Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RELOAD STAPLER 60MM

Facility

$87.00

Hospital Charge Code	270338700
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.10
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

RELOAD STAPLER 60MM

Facility

$87.00

Hospital Charge Code	270338700
Hospital Revenue Code	272
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

RELOAD STAPLER BLUE 45

Facility

$900.00

Hospital Charge Code	270666135
Hospital Revenue Code	270
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

RELOAD STAPLER BLUE 45

Facility

$900.00

Hospital Charge Code	270666135
Hospital Revenue Code	270
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

RELOAD STAPLER GREEN 45

Facility

$900.00

Hospital Charge Code	270666136
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

RELOAD STAPLER GREEN 45

Facility

$900.00

Hospital Charge Code	270666136
Hospital Revenue Code	272
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$97.72
Max. Negotiated Rate	$97.72
Rate for Payer: Qualcare PPO/HMO/WC	$97.72

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$325.73
Rate for Payer: Aetna Commercial	$247.55
Rate for Payer: Aetna Medicare Advantage	$195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.12
Rate for Payer: Cigna Commercial	$325.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.44
Rate for Payer: Oxford Commercial	$130.29
Rate for Payer: Qualcare PPO/HMO/WC	$97.72
Rate for Payer: UnitedHealthcare Commercial	$130.29
Rate for Payer: UnitedHealthcare Community & State	$15.70
Rate for Payer: Wellpoint Medicaid Managed Care	$17.26

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$332.58
Max. Negotiated Rate	$6,900.00
Rate for Payer: Aetna Commercial	$5,244.00
Rate for Payer: Aetna Medicare Advantage	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,519.00
Rate for Payer: Cigna Commercial	$6,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,140.00
Rate for Payer: Oxford Commercial	$2,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00
Rate for Payer: UnitedHealthcare Commercial	$2,760.00
Rate for Payer: UnitedHealthcare Community & State	$332.58
Rate for Payer: Wellpoint Medicaid Managed Care	$365.70

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$2,070.00
Max. Negotiated Rate	$2,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD UNIT ENDO GIA 60 MULTIF

Facility

$656.00

Hospital Charge Code	270335156
Hospital Revenue Code	272
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$328.00
Rate for Payer: Aetna Commercial	$249.28
Rate for Payer: Aetna Medicare Advantage	$196.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.28
Rate for Payer: Cigna Commercial	$328.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.80
Rate for Payer: Oxford Commercial	$131.20
Rate for Payer: Qualcare PPO/HMO/WC	$98.40
Rate for Payer: UnitedHealthcare Commercial	$131.20
Rate for Payer: UnitedHealthcare Community & State	$15.81
Rate for Payer: Wellpoint Medicaid Managed Care	$17.38

RELOAD UNIT ENDO GIA 60 MULTIF

Facility

$656.00

Hospital Charge Code	270335156
Hospital Revenue Code	272
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$98.40

RELOAD VAS. STAPLER 30MM

Facility

$82.00

Hospital Charge Code	270338701
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

RELOAD VAS. STAPLER 30MM

Facility

$82.00

Hospital Charge Code	270338701
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Oxford Commercial	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

REM ANT SEGMENT INSTRUMENT

Facility

$12,585.60

Service Code	HCPCS 22855
Hospital Charge Code	1600000451
Hospital Revenue Code	360
Min. Negotiated Rate	$303.31
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,775.68
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.84
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$303.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$333.52

REM ANT SEGMENT INSTRUMENT

Facility

$12,585.60

Service Code	HCPCS 22855
Hospital Charge Code	1600000451
Hospital Revenue Code	360
Min. Negotiated Rate	$1,887.84
Max. Negotiated Rate	$1,887.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.84

REM COREAL FB W/O SLIT LAM

Facility

$440.10

Service Code	HCPCS 65220
Hospital Charge Code	5780245
Hospital Revenue Code	450
Min. Negotiated Rate	$66.02
Max. Negotiated Rate	$66.02
Rate for Payer: Qualcare PPO/HMO/WC	$66.02

Know your out-of-pocket cost for care.

All Charges