Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN TIB POR 0 DEG SPK KEL C RT

Facility

$26,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270703871
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,775.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

PSN TIB POR 2 PEG SZ C L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695670
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN TIB POR 2 PEG SZ C L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695670
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN TIB POR 2 PEG SZF L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694748
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN TIB POR 2 PEG SZF L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694748
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN TIB POR 2 PEG SZ G R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694199
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN TIB POR 2 PEG SZ G R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694199
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN TIB POR 2 PEG SZ H L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270698699
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN TIB POR 2 PEG SZ H L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270698699
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN TIB POR PEG SZ E R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695090
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN TIB POR PEG SZ E R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695090
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN TIB REV TM CTL CONE SZ MED

Facility

$37,156.25

Service Code	HCPCS C1776
Hospital Charge Code	270695264
Hospital Revenue Code	278
Min. Negotiated Rate	$5,573.44
Max. Negotiated Rate	$8,991.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,991.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,174.38
Rate for Payer: Qualcare PPO/HMO/WC	$5,573.44

PSN TIB REV TM CTL CONE SZ MED

Facility

$37,156.25

Service Code	HCPCS C1776
Hospital Charge Code	270695264
Hospital Revenue Code	278
Min. Negotiated Rate	$895.47
Max. Negotiated Rate	$18,578.12
Rate for Payer: Aetna Commercial	$14,119.38
Rate for Payer: Aetna Medicare Advantage	$11,146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,474.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,474.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,431.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,474.84
Rate for Payer: Cigna Commercial	$18,578.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,991.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,174.38
Rate for Payer: Qualcare PPO/HMO/WC	$5,573.44
Rate for Payer: UnitedHealthcare Community & State	$895.47
Rate for Payer: Wellpoint Medicaid Managed Care	$984.64

PSN TIB STM 5 DEG SZ C R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690018
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PSN TIB STM 5 DEG SZ C R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690018
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5DEG SZ D L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691311
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN TIB STM 5DEG SZ D L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691311
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN TIB STM 5 DEG SZ E L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686933
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PSN TIB STM 5 DEG SZ E L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686933
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ F L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689624
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ F L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689624
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PSN TIB STM 5 DEG SZ GR

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689745
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ GR

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689745
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PSN TRAB METAL PS CCR SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693240
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN TRAB METAL PS CCR SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693240
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

Know your out-of-pocket cost for care.

All Charges