Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD CONNECTING 11X200MM

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270669477
Hospital Revenue Code	278
Min. Negotiated Rate	$379.50
Max. Negotiated Rate	$612.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$379.50

ROD CONNECTING 11X350MM

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Charge Code	270669476
Hospital Revenue Code	278
Min. Negotiated Rate	$62.54
Max. Negotiated Rate	$1,297.50
Rate for Payer: Aetna Commercial	$986.10
Rate for Payer: Aetna Medicare Advantage	$778.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$661.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$661.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$661.73
Rate for Payer: Cigna Commercial	$1,297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$570.90
Rate for Payer: Qualcare PPO/HMO/WC	$389.25
Rate for Payer: UnitedHealthcare Community & State	$62.54
Rate for Payer: Wellpoint Medicaid Managed Care	$68.77

ROD CONNECTING 11X350MM

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Charge Code	270669476
Hospital Revenue Code	278
Min. Negotiated Rate	$389.25
Max. Negotiated Rate	$627.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$570.90
Rate for Payer: Qualcare PPO/HMO/WC	$389.25

ROD CONNECTING 8x400mm MRI

Facility

$2,240.00

Hospital Charge Code	270648002
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$492.80
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING 8x400mm MRI

Facility

$2,240.00

Hospital Charge Code	270648002
Hospital Revenue Code	278
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$851.20
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$492.80
Rate for Payer: Qualcare PPO/HMO/WC	$336.00
Rate for Payer: UnitedHealthcare Community & State	$53.98
Rate for Payer: Wellpoint Medicaid Managed Care	$59.36

ROD CONNECTING 8x450mm MRI

Facility

$2,240.00

Hospital Charge Code	270648001
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$492.80
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING 8x450mm MRI

Facility

$2,240.00

Hospital Charge Code	270648001
Hospital Revenue Code	278
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$851.20
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$492.80
Rate for Payer: Qualcare PPO/HMO/WC	$336.00
Rate for Payer: UnitedHealthcare Community & State	$53.98
Rate for Payer: Wellpoint Medicaid Managed Care	$59.36

ROD CONNECTING LG FA100003

Facility

$4,811.25

Hospital Charge Code	270621621
Hospital Revenue Code	278
Min. Negotiated Rate	$721.69
Max. Negotiated Rate	$1,164.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$962.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,164.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,058.47
Rate for Payer: Qualcare PPO/HMO/WC	$721.69

ROD CONNECTING LG FA100003

Facility

$4,811.25

Hospital Charge Code	270621621
Hospital Revenue Code	278
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$2,405.62
Rate for Payer: Aetna Commercial	$1,828.28
Rate for Payer: Aetna Medicare Advantage	$1,443.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,226.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,226.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$962.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,226.87
Rate for Payer: Cigna Commercial	$2,405.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,164.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,058.47
Rate for Payer: Qualcare PPO/HMO/WC	$721.69
Rate for Payer: UnitedHealthcare Community & State	$115.95
Rate for Payer: Wellpoint Medicaid Managed Care	$127.50

ROD CONNECTING SHORT FA100001

Facility

$3,769.65

Hospital Charge Code	270632631
Hospital Revenue Code	278
Min. Negotiated Rate	$565.45
Max. Negotiated Rate	$912.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$753.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.32
Rate for Payer: Qualcare PPO/HMO/WC	$565.45

ROD CONNECTING SHORT FA100001

Facility

$3,769.65

Hospital Charge Code	270632631
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$1,884.83
Rate for Payer: Aetna Commercial	$1,432.47
Rate for Payer: Aetna Medicare Advantage	$1,130.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$753.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.26
Rate for Payer: Cigna Commercial	$1,884.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.32
Rate for Payer: Qualcare PPO/HMO/WC	$565.45
Rate for Payer: UnitedHealthcare Community & State	$90.85
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

ROD CONNECTOR 3.5MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704794
Hospital Revenue Code	278
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$189.79
Rate for Payer: Wellpoint Medicaid Managed Care	$208.69

ROD CONNECTOR 3.5MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

ROD CONNECT SM EXT FIX 4x60mm

Facility

$176.15

Service Code	HCPCS C1713
Hospital Charge Code	270639003
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$88.08
Rate for Payer: Aetna Commercial	$66.94
Rate for Payer: Aetna Medicare Advantage	$52.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.92
Rate for Payer: Cigna Commercial	$88.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.42
Rate for Payer: UnitedHealthcare Community & State	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.67

ROD CONNECT SM EXT FIX 4x60mm

Facility

$176.15

Service Code	HCPCS C1713
Hospital Charge Code	270639003
Hospital Revenue Code	278
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$42.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.42

ROD CONNECT SM EXT FIX 4x80mm

Facility

$176.15

Service Code	HCPCS C1713
Hospital Charge Code	270639004
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$88.08
Rate for Payer: Aetna Commercial	$66.94
Rate for Payer: Aetna Medicare Advantage	$52.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.92
Rate for Payer: Cigna Commercial	$88.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.42
Rate for Payer: UnitedHealthcare Community & State	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.67

ROD CONNECT SM EXT FIX 4x80mm

Facility

$176.15

Service Code	HCPCS C1713
Hospital Charge Code	270639004
Hospital Revenue Code	278
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$42.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.42

ROD CONNET CAR 8x1000 50288100

Facility

$1,905.00

Hospital Charge Code	270643443
Hospital Revenue Code	278
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$952.50
Rate for Payer: Aetna Commercial	$723.90
Rate for Payer: Aetna Medicare Advantage	$571.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$485.77
Rate for Payer: Cigna Commercial	$952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$419.10
Rate for Payer: Qualcare PPO/HMO/WC	$285.75
Rate for Payer: UnitedHealthcare Community & State	$45.91
Rate for Payer: Wellpoint Medicaid Managed Care	$50.48

ROD CONNET CAR 8x1000 50288100

Facility

$1,905.00

Hospital Charge Code	270643443
Hospital Revenue Code	278
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$461.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$381.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$419.10
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

ROD CONN LG 150,200,250,300***

Facility

$67.00

Hospital Charge Code	1601913
Hospital Revenue Code	274
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.74
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

ROD CONN LG 150,200,250,300***

Facility

$67.00

Hospital Charge Code	1601913
Hospital Revenue Code	274
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.74
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

ROD CONN LG 350 & 400 MM****

Facility

$78.00

Hospital Charge Code	1601921
Hospital Revenue Code	274
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$18.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.16
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

ROD CONN LG 350 & 400 MM****

Facility

$78.00

Hospital Charge Code	1601921
Hospital Revenue Code	274
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.16
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ROD CONN LG 450 & 500 MM***

Facility

$92.00

Hospital Charge Code	1601939
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

ROD CONN LG 450 & 500 MM***

Facility

$92.00

Hospital Charge Code	1601939
Hospital Revenue Code	274
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

Know your out-of-pocket cost for care.

All Charges