: Qualcare PPO/HMO/WC	$33.46

Know your out-of-pocket cost for care.

All Charges