Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATCH ATK CUFF 6.5 6 920000

Facility

$14,828.85

Hospital Charge Code	270629639
Hospital Revenue Code	272
Min. Negotiated Rate	$2,224.33
Max. Negotiated Rate	$2,224.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,224.33

PATCH ATK CUFF 6.5 6 920000

Facility

$14,828.85

Hospital Charge Code	270629639
Hospital Revenue Code	272
Min. Negotiated Rate	$357.38
Max. Negotiated Rate	$7,414.43
Rate for Payer: Aetna Commercial	$5,634.96
Rate for Payer: Aetna Medicare Advantage	$4,448.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,781.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,781.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,781.36
Rate for Payer: Cigna Commercial	$7,414.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,448.65
Rate for Payer: Oxford Commercial	$2,965.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,224.33
Rate for Payer: UnitedHealthcare Commercial	$2,965.77
Rate for Payer: UnitedHealthcare Community & State	$357.38
Rate for Payer: Wellpoint Medicaid Managed Care	$392.96

PATCH BD HERNIA 11 14 0010205

Facility

$4,221.00

Hospital Charge Code	270623365
Hospital Revenue Code	278
Min. Negotiated Rate	$101.73
Max. Negotiated Rate	$2,110.50
Rate for Payer: Aetna Commercial	$1,603.98
Rate for Payer: Aetna Medicare Advantage	$1,266.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$844.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,076.36
Rate for Payer: Cigna Commercial	$2,110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,021.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$928.62
Rate for Payer: Qualcare PPO/HMO/WC	$633.15
Rate for Payer: UnitedHealthcare Community & State	$101.73
Rate for Payer: Wellpoint Medicaid Managed Care	$111.86

PATCH BD HERNIA 11 14 0010205

Facility

$4,221.00

Hospital Charge Code	270623365
Hospital Revenue Code	278
Min. Negotiated Rate	$633.15
Max. Negotiated Rate	$1,021.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$844.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,021.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$928.62
Rate for Payer: Qualcare PPO/HMO/WC	$633.15

PATCH BD HERNIA 14 18 0010202

Facility

$5,351.90

Hospital Charge Code	270623366
Hospital Revenue Code	278
Min. Negotiated Rate	$128.98
Max. Negotiated Rate	$2,675.95
Rate for Payer: Aetna Commercial	$2,033.72
Rate for Payer: Aetna Medicare Advantage	$1,605.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,364.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,364.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,364.73
Rate for Payer: Cigna Commercial	$2,675.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,295.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,177.42
Rate for Payer: Qualcare PPO/HMO/WC	$802.78
Rate for Payer: UnitedHealthcare Community & State	$128.98
Rate for Payer: Wellpoint Medicaid Managed Care	$141.83

PATCH BD HERNIA 14 18 0010202

Facility

$5,351.90

Hospital Charge Code	270623366
Hospital Revenue Code	278
Min. Negotiated Rate	$802.78
Max. Negotiated Rate	$1,295.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,295.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,177.42
Rate for Payer: Qualcare PPO/HMO/WC	$802.78

PATCH BD HERNIA 8 12 0010201

Facility

$2,882.50

Hospital Charge Code	270623364
Hospital Revenue Code	278
Min. Negotiated Rate	$69.47
Max. Negotiated Rate	$1,441.25
Rate for Payer: Aetna Commercial	$1,095.35
Rate for Payer: Aetna Medicare Advantage	$864.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$735.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$735.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$735.04
Rate for Payer: Cigna Commercial	$1,441.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$634.15
Rate for Payer: Qualcare PPO/HMO/WC	$432.38
Rate for Payer: UnitedHealthcare Community & State	$69.47
Rate for Payer: Wellpoint Medicaid Managed Care	$76.39

PATCH BD HERNIA 8 12 0010201

Facility

$2,882.50

Hospital Charge Code	270623364
Hospital Revenue Code	278
Min. Negotiated Rate	$432.38
Max. Negotiated Rate	$697.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$634.15
Rate for Payer: Qualcare PPO/HMO/WC	$432.38

PATCH BD HERNIA 8 8 0010203

Facility

$2,362.50

Hospital Charge Code	270623794
Hospital Revenue Code	278
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$1,181.25
Rate for Payer: Aetna Commercial	$897.75
Rate for Payer: Aetna Medicare Advantage	$708.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$602.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$602.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$602.44
Rate for Payer: Cigna Commercial	$1,181.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$571.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$519.75
Rate for Payer: Qualcare PPO/HMO/WC	$354.38
Rate for Payer: UnitedHealthcare Community & State	$56.94
Rate for Payer: Wellpoint Medicaid Managed Care	$62.61

PATCH BD HERNIA 8 8 0010203

Facility

$2,362.50

Hospital Charge Code	270623794
Hospital Revenue Code	278
Min. Negotiated Rate	$354.38
Max. Negotiated Rate	$571.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$571.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$519.75
Rate for Payer: Qualcare PPO/HMO/WC	$354.38

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$249.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.60
Rate for Payer: Qualcare PPO/HMO/WC	$154.50

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$515.00
Rate for Payer: Aetna Commercial	$391.40
Rate for Payer: Aetna Medicare Advantage	$309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.65
Rate for Payer: Cigna Commercial	$515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.60
Rate for Payer: Qualcare PPO/HMO/WC	$154.50
Rate for Payer: UnitedHealthcare Community & State	$24.82
Rate for Payer: Wellpoint Medicaid Managed Care	$27.30

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PATCH EYE ***********

Facility

$1.00

Hospital Charge Code	8000648
Hospital Revenue Code	279
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

PATCH EYE ***********

Facility

$1.00

Hospital Charge Code	8000648
Hospital Revenue Code	279
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PATCH FASCIALATA 2X3 93-7200

Facility

$2,261.65

Hospital Charge Code	270613144
Hospital Revenue Code	272
Min. Negotiated Rate	$339.25
Max. Negotiated Rate	$339.25
Rate for Payer: Qualcare PPO/HMO/WC	$339.25

PATCH FASCIALATA 2X3 93-7200

Facility

$2,261.65

Hospital Charge Code	270613144
Hospital Revenue Code	272
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$1,130.83
Rate for Payer: Aetna Commercial	$859.43
Rate for Payer: Aetna Medicare Advantage	$678.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.72
Rate for Payer: Cigna Commercial	$1,130.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.50
Rate for Payer: Oxford Commercial	$452.33
Rate for Payer: Qualcare PPO/HMO/WC	$339.25
Rate for Payer: UnitedHealthcare Commercial	$452.33
Rate for Payer: UnitedHealthcare Community & State	$54.51
Rate for Payer: Wellpoint Medicaid Managed Care	$59.93

PATCH GTX 2X9CM 1802009004****

Facility

$140.00

Hospital Charge Code	1604222
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

PATCH GTX 2X9CM 1802009004****

Facility

$140.00

Hospital Charge Code	1604222
Hospital Revenue Code	278
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

PATCH GTX SFT TISS1320030020**

Facility

$2,283.00

Hospital Charge Code	1604040
Hospital Revenue Code	278
Min. Negotiated Rate	$342.45
Max. Negotiated Rate	$552.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$502.26
Rate for Payer: Qualcare PPO/HMO/WC	$342.45

Know your out-of-pocket cost for care.

All Charges