Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATCH VASCULAR 0.4MM 2x9CM

Facility

$1,255.00

Service Code	HCPCS C1768
Hospital Charge Code	270601201
Hospital Revenue Code	278
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Community & State	$30.25
Rate for Payer: Wellpoint Medicaid Managed Care	$33.26

PATCH VASCULAR 0.4MM 2x9CM

Facility

$1,255.00

Service Code	HCPCS C1768
Hospital Charge Code	270601201
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

PATCH VASCULAR 0.6MM 2.5x15CM

Facility

$1,530.00

Service Code	HCPCS C1768
Hospital Charge Code	270650847
Hospital Revenue Code	278
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$370.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.60
Rate for Payer: Qualcare PPO/HMO/WC	$229.50

PATCH VASCULAR 0.6MM 2.5x15CM

Facility

$1,530.00

Service Code	HCPCS C1768
Hospital Charge Code	270650847
Hospital Revenue Code	278
Min. Negotiated Rate	$36.87
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna Commercial	$581.40
Rate for Payer: Aetna Medicare Advantage	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.15
Rate for Payer: Cigna Commercial	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.60
Rate for Payer: Qualcare PPO/HMO/WC	$229.50
Rate for Payer: UnitedHealthcare Community & State	$36.87
Rate for Payer: Wellpoint Medicaid Managed Care	$40.55

PATCH VASCULAR 0.6MM 5x7.5CM

Facility

$1,580.00

Service Code	HCPCS C1768
Hospital Charge Code	270655457
Hospital Revenue Code	278
Min. Negotiated Rate	$38.08
Max. Negotiated Rate	$790.00
Rate for Payer: Aetna Commercial	$600.40
Rate for Payer: Aetna Medicare Advantage	$474.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$316.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.90
Rate for Payer: Cigna Commercial	$790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$347.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.00
Rate for Payer: UnitedHealthcare Community & State	$38.08
Rate for Payer: Wellpoint Medicaid Managed Care	$41.87

PATCH VASCULAR 0.6MM 5x7.5CM

Facility

$1,580.00

Service Code	HCPCS C1768
Hospital Charge Code	270655457
Hospital Revenue Code	278
Min. Negotiated Rate	$237.00
Max. Negotiated Rate	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$316.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$347.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.00

PATCH VENTRALEX W/STRAP LG

Facility

$3,455.00

Hospital Charge Code	270642380
Hospital Revenue Code	278
Min. Negotiated Rate	$83.27
Max. Negotiated Rate	$1,727.50
Rate for Payer: Aetna Commercial	$1,312.90
Rate for Payer: Aetna Medicare Advantage	$1,036.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$881.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$881.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$881.02
Rate for Payer: Cigna Commercial	$1,727.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$760.10
Rate for Payer: Qualcare PPO/HMO/WC	$518.25
Rate for Payer: UnitedHealthcare Community & State	$83.27
Rate for Payer: Wellpoint Medicaid Managed Care	$91.56

PATCH VENTRALEX W/STRAP LG

Facility

$3,455.00

Hospital Charge Code	270642380
Hospital Revenue Code	278
Min. Negotiated Rate	$518.25
Max. Negotiated Rate	$836.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$760.10
Rate for Payer: Qualcare PPO/HMO/WC	$518.25

PATCH VENTRALEX W/STRAP MED

Facility

$2,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270632015
Hospital Revenue Code	278
Min. Negotiated Rate	$68.56
Max. Negotiated Rate	$1,422.50
Rate for Payer: Aetna Commercial	$1,081.10
Rate for Payer: Aetna Medicare Advantage	$853.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.48
Rate for Payer: Cigna Commercial	$1,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.90
Rate for Payer: Qualcare PPO/HMO/WC	$426.75
Rate for Payer: UnitedHealthcare Community & State	$68.56
Rate for Payer: Wellpoint Medicaid Managed Care	$75.39

PATCH VENTRALEX W/STRAP MED

Facility

$2,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270632015
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.90
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

PATCH VENTRALEX W/STRAP SML

Facility

$2,822.00

Hospital Charge Code	270632014
Hospital Revenue Code	278
Min. Negotiated Rate	$423.30
Max. Negotiated Rate	$682.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$564.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$620.84
Rate for Payer: Qualcare PPO/HMO/WC	$423.30

PATCH VENTRALEX W/STRAP SML

Facility

$2,822.00

Hospital Charge Code	270632014
Hospital Revenue Code	278
Min. Negotiated Rate	$68.01
Max. Negotiated Rate	$1,411.00
Rate for Payer: Aetna Commercial	$1,072.36
Rate for Payer: Aetna Medicare Advantage	$846.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$719.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$719.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$564.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$719.61
Rate for Payer: Cigna Commercial	$1,411.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$620.84
Rate for Payer: Qualcare PPO/HMO/WC	$423.30
Rate for Payer: UnitedHealthcare Community & State	$68.01
Rate for Payer: Wellpoint Medicaid Managed Care	$74.78

