Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
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

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

ROD 60MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688861
Hospital Revenue Code	278
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$445.60
Rate for Payer: Aetna Commercial	$338.66
Rate for Payer: Aetna Medicare Advantage	$267.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.26
Rate for Payer: Cigna Commercial	$445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.06
Rate for Payer: Qualcare PPO/HMO/WC	$133.68
Rate for Payer: UnitedHealthcare Community & State	$21.48
Rate for Payer: Wellpoint Medicaid Managed Care	$23.62

ROD 60MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697038
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
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

ROD 60MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697038
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

ROD 60MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688861
Hospital Revenue Code	278
Min. Negotiated Rate	$133.68
Max. Negotiated Rate	$215.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.06
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

ROD 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

ROD 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.60
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

ROD 65MM

Facility

$2,625.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

ROD 65MM

Facility

$2,625.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$1,640.00
Rate for Payer: Aetna Commercial	$1,246.40
Rate for Payer: Aetna Medicare Advantage	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.40
Rate for Payer: Cigna Commercial	$1,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.60
Rate for Payer: Qualcare PPO/HMO/WC	$492.00
Rate for Payer: UnitedHealthcare Community & State	$79.05
Rate for Payer: Wellpoint Medicaid Managed Care	$86.92

ROD 6.5x40mm 9690040

Facility

$1,542.65

Hospital Charge Code	270630337
Hospital Revenue Code	278
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$771.33
Rate for Payer: Aetna Commercial	$586.21
Rate for Payer: Aetna Medicare Advantage	$462.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.38
Rate for Payer: Cigna Commercial	$771.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.38
Rate for Payer: Qualcare PPO/HMO/WC	$231.40
Rate for Payer: UnitedHealthcare Community & State	$37.18
Rate for Payer: Wellpoint Medicaid Managed Care	$40.88

ROD 6.5x40mm 9690040

Facility

$1,542.65

Hospital Charge Code	270630337
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$373.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.38
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6.5x50mm 9690050

Facility

$1,542.65

Hospital Charge Code	270630636
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$373.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.38
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6.5x50mm 9690050

Facility

$1,542.65

Hospital Charge Code	270630636
Hospital Revenue Code	278
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$771.33
Rate for Payer: Aetna Commercial	$586.21
Rate for Payer: Aetna Medicare Advantage	$462.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.38
Rate for Payer: Cigna Commercial	$771.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.38
Rate for Payer: Qualcare PPO/HMO/WC	$231.40
Rate for Payer: UnitedHealthcare Community & State	$37.18
Rate for Payer: Wellpoint Medicaid Managed Care	$40.88

ROD 6X35MM REF #016.3035

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705831
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
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

ROD 6X35MM REF #016.3035

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705831
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 6X40MM REF#016.3040

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705832
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
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

ROD 6X40MM REF#016.3040

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705832
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

Know your out-of-pocket cost for care.

All Charges