Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESTORE INSTRUMENT SET MITEK

Facility

$1,500.00

Hospital Charge Code	270645770
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

RESTORE PROLYSTICA

Facility

$217.20

Hospital Charge Code	270666125
Hospital Revenue Code	270
Min. Negotiated Rate	$32.58
Max. Negotiated Rate	$32.58
Rate for Payer: Qualcare PPO/HMO/WC	$32.58

RESTORE PROLYSTICA

Facility

$217.20

Hospital Charge Code	270666125
Hospital Revenue Code	270
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$108.60
Rate for Payer: Aetna Commercial	$82.54
Rate for Payer: Aetna Medicare Advantage	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.39
Rate for Payer: Cigna Commercial	$108.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.16
Rate for Payer: Oxford Commercial	$43.44
Rate for Payer: Qualcare PPO/HMO/WC	$32.58
Rate for Payer: UnitedHealthcare Commercial	$43.44
Rate for Payer: UnitedHealthcare Community & State	$5.23
Rate for Payer: Wellpoint Medicaid Managed Care	$5.76

Restore Ssnsor

Facility

$93,750.00

Service Code	HCPCS C1767
Hospital Charge Code	270647769
Hospital Revenue Code	278
Min. Negotiated Rate	$14,062.50
Max. Negotiated Rate	$22,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,687.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,062.50

Restore Ssnsor

Facility

$93,750.00

Service Code	HCPCS C1767
Hospital Charge Code	270647769
Hospital Revenue Code	278
Min. Negotiated Rate	$2,259.38
Max. Negotiated Rate	$46,875.00
Rate for Payer: Aetna Commercial	$35,625.00
Rate for Payer: Aetna Medicare Advantage	$28,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,906.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,906.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,906.25
Rate for Payer: Cigna Commercial	$46,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,687.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,062.50
Rate for Payer: UnitedHealthcare Community & State	$2,259.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2,484.38

RESTOREULTRA 37712

Facility

$117,187.50

Hospital Charge Code	270640323
Hospital Revenue Code	278
Min. Negotiated Rate	$2,824.22
Max. Negotiated Rate	$58,593.75
Rate for Payer: Aetna Commercial	$44,531.25
Rate for Payer: Aetna Medicare Advantage	$35,156.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,882.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,882.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,882.81
Rate for Payer: Cigna Commercial	$58,593.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,359.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$17,578.12
Rate for Payer: UnitedHealthcare Community & State	$2,824.22
Rate for Payer: Wellpoint Medicaid Managed Care	$3,105.47

RESTOREULTRA 37712

Facility

$117,187.50

Hospital Charge Code	270640323
Hospital Revenue Code	278
Min. Negotiated Rate	$17,578.12
Max. Negotiated Rate	$28,359.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,359.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$17,578.12

RESTORIGIN AMNIOT FLUID XL 2ML

Facility

$7,475.00

Service Code	HCPCS Q4192
Hospital Charge Code	270694943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

RESTORIGIN AMNIOT FLUID XL 2ML

Facility

$7,475.00

Service Code	HCPCS Q4192
Hospital Charge Code	270694943
Hospital Revenue Code	278
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

RESTORIL/15MG/CAP

Facility

$6.00

Hospital Charge Code	60634336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

RESTORIL/15MG/CAP

Facility

$6.00

Hospital Charge Code	60634336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

RESTORIL/30MG/CAP

Facility

$6.00

Hospital Charge Code	60634337
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

RESTORIL/30MG/CAP

Facility

$6.00

Hospital Charge Code	60634337
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

RESTORIS MCK BI INLAY

Facility

$22,770.00

Hospital Charge Code	270668065
Hospital Revenue Code	278
Min. Negotiated Rate	$3,415.50
Max. Negotiated Rate	$5,510.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,554.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,510.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,009.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,415.50

RESTORIS MCK BI INLAY

Facility

$22,770.00

Hospital Charge Code	270668065
Hospital Revenue Code	278
Min. Negotiated Rate	$548.76
Max. Negotiated Rate	$11,385.00
Rate for Payer: Aetna Commercial	$8,652.60
Rate for Payer: Aetna Medicare Advantage	$6,831.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,806.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,806.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,806.35
Rate for Payer: Cigna Commercial	$11,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,510.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,009.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,415.50
Rate for Payer: UnitedHealthcare Community & State	$548.76
Rate for Payer: Wellpoint Medicaid Managed Care	$603.40

