Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD 45MM

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705946
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

ROD 45MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270705520
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

ROD 45mm 177010045

Facility

$1,612.00

Hospital Charge Code	270632111
Hospital Revenue Code	278
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$806.00
Rate for Payer: Aetna Commercial	$612.56
Rate for Payer: Aetna Medicare Advantage	$483.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.06
Rate for Payer: Cigna Commercial	$806.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.64
Rate for Payer: Qualcare PPO/HMO/WC	$241.80
Rate for Payer: UnitedHealthcare Community & State	$38.85
Rate for Payer: Wellpoint Medicaid Managed Care	$42.72

ROD 45mm 177010045

Facility

$1,612.00

Hospital Charge Code	270632111
Hospital Revenue Code	278
Min. Negotiated Rate	$241.80
Max. Negotiated Rate	$390.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.64
Rate for Payer: Qualcare PPO/HMO/WC	$241.80

ROD 45MM EXTENDED TAB

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692594
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

ROD 45MM EXTENDED TAB

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692594
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

ROD 45MM PREBENT LORDOTIC

Facility

$4,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270672670
Hospital Revenue Code	278
Min. Negotiated Rate	$648.75
Max. Negotiated Rate	$1,046.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,046.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$951.50
Rate for Payer: Qualcare PPO/HMO/WC	$648.75

ROD 45MM PREBENT LORDOTIC

Facility

$4,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270672670
Hospital Revenue Code	278
Min. Negotiated Rate	$104.23
Max. Negotiated Rate	$2,162.50
Rate for Payer: Aetna Commercial	$1,643.50
Rate for Payer: Aetna Medicare Advantage	$1,297.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,102.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,102.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,102.88
Rate for Payer: Cigna Commercial	$2,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,046.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$951.50
Rate for Payer: Qualcare PPO/HMO/WC	$648.75
Rate for Payer: UnitedHealthcare Community & State	$104.23
Rate for Payer: Wellpoint Medicaid Managed Care	$114.61

ROD 4.75MM COB CHR CAPPED 40MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270697070
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

ROD 4.75MM COB CHR CAPPED 40MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270697070
Hospital Revenue Code	278
Min. Negotiated Rate	$165.09
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,603.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,507.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50
Rate for Payer: UnitedHealthcare Community & State	$165.09
Rate for Payer: Wellpoint Medicaid Managed Care	$181.53

ROD 50 MM

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691519
Hospital Revenue Code	278
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

ROD 50 MM

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691519
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

ROD 50MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270705518
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

ROD 50MM

Facility

$875.00

Hospital Charge Code	270702972
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

ROD 50MM

Facility

$875.00

Hospital Charge Code	270702972
Hospital Revenue Code	278
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

ROD 50MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270705518
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

ROD 55MM OVERWATCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692592
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

ROD 55MM OVERWATCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692592
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

ROD 5.5mm x 50mm 8690050

Facility

$1,636.85

Hospital Charge Code	270632421
Hospital Revenue Code	278
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$818.42
Rate for Payer: Aetna Commercial	$622.00
Rate for Payer: Aetna Medicare Advantage	$491.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.40
Rate for Payer: Cigna Commercial	$818.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$360.11
Rate for Payer: Qualcare PPO/HMO/WC	$245.53
Rate for Payer: UnitedHealthcare Community & State	$39.45
Rate for Payer: Wellpoint Medicaid Managed Care	$43.38

ROD 5.5mm x 50mm 8690050

Facility

$1,636.85

Hospital Charge Code	270632421
Hospital Revenue Code	278
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$360.11
Rate for Payer: Qualcare PPO/HMO/WC	$245.53

ROD 5.5 TI CP4 NS CRV 80MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698928
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$304.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$277.20
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 TI CP4 NS CRV 80MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698928
Hospital Revenue Code	278
Min. Negotiated Rate	$30.37
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$478.80
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.30
Rate for Payer: Cigna Commercial	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$277.20
Rate for Payer: Qualcare PPO/HMO/WC	$189.00
Rate for Payer: UnitedHealthcare Community & State	$30.37
Rate for Payer: Wellpoint Medicaid Managed Care	$33.39

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$304.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$277.20
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$30.37
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$478.80
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.30
Rate for Payer: Cigna Commercial	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$277.20
Rate for Payer: Qualcare PPO/HMO/WC	$189.00
Rate for Payer: UnitedHealthcare Community & State	$30.37
Rate for Payer: Wellpoint Medicaid Managed Care	$33.39

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

Know your out-of-pocket cost for care.

All Charges