Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD EXTND TAB 50MM OVRWTCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692587
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 FIXED 60 MM PALISADE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692238
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD FIXED 60 MM PALISADE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692238
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

ROD HMD CONNECT 5/100 50495510

Facility

$292.85

Hospital Charge Code	270619343
Hospital Revenue Code	278
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.43
Rate for Payer: Aetna Commercial	$111.28
Rate for Payer: Aetna Medicare Advantage	$87.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.68
Rate for Payer: Cigna Commercial	$146.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.43
Rate for Payer: Qualcare PPO/HMO/WC	$43.93
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

ROD HMD CONNECT 5/100 50495510

Facility

$292.85

Hospital Charge Code	270619343
Hospital Revenue Code	278
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$70.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.43
Rate for Payer: Qualcare PPO/HMO/WC	$43.93

ROD HMD CONNECT 5/150 50495515

Facility

$307.25

Hospital Charge Code	270619344
Hospital Revenue Code	278
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$74.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

ROD HMD CONNECT 5/150 50495515

Facility

$307.25

Hospital Charge Code	270619344
Hospital Revenue Code	278
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$116.75
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

ROD HMD CONNECT 5/200 50495520

Facility

$323.25

Hospital Charge Code	270619345
Hospital Revenue Code	278
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$78.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

ROD HMD CONNECT 5/200 50495520

Facility

$323.25

Hospital Charge Code	270619345
Hospital Revenue Code	278
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$122.83
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Community & State	$7.79
Rate for Payer: Wellpoint Medicaid Managed Care	$8.57

ROD HMD CONNECT 5/250 50495525

Facility

$323.25

Hospital Charge Code	270619346
Hospital Revenue Code	272
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$48.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

ROD HMD CONNECT 5/250 50495525

Facility

$323.25

Hospital Charge Code	270619346
Hospital Revenue Code	272
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$122.83
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.97
Rate for Payer: Oxford Commercial	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Commercial	$64.65
Rate for Payer: UnitedHealthcare Community & State	$7.79
Rate for Payer: Wellpoint Medicaid Managed Care	$8.57

ROD HMD CONNECT 5/65 5049-5505

Facility

$292.85

Hospital Charge Code	270619342
Hospital Revenue Code	272
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.43
Rate for Payer: Aetna Commercial	$111.28
Rate for Payer: Aetna Medicare Advantage	$87.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.68
Rate for Payer: Cigna Commercial	$146.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.86
Rate for Payer: Oxford Commercial	$58.57
Rate for Payer: Qualcare PPO/HMO/WC	$43.93
Rate for Payer: UnitedHealthcare Commercial	$58.57
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

ROD HMD CONNECT 5/65 5049-5505

Facility

$292.85

Hospital Charge Code	270619342
Hospital Revenue Code	272
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$43.93

ROD HMD CONNECT 8/100 50298810

Facility

$522.45

Hospital Charge Code	270621583
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$78.37

ROD HMD CONNECT 8/100 50298810

Facility

$522.45

Hospital Charge Code	270621583
Hospital Revenue Code	278
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$261.23
Rate for Payer: Aetna Commercial	$198.53
Rate for Payer: Aetna Medicare Advantage	$156.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.22
Rate for Payer: Cigna Commercial	$261.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$78.37
Rate for Payer: UnitedHealthcare Community & State	$12.59
Rate for Payer: Wellpoint Medicaid Managed Care	$13.84

ROD HMD CONNECT 8/150 50298815

Facility

$522.45

Hospital Charge Code	270621584
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$78.37

ROD HMD CONNECT 8/150 50298815

Facility

$522.45

Hospital Charge Code	270621584
Hospital Revenue Code	278
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$261.23
Rate for Payer: Aetna Commercial	$198.53
Rate for Payer: Aetna Medicare Advantage	$156.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.22
Rate for Payer: Cigna Commercial	$261.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$78.37
Rate for Payer: UnitedHealthcare Community & State	$12.59
Rate for Payer: Wellpoint Medicaid Managed Care	$13.84

ROD HMD CONNECT 8/250 50298825

Facility

$553.65

Hospital Charge Code	270621585
Hospital Revenue Code	278
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$133.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.80
Rate for Payer: Qualcare PPO/HMO/WC	$83.05

ROD HMD CONNECT 8/250 50298825

Facility

$553.65

Hospital Charge Code	270621585
Hospital Revenue Code	278
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$276.82
Rate for Payer: Aetna Commercial	$210.39
Rate for Payer: Aetna Medicare Advantage	$166.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.18
Rate for Payer: Cigna Commercial	$276.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.80
Rate for Payer: Qualcare PPO/HMO/WC	$83.05
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$14.67

ROD HMD CONNECT 8/300 50298830

Facility

$553.65

Hospital Charge Code	270621586
Hospital Revenue Code	278
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$276.82
Rate for Payer: Aetna Commercial	$210.39
Rate for Payer: Aetna Medicare Advantage	$166.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.18
Rate for Payer: Cigna Commercial	$276.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.80
Rate for Payer: Qualcare PPO/HMO/WC	$83.05
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$14.67

ROD HMD CONNECT 8/300 50298830

Facility

$553.65

Hospital Charge Code	270621586
Hospital Revenue Code	278
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$133.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.80
Rate for Payer: Qualcare PPO/HMO/WC	$83.05

ROD HMD GAM LNG 11 240 3370630

Facility

$3,802.45

Hospital Charge Code	270611711
Hospital Revenue Code	278
Min. Negotiated Rate	$570.37
Max. Negotiated Rate	$920.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$836.54
Rate for Payer: Qualcare PPO/HMO/WC	$570.37

ROD HMD GAM LNG 11 240 3370630

Facility

$3,802.45

Hospital Charge Code	270611711
Hospital Revenue Code	278
Min. Negotiated Rate	$91.64
Max. Negotiated Rate	$1,901.22
Rate for Payer: Aetna Commercial	$1,444.93
Rate for Payer: Aetna Medicare Advantage	$1,140.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$969.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$969.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$969.62
Rate for Payer: Cigna Commercial	$1,901.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$836.54
Rate for Payer: Qualcare PPO/HMO/WC	$570.37
Rate for Payer: UnitedHealthcare Community & State	$91.64
Rate for Payer: Wellpoint Medicaid Managed Care	$100.76

ROD HUNTER 5MMX24.5CM

Facility

$7,150.00

Service Code	HCPCS C1889
Hospital Charge Code	270692638
Hospital Revenue Code	278
Min. Negotiated Rate	$1,072.50
Max. Negotiated Rate	$1,730.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50

ROD HUNTER 5MMX24.5CM

Facility

$7,150.00

Service Code	HCPCS C1889
Hospital Charge Code	270692638
Hospital Revenue Code	278
Min. Negotiated Rate	$172.31
Max. Negotiated Rate	$3,575.00
Rate for Payer: Aetna Commercial	$2,717.00
Rate for Payer: Aetna Medicare Advantage	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,823.25
Rate for Payer: Cigna Commercial	$3,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50
Rate for Payer: UnitedHealthcare Community & State	$172.31
Rate for Payer: Wellpoint Medicaid Managed Care	$189.47

Know your out-of-pocket cost for care.

All Charges