RESTORIS MCK BI ONLAY PRE PLOY

Facility

$28,845.00

Hospital Charge Code	270668067
Hospital Revenue Code	278
Min. Negotiated Rate	$4,326.75
Max. Negotiated Rate	$6,980.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,769.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,980.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,345.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,326.75

RESTORIS MCK BI ONLAY PRE PLOY

Facility

$28,845.00

Hospital Charge Code	270668067
Hospital Revenue Code	278
Min. Negotiated Rate	$695.16
Max. Negotiated Rate	$14,422.50
Rate for Payer: Aetna Commercial	$10,961.10
Rate for Payer: Aetna Medicare Advantage	$8,653.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,355.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,355.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,355.48
Rate for Payer: Cigna Commercial	$14,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,980.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,345.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,326.75
Rate for Payer: UnitedHealthcare Community & State	$695.16
Rate for Payer: Wellpoint Medicaid Managed Care	$764.39

RESTORIS MCK BI ONLAY STD PLOY

Facility

$27,270.00

Hospital Charge Code	270668066
Hospital Revenue Code	278
Min. Negotiated Rate	$4,090.50
Max. Negotiated Rate	$6,599.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,454.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,599.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,999.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,090.50

RESTORIS MCK BI ONLAY STD PLOY

Facility

$27,270.00

Hospital Charge Code	270668066
Hospital Revenue Code	278
Min. Negotiated Rate	$657.21
Max. Negotiated Rate	$13,635.00
Rate for Payer: Aetna Commercial	$10,362.60
Rate for Payer: Aetna Medicare Advantage	$8,181.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,953.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,953.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,454.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,953.85
Rate for Payer: Cigna Commercial	$13,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,599.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,999.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,090.50
Rate for Payer: UnitedHealthcare Community & State	$657.21
Rate for Payer: Wellpoint Medicaid Managed Care	$722.65

RESTORIS MCK CONSUMABLES

Facility

$4,330.00

Hospital Charge Code	270668070
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$1,047.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50

RESTORIS MCK CONSUMABLES

Facility

$4,330.00

Hospital Charge Code	270668070
Hospital Revenue Code	278
Min. Negotiated Rate	$104.35
Max. Negotiated Rate	$2,165.00
Rate for Payer: Aetna Commercial	$1,645.40
Rate for Payer: Aetna Medicare Advantage	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50
Rate for Payer: UnitedHealthcare Community & State	$104.35
Rate for Payer: Wellpoint Medicaid Managed Care	$114.75

RESTORIS MCK PFJ

Facility

$16,350.00

Hospital Charge Code	270668064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,452.50
Max. Negotiated Rate	$3,956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,597.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50

RESTORIS MCK PFJ

Facility

$16,350.00

Hospital Charge Code	270668064
Hospital Revenue Code	278
Min. Negotiated Rate	$394.04
Max. Negotiated Rate	$8,175.00
Rate for Payer: Aetna Commercial	$6,213.00
Rate for Payer: Aetna Medicare Advantage	$4,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,169.25
Rate for Payer: Cigna Commercial	$8,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,597.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50
Rate for Payer: UnitedHealthcare Community & State	$394.04
Rate for Payer: Wellpoint Medicaid Managed Care	$433.27

RESTORIS MCK UNI INLAY

Facility

$16,055.00

Hospital Charge Code	270668060
Hospital Revenue Code	278
Min. Negotiated Rate	$386.93
Max. Negotiated Rate	$8,027.50
Rate for Payer: Aetna Commercial	$6,100.90
Rate for Payer: Aetna Medicare Advantage	$4,816.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,094.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,094.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,211.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,094.03
Rate for Payer: Cigna Commercial	$8,027.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,885.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,532.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,408.25
Rate for Payer: UnitedHealthcare Community & State	$386.93
Rate for Payer: Wellpoint Medicaid Managed Care	$425.46

RESTORIS MCK UNI INLAY

Facility

$16,055.00

Hospital Charge Code	270668060
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.25
Max. Negotiated Rate	$3,885.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,885.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,532.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,408.25

Know your out-of-pocket cost for care.

All Charges