PATCH WITTMANN 20x40 WP2040

Facility

$7,950.00

Hospital Charge Code	270647556
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

PATCH WITTMANN 20x40 WP2040

Facility

$7,950.00

Hospital Charge Code	270647556
Hospital Revenue Code	278
Min. Negotiated Rate	$191.59
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$191.59
Rate for Payer: Wellpoint Medicaid Managed Care	$210.68

PATCH YAMA URO 2X4 SHP77724URO

Facility

$1,276.00

Hospital Charge Code	270618081
Hospital Revenue Code	272
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$191.40

PATCH YAMA URO 2X4 SHP77724URO

Facility

$1,276.00

Hospital Charge Code	270618081
Hospital Revenue Code	272
Min. Negotiated Rate	$30.75
Max. Negotiated Rate	$638.00
Rate for Payer: Aetna Commercial	$484.88
Rate for Payer: Aetna Medicare Advantage	$382.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.38
Rate for Payer: Cigna Commercial	$638.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.80
Rate for Payer: Oxford Commercial	$255.20
Rate for Payer: Qualcare PPO/HMO/WC	$191.40
Rate for Payer: UnitedHealthcare Commercial	$255.20
Rate for Payer: UnitedHealthcare Community & State	$30.75
Rate for Payer: Wellpoint Medicaid Managed Care	$33.81

PATCH YAMA URO 2X9 SHP55529URO

Facility

$2,667.25

Hospital Charge Code	270616772
Hospital Revenue Code	272
Min. Negotiated Rate	$400.09
Max. Negotiated Rate	$400.09
Rate for Payer: Qualcare PPO/HMO/WC	$400.09

PATCH YAMA URO 2X9 SHP55529URO

Facility

$2,667.25

Hospital Charge Code	270616772
Hospital Revenue Code	272
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$1,333.62
Rate for Payer: Aetna Commercial	$1,013.55
Rate for Payer: Aetna Medicare Advantage	$800.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$680.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$680.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$680.15
Rate for Payer: Cigna Commercial	$1,333.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.17
Rate for Payer: Oxford Commercial	$533.45
Rate for Payer: Qualcare PPO/HMO/WC	$400.09
Rate for Payer: UnitedHealthcare Commercial	$533.45
Rate for Payer: UnitedHealthcare Community & State	$64.28
Rate for Payer: Wellpoint Medicaid Managed Care	$70.68

PATCH YAMA URO 2X9 SHP77729URO

Facility

$569.65

Hospital Charge Code	270619891
Hospital Revenue Code	272
Min. Negotiated Rate	$85.45
Max. Negotiated Rate	$85.45
Rate for Payer: Qualcare PPO/HMO/WC	$85.45

PATCH YAMA URO 2X9 SHP77729URO

Facility

$569.65

Hospital Charge Code	270619891
Hospital Revenue Code	272
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$284.82
Rate for Payer: Aetna Commercial	$216.47
Rate for Payer: Aetna Medicare Advantage	$170.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.26
Rate for Payer: Cigna Commercial	$284.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.90
Rate for Payer: Oxford Commercial	$113.93
Rate for Payer: Qualcare PPO/HMO/WC	$85.45
Rate for Payer: UnitedHealthcare Commercial	$113.93
Rate for Payer: UnitedHealthcare Community & State	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$15.10

PATE 44MM

Facility

$3,075.00

Hospital Charge Code	270703197
Hospital Revenue Code	278
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$744.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

PATE 44MM

Facility

$3,075.00

Hospital Charge Code	270703197
Hospital Revenue Code	278
Min. Negotiated Rate	$74.11
Max. Negotiated Rate	$1,537.50
Rate for Payer: Aetna Commercial	$1,168.50
Rate for Payer: Aetna Medicare Advantage	$922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.12
Rate for Payer: Cigna Commercial	$1,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Community & State	$74.11
Rate for Payer: Wellpoint Medicaid Managed Care	$81.49

PATEL 10mm TM NEX PORO58786535

Facility

$7,019.15

Hospital Charge Code	270639088
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.87
Max. Negotiated Rate	$1,698.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,403.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,698.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,544.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,052.87

PATEL 10mm TM NEX PORO58786535

Facility

$7,019.15

Hospital Charge Code	270639088
Hospital Revenue Code	278
Min. Negotiated Rate	$169.16
Max. Negotiated Rate	$3,509.57
Rate for Payer: Aetna Commercial	$2,667.28
Rate for Payer: Aetna Medicare Advantage	$2,105.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,789.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,789.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,403.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,789.88
Rate for Payer: Cigna Commercial	$3,509.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,698.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,544.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,052.87
Rate for Payer: UnitedHealthcare Community & State	$169.16
Rate for Payer: Wellpoint Medicaid Managed Care	$186.01

PATELLA 1 29MM 9MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270691041
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

Know your out-of-pocket cost for care.

All Charges