Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RECORDER REVEAL LOOP XL 9529

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270662230N
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.25
Max. Negotiated Rate	$6,043.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25

RECORDER REVEAL LOOP XL 9529

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270662230
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

RECORDER REVEAL LOOP XL 9529

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270662230
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

RECORDER REVEAL LOOP XL 9529

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270662230N
Hospital Revenue Code	278
Min. Negotiated Rate	$601.90
Max. Negotiated Rate	$12,487.50
Rate for Payer: Aetna Commercial	$9,490.50
Rate for Payer: Aetna Medicare Advantage	$7,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,368.62
Rate for Payer: Cigna Commercial	$12,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25
Rate for Payer: UnitedHealthcare Community & State	$601.90
Rate for Payer: Wellpoint Medicaid Managed Care	$661.84

RECOV EA ADD 30 MIN (NON-PACU)

Facility

$400.00

Hospital Charge Code	41101005
Hospital Revenue Code	710
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

RECOV EA ADD 30 MIN (NON-PACU)

Facility

$400.00

Hospital Charge Code	1001189
Hospital Revenue Code	710
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

RECOV EA ADD 30 MIN (NON-PACU)

Facility

$400.00

Hospital Charge Code	1001189
Hospital Revenue Code	710
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

RECOV EA ADD 30 MIN (NON-PACU)

Facility

$400.00

Hospital Charge Code	41101005
Hospital Revenue Code	710
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

RECOVERY: 106-120 MINS

Facility

$2,205.00

Hospital Charge Code	93500109
Hospital Revenue Code	710
Min. Negotiated Rate	$53.14
Max. Negotiated Rate	$1,102.50
Rate for Payer: Aetna Commercial	$837.90
Rate for Payer: Aetna Medicare Advantage	$661.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$562.27
Rate for Payer: Cigna Commercial	$1,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$661.50
Rate for Payer: Oxford Commercial	$441.00
Rate for Payer: Qualcare PPO/HMO/WC	$330.75
Rate for Payer: UnitedHealthcare Commercial	$441.00
Rate for Payer: UnitedHealthcare Community & State	$53.14
Rate for Payer: Wellpoint Medicaid Managed Care	$58.43

RECOVERY: 106-120 MINS

Facility

$2,205.00

Hospital Charge Code	93500109
Hospital Revenue Code	710
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$330.75
Rate for Payer: Qualcare PPO/HMO/WC	$330.75

RECOVERY: 1-15 MINS

Facility

$276.00

Hospital Charge Code	93500111
Hospital Revenue Code	710
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

RECOVERY: 1-15 MINS

Facility

$276.00

Hospital Charge Code	93500111
Hospital Revenue Code	710
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

RECOVERY: 121-135 MINS

Facility

$2,418.00

Hospital Charge Code	93500113
Hospital Revenue Code	710
Min. Negotiated Rate	$362.70
Max. Negotiated Rate	$362.70
Rate for Payer: Qualcare PPO/HMO/WC	$362.70

RECOVERY: 121-135 MINS

Facility

$2,418.00

Hospital Charge Code	93500113
Hospital Revenue Code	710
Min. Negotiated Rate	$58.27
Max. Negotiated Rate	$1,209.00
Rate for Payer: Aetna Commercial	$918.84
Rate for Payer: Aetna Medicare Advantage	$725.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$616.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$616.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$616.59
Rate for Payer: Cigna Commercial	$1,209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$725.40
Rate for Payer: Oxford Commercial	$483.60
Rate for Payer: Qualcare PPO/HMO/WC	$362.70
Rate for Payer: UnitedHealthcare Commercial	$483.60
Rate for Payer: UnitedHealthcare Community & State	$58.27
Rate for Payer: Wellpoint Medicaid Managed Care	$64.08

RECOVERY: 136-150 MINS

Facility

$2,756.00

Hospital Charge Code	93500115
Hospital Revenue Code	710
Min. Negotiated Rate	$413.40
Max. Negotiated Rate	$413.40
Rate for Payer: Qualcare PPO/HMO/WC	$413.40

