Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW ZIM PRTC 4.5 6 23472365

Facility

$139.25

Hospital Charge Code	270615655
Hospital Revenue Code	278
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$33.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

SCREW ZIM PRTC 4.5 8 23472380

Facility

$139.25

Hospital Charge Code	270615656
Hospital Revenue Code	278
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

SCREW ZIM PRTC 4.5 8 23472380

Facility

$139.25

Hospital Charge Code	270615656
Hospital Revenue Code	278
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$33.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

SCR LG ONE-PCE11m 100m22590142

Facility

$1,036.10

Hospital Charge Code	270636585
Hospital Revenue Code	278
Min. Negotiated Rate	$155.41
Max. Negotiated Rate	$250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$227.94
Rate for Payer: Qualcare PPO/HMO/WC	$155.41

SCR LG ONE-PCE11m 100m22590142

Facility

$1,036.10

Hospital Charge Code	270636585
Hospital Revenue Code	278
Min. Negotiated Rate	$24.97
Max. Negotiated Rate	$518.05
Rate for Payer: Aetna Commercial	$393.72
Rate for Payer: Aetna Medicare Advantage	$310.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.21
Rate for Payer: Cigna Commercial	$518.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$227.94
Rate for Payer: Qualcare PPO/HMO/WC	$155.41
Rate for Payer: UnitedHealthcare Community & State	$24.97
Rate for Payer: Wellpoint Medicaid Managed Care	$27.46

SCR LINEUM 3.5C12MM 14-524212

Facility

$11,735.00

Service Code	HCPCS C1713
Hospital Charge Code	270698916
Hospital Revenue Code	278
Min. Negotiated Rate	$282.81
Max. Negotiated Rate	$5,867.50
Rate for Payer: Aetna Commercial	$4,459.30
Rate for Payer: Aetna Medicare Advantage	$3,520.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,992.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,992.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,347.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,992.43
Rate for Payer: Cigna Commercial	$5,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,839.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,581.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,760.25
Rate for Payer: UnitedHealthcare Community & State	$282.81
Rate for Payer: Wellpoint Medicaid Managed Care	$310.98

SCR LINEUM 3.5C12MM 14-524212

Facility

$11,735.00

Service Code	HCPCS C1713
Hospital Charge Code	270698916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,760.25
Max. Negotiated Rate	$2,839.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,347.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,839.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,581.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,760.25

SCR LOCK CANN 5.0x30m222.536

Facility

$754.00

Hospital Charge Code	270635682
Hospital Revenue Code	278
Min. Negotiated Rate	$113.10
Max. Negotiated Rate	$182.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.88
Rate for Payer: Qualcare PPO/HMO/WC	$113.10

SCR LOCK CANN 5.0x30m222.536

Facility

$754.00

Hospital Charge Code	270635682
Hospital Revenue Code	278
Min. Negotiated Rate	$18.17
Max. Negotiated Rate	$377.00
Rate for Payer: Aetna Commercial	$286.52
Rate for Payer: Aetna Medicare Advantage	$226.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.27
Rate for Payer: Cigna Commercial	$377.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.88
Rate for Payer: Qualcare PPO/HMO/WC	$113.10
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$19.98

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
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

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
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

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$489.44
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,092.56
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$489.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$538.18

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$3,046.28
Max. Negotiated Rate	$3,046.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.27
Max. Negotiated Rate	$2,825.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$453.93
Max. Negotiated Rate	$22,993.64
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,993.64
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,650.54
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$453.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$499.13

Know your out-of-pocket cost for care.

All Charges