Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON 11x450

Facility

$2,154.25

Service Code	HCPCS C1713
Hospital Charge Code	270648626
Hospital Revenue Code	278
Min. Negotiated Rate	$51.92
Max. Negotiated Rate	$1,077.12
Rate for Payer: Aetna Commercial	$818.62
Rate for Payer: Aetna Medicare Advantage	$646.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$549.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$549.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$430.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$549.33
Rate for Payer: Cigna Commercial	$1,077.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$473.94
Rate for Payer: Qualcare PPO/HMO/WC	$323.14
Rate for Payer: UnitedHealthcare Community & State	$51.92
Rate for Payer: Wellpoint Medicaid Managed Care	$57.09

ROD CARBON 11x450

Facility

$2,154.25

Service Code	HCPCS C1713
Hospital Charge Code	270648626
Hospital Revenue Code	278
Min. Negotiated Rate	$323.14
Max. Negotiated Rate	$521.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$430.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$473.94
Rate for Payer: Qualcare PPO/HMO/WC	$323.14

ROD CARBON 150MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699326
Hospital Revenue Code	278
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

ROD CARBON 150MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699326
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 150mm 14160

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270639791
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

ROD CARBON 150mm 14160

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270639791
Hospital Revenue Code	278
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

ROD CARBON 200MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699327
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 200MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699327
Hospital Revenue Code	278
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

ROD CARBON 200mm 14165

Facility

$887.50

Hospital Charge Code	270637347
Hospital Revenue Code	278
Min. Negotiated Rate	$21.39
Max. Negotiated Rate	$443.75
Rate for Payer: Aetna Commercial	$337.25
Rate for Payer: Aetna Medicare Advantage	$266.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.31
Rate for Payer: Cigna Commercial	$443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.25
Rate for Payer: Qualcare PPO/HMO/WC	$133.12
Rate for Payer: UnitedHealthcare Community & State	$21.39
Rate for Payer: Wellpoint Medicaid Managed Care	$23.52

ROD CARBON 200mm 14165

Facility

$887.50

Hospital Charge Code	270637347
Hospital Revenue Code	278
Min. Negotiated Rate	$133.12
Max. Negotiated Rate	$214.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.25
Rate for Payer: Qualcare PPO/HMO/WC	$133.12

ROD CARBON 300MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699328
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 300MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699328
Hospital Revenue Code	278
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

ROD CARBON 400MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699329
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

ROD CARBON 400MM

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	270699329
Hospital Revenue Code	278
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

ROD CARBON 450MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270700199
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

ROD CARBON 450MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270700199
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD CARBON 5X150MM

Facility

$820.00

Hospital Charge Code	270669005
Hospital Revenue Code	278
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$311.60
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.40
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Community & State	$19.76
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

ROD CARBON 5X150MM

Facility

$820.00

Hospital Charge Code	270669005
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$198.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.40
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

ROD CARBON 5x300MM 5049-5-530

Facility

$595.00

Hospital Charge Code	270647957
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

ROD CARBON 5x300MM 5049-5-530

Facility

$595.00

Hospital Charge Code	270647957
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

ROD CARBON 9.5x250mm 14170

Facility

$630.00

Hospital Charge Code	270643268
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

ROD CARBON 9.5x250mm 14170

Facility

$630.00

Hospital Charge Code	270643268
Hospital Revenue Code	278
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

Rod Carbon 9.5x300mm 14175

Facility

$630.00

Hospital Charge Code	270643267
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

Rod Carbon 9.5x300mm 14175

Facility

$630.00

Hospital Charge Code	270643267
Hospital Revenue Code	278
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

ROD CARBON 9.5 X 400MM 14185

Facility

$987.50

Service Code	HCPCS C1713
Hospital Charge Code	270637342
Hospital Revenue Code	278
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$238.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$217.25
Rate for Payer: Qualcare PPO/HMO/WC	$148.12

Know your out-of-pocket cost for care.

All Charges