Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	2011506
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	7412033
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	2011506
Hospital Revenue Code	361
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,567.76
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59
Rate for Payer: UnitedHealthcare Community & State	$162.85
Rate for Payer: Wellpoint Medicaid Managed Care	$179.07

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	7412033
Hospital Revenue Code	361
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,567.76
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59
Rate for Payer: UnitedHealthcare Community & State	$162.85
Rate for Payer: Wellpoint Medicaid Managed Care	$179.07

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	7412034
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	2011507
Hospital Revenue Code	361
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,567.76
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59
Rate for Payer: UnitedHealthcare Community & State	$162.85
Rate for Payer: Wellpoint Medicaid Managed Care	$179.07

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	2011507
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	7412034
Hospital Revenue Code	361
Min. Negotiated Rate	$162.85
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,567.76
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59
Rate for Payer: UnitedHealthcare Community & State	$162.85
Rate for Payer: Wellpoint Medicaid Managed Care	$179.07

REPLIFORM 4X7

Facility

$3,912.00

Hospital Charge Code	270650889
Hospital Revenue Code	272
Min. Negotiated Rate	$94.28
Max. Negotiated Rate	$1,956.00
Rate for Payer: Aetna Commercial	$1,486.56
Rate for Payer: Aetna Medicare Advantage	$1,173.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$997.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$997.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$997.56
Rate for Payer: Cigna Commercial	$1,956.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,173.60
Rate for Payer: Oxford Commercial	$782.40
Rate for Payer: Qualcare PPO/HMO/WC	$586.80
Rate for Payer: UnitedHealthcare Commercial	$782.40
Rate for Payer: UnitedHealthcare Community & State	$94.28
Rate for Payer: Wellpoint Medicaid Managed Care	$103.67

REPLIFORM 4X7

Facility

$3,912.00

Hospital Charge Code	270650889
Hospital Revenue Code	272
Min. Negotiated Rate	$586.80
Max. Negotiated Rate	$586.80
Rate for Payer: Qualcare PPO/HMO/WC	$586.80

REP LOC MITEK EXP RENT 900647

Facility

$1,250.00

Hospital Charge Code	270639033
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

REP LOC MITEK EXP RENT 900647

Facility

$1,250.00

Hospital Charge Code	270639033
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

REPL TUNNELED VAD W PORT

Facility

$28,691.63

Service Code	HCPCS 36582
Hospital Charge Code	1600000784
Hospital Revenue Code	360
Min. Negotiated Rate	$691.47
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,607.49
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,303.74
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$691.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$760.33

REPL TUNNELED VAD W PORT

Facility

$28,691.63

Service Code	HCPCS 36582
Hospital Charge Code	1600000784
Hospital Revenue Code	360
Min. Negotiated Rate	$4,303.74
Max. Negotiated Rate	$4,303.74
Rate for Payer: Qualcare PPO/HMO/WC	$4,303.74

REPLY DR

Facility

$21,210.00

Service Code	HCPCS C1785
Hospital Charge Code	270656329
Hospital Revenue Code	275
Min. Negotiated Rate	$3,181.50
Max. Negotiated Rate	$5,132.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,132.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,666.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,181.50

REPLY DR

Facility

$21,210.00

Service Code	HCPCS C1785
Hospital Charge Code	270656329
Hospital Revenue Code	275
Min. Negotiated Rate	$511.16
Max. Negotiated Rate	$10,605.00
Rate for Payer: Aetna Commercial	$8,059.80
Rate for Payer: Aetna Medicare Advantage	$6,363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,408.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,408.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,408.55
Rate for Payer: Cigna Commercial	$10,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,132.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,666.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,181.50
Rate for Payer: UnitedHealthcare Community & State	$511.16
Rate for Payer: Wellpoint Medicaid Managed Care	$562.07

REPLY SR PACEMAKER SINGLE RATE

Facility

$4,500.00

Hospital Charge Code	270662057
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

REPLY SR PACEMAKER SINGLE RATE

Facility

$4,500.00

Hospital Charge Code	270662057
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

REP NU/MU,METATARSAL

Facility

$57,824.50

Service Code	HCPCS 28322
Hospital Charge Code	16000516
Hospital Revenue Code	360
Min. Negotiated Rate	$1,393.57
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	$17,347.35
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,673.67
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$1,393.57
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	$1,532.35

REP NU/MU,METATARSAL

Facility

$57,824.50

Service Code	HCPCS 28322
Hospital Charge Code	16000516
Hospital Revenue Code	360
Min. Negotiated Rate	$8,673.67
Max. Negotiated Rate	$8,673.67
Rate for Payer: Qualcare PPO/HMO/WC	$8,673.67

REPORT AND INTERPRETATION

Facility

$111.00

Hospital Charge Code	3032738D
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

REPORT AND INTERPRETATION

Facility

$111.00

Hospital Charge Code	3032738D
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

REPOSITIONABLE22M OPENING 235

Facility

$775.00

Hospital Charge Code	270700610
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

REPOSITIONABLE22M OPENING 235

Facility

$775.00

Hospital Charge Code	270700610
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

REPOSITIONABLE MAX SURECLIP 1

Facility

$500.00

Hospital Charge Code	270700612
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

Know your out-of-pocket cost for care.

All Charges