Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.96
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$26,457.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,317.50
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75
Rate for Payer: UnitedHealthcare Community & State	$1,677.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1,845.06

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$16,849.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,317.50
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$645.00
Max. Negotiated Rate	$645.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$103.63
Max. Negotiated Rate	$2,150.00
Rate for Payer: Aetna Commercial	$1,634.00
Rate for Payer: Aetna Medicare Advantage	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,096.50
Rate for Payer: Cigna Commercial	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,290.00
Rate for Payer: Oxford Commercial	$860.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00
Rate for Payer: UnitedHealthcare Commercial	$860.00
Rate for Payer: UnitedHealthcare Community & State	$103.63
Rate for Payer: Wellpoint Medicaid Managed Care	$113.95

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.27
Max. Negotiated Rate	$7,042.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,402.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$701.35
Max. Negotiated Rate	$14,550.90
Rate for Payer: Aetna Commercial	$11,058.68
Rate for Payer: Aetna Medicare Advantage	$8,730.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,420.96
Rate for Payer: Cigna Commercial	$14,550.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,402.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27
Rate for Payer: UnitedHealthcare Community & State	$701.35
Rate for Payer: Wellpoint Medicaid Managed Care	$771.20

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.54
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.27
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$39.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$43.15

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$244.27
Max. Negotiated Rate	$244.27
Rate for Payer: Qualcare PPO/HMO/WC	$244.27

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.45
Max. Negotiated Rate	$44,262.50
Rate for Payer: Aetna Commercial	$33,639.50
Rate for Payer: Aetna Medicare Advantage	$26,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,573.88
Rate for Payer: Cigna Commercial	$44,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,475.50
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75
Rate for Payer: UnitedHealthcare Community & State	$2,133.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2,345.91

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$21,423.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,475.50
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$854.12
Max. Negotiated Rate	$17,720.35
Rate for Payer: Aetna Commercial	$13,467.47
Rate for Payer: Aetna Medicare Advantage	$10,632.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,037.38
Rate for Payer: Cigna Commercial	$17,720.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,796.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10
Rate for Payer: UnitedHealthcare Community & State	$854.12
Rate for Payer: Wellpoint Medicaid Managed Care	$939.18

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$5,316.10
Max. Negotiated Rate	$8,576.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,796.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$7,728.75
Max. Negotiated Rate	$12,469.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,335.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$475.37
Max. Negotiated Rate	$9,862.50
Rate for Payer: Aetna Commercial	$7,495.50
Rate for Payer: Aetna Medicare Advantage	$5,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,029.88
Rate for Payer: Cigna Commercial	$9,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,339.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75
Rate for Payer: UnitedHealthcare Community & State	$475.37
Rate for Payer: Wellpoint Medicaid Managed Care	$522.71

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.75
Max. Negotiated Rate	$25,762.50
Rate for Payer: Aetna Commercial	$19,579.50
Rate for Payer: Aetna Medicare Advantage	$15,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,138.88
Rate for Payer: Cigna Commercial	$25,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,335.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75
Rate for Payer: UnitedHealthcare Community & State	$1,241.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,365.41

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$2,958.75
Max. Negotiated Rate	$4,773.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,339.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.63
Max. Negotiated Rate	$33,851.28
Rate for Payer: Aetna Commercial	$25,726.97
Rate for Payer: Aetna Medicare Advantage	$20,310.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,264.15
Rate for Payer: Cigna Commercial	$33,851.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,894.56
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38
Rate for Payer: UnitedHealthcare Community & State	$1,631.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1,794.12

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$10,155.38
Max. Negotiated Rate	$16,384.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,894.56
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.41
Max. Negotiated Rate	$32,726.28
Rate for Payer: Aetna Commercial	$24,871.97
Rate for Payer: Aetna Medicare Advantage	$19,635.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,690.40
Rate for Payer: Cigna Commercial	$32,726.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,399.56
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88
Rate for Payer: UnitedHealthcare Community & State	$1,577.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1,734.49

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$9,817.88
Max. Negotiated Rate	$15,839.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,399.56
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$9,138.75
Max. Negotiated Rate	$14,743.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,403.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.29
Max. Negotiated Rate	$30,462.50
Rate for Payer: Aetna Commercial	$23,151.50
Rate for Payer: Aetna Medicare Advantage	$18,277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,535.88
Rate for Payer: Cigna Commercial	$30,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,403.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75
Rate for Payer: UnitedHealthcare Community & State	$1,468.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1,614.51

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$9,607.50
Max. Negotiated Rate	$15,500.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,091.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,543.61
Max. Negotiated Rate	$32,025.00
Rate for Payer: Aetna Commercial	$24,339.00
Rate for Payer: Aetna Medicare Advantage	$19,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,332.75
Rate for Payer: Cigna Commercial	$32,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,091.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50
Rate for Payer: UnitedHealthcare Community & State	$1,543.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1,697.33

PENILE PROTHESIS 16CMX14MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694753
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$21,423.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19,475.50
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

Know your out-of-pocket cost for care.

All Charges