RECOVERY: 136-150 MINS

Facility

$2,756.00

Hospital Charge Code	93500115
Hospital Revenue Code	710
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$1,378.00
Rate for Payer: Aetna Commercial	$1,047.28
Rate for Payer: Aetna Medicare Advantage	$826.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$702.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$702.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$702.78
Rate for Payer: Cigna Commercial	$1,378.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.80
Rate for Payer: Oxford Commercial	$551.20
Rate for Payer: Qualcare PPO/HMO/WC	$413.40
Rate for Payer: UnitedHealthcare Commercial	$551.20
Rate for Payer: UnitedHealthcare Community & State	$66.42
Rate for Payer: Wellpoint Medicaid Managed Care	$73.03

RECOVERY: 151-165 MINS

Facility

$3,032.00

Hospital Charge Code	93500117
Hospital Revenue Code	710
Min. Negotiated Rate	$454.80
Max. Negotiated Rate	$454.80
Rate for Payer: Qualcare PPO/HMO/WC	$454.80

RECOVERY: 151-165 MINS

Facility

$3,032.00

Hospital Charge Code	93500117
Hospital Revenue Code	710
Min. Negotiated Rate	$73.07
Max. Negotiated Rate	$1,516.00
Rate for Payer: Aetna Commercial	$1,152.16
Rate for Payer: Aetna Medicare Advantage	$909.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$773.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$773.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$773.16
Rate for Payer: Cigna Commercial	$1,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$909.60
Rate for Payer: Oxford Commercial	$606.40
Rate for Payer: Qualcare PPO/HMO/WC	$454.80
Rate for Payer: UnitedHealthcare Commercial	$606.40
Rate for Payer: UnitedHealthcare Community & State	$73.07
Rate for Payer: Wellpoint Medicaid Managed Care	$80.35

RECOVERY: 16-30 MINS

Facility

$551.00

Hospital Charge Code	93500119
Hospital Revenue Code	710
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

RECOVERY: 16-30 MINS

Facility

$551.00

Hospital Charge Code	93500119
Hospital Revenue Code	710
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: Aetna Medicare Advantage	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.50
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.30
Rate for Payer: Oxford Commercial	$110.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: UnitedHealthcare Community & State	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

RECOVERY: 166-180 MINS

Facility

$3,308.00

Hospital Charge Code	93500121
Hospital Revenue Code	710
Min. Negotiated Rate	$79.72
Max. Negotiated Rate	$1,654.00
Rate for Payer: Aetna Commercial	$1,257.04
Rate for Payer: Aetna Medicare Advantage	$992.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$843.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$843.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$843.54
Rate for Payer: Cigna Commercial	$1,654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.40
Rate for Payer: Oxford Commercial	$661.60
Rate for Payer: Qualcare PPO/HMO/WC	$496.20
Rate for Payer: UnitedHealthcare Commercial	$661.60
Rate for Payer: UnitedHealthcare Community & State	$79.72
Rate for Payer: Wellpoint Medicaid Managed Care	$87.66

RECOVERY: 166-180 MINS

Facility

$3,308.00

Hospital Charge Code	93500121
Hospital Revenue Code	710
Min. Negotiated Rate	$496.20
Max. Negotiated Rate	$496.20
Rate for Payer: Qualcare PPO/HMO/WC	$496.20

RECOVERY: 31-45 MINS

Facility

$827.00

Hospital Charge Code	93500123
Hospital Revenue Code	710
Min. Negotiated Rate	$19.93
Max. Negotiated Rate	$413.50
Rate for Payer: Aetna Commercial	$314.26
Rate for Payer: Aetna Medicare Advantage	$248.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.88
Rate for Payer: Cigna Commercial	$413.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.10
Rate for Payer: Oxford Commercial	$165.40
Rate for Payer: Qualcare PPO/HMO/WC	$124.05
Rate for Payer: UnitedHealthcare Commercial	$165.40
Rate for Payer: UnitedHealthcare Community & State	$19.93
Rate for Payer: Wellpoint Medicaid Managed Care	$21.92

RECOVERY: 31-45 MINS

Facility

$827.00

Hospital Charge Code	93500123
Hospital Revenue Code	710
Min. Negotiated Rate	$124.05
Max. Negotiated Rate	$124.05
Rate for Payer: Qualcare PPO/HMO/WC	$124.05

RECOVERY: 46-60 MINS

Facility

$1,103.00

Hospital Charge Code	93500125
Hospital Revenue Code	710
Min. Negotiated Rate	$165.45
Max. Negotiated Rate	$165.45
Rate for Payer: Qualcare PPO/HMO/WC	$165.45

Know your out-of-pocket cost for care.

All Charges