Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCR PER 3.5Mx12M W2.7M23481235

Facility

$140.40

Hospital Charge Code	270640541
Hospital Revenue Code	278
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$53.35
Rate for Payer: Aetna Medicare Advantage	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.80
Rate for Payer: Cigna Commercial	$70.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.89
Rate for Payer: Qualcare PPO/HMO/WC	$21.06
Rate for Payer: UnitedHealthcare Community & State	$3.38
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

SCR PER 3.5Mx12M W2.7M23481235

Facility

$140.40

Hospital Charge Code	270640541
Hospital Revenue Code	278
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.89
Rate for Payer: Qualcare PPO/HMO/WC	$21.06

SCR SELF CORT 4.5/34MM48453401

Facility

$64.25

Hospital Charge Code	270605566
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.64

SCR SELF CORT 4.5/34MM48453401

Facility

$64.25

Hospital Charge Code	270605566
Hospital Revenue Code	278
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$32.12
Rate for Payer: Aetna Commercial	$24.41
Rate for Payer: Aetna Medicare Advantage	$19.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.38
Rate for Payer: Cigna Commercial	$32.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.64
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

SCRUB TOP 2PK MISTY ENCORE

Facility

$22.15

Hospital Charge Code	270658929
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

SCRUB TOP 2PK MISTY ENCORE

Facility

$22.15

Hospital Charge Code	270658929
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.07
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna Medicare Advantage	$6.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.65
Rate for Payer: Cigna Commercial	$11.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.64
Rate for Payer: Oxford Commercial	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$4.43
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

SCRUB TOP 2PK MISTY ENCORE

Facility

$24.85

Hospital Charge Code	270658931
Hospital Revenue Code	270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SCRUB TOP 2PK MISTY ENCORE

Facility

$26.40

Hospital Charge Code	270658930
Hospital Revenue Code	270
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$3.96

SCRUB TOP 2PK MISTY ENCORE

Facility

$24.85

Hospital Charge Code	270658931
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SCRUB TOP 2PK MISTY ENCORE

Facility

$26.40

Hospital Charge Code	270658930
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.20
Rate for Payer: Aetna Commercial	$10.03
Rate for Payer: Aetna Medicare Advantage	$7.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.73
Rate for Payer: Cigna Commercial	$13.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.92
Rate for Payer: Oxford Commercial	$5.28
Rate for Payer: Qualcare PPO/HMO/WC	$3.96
Rate for Payer: UnitedHealthcare Commercial	$5.28
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.00

Hospital Charge Code	270658923
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

SCRUB TOP 2PKT MISTY ENCORE

Facility

$22.80

Hospital Charge Code	270658927
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.40
Rate for Payer: Aetna Commercial	$8.66
Rate for Payer: Aetna Medicare Advantage	$6.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.81
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.84
Rate for Payer: Oxford Commercial	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Commercial	$4.56
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.65

Hospital Charge Code	270658925
Hospital Revenue Code	270
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.95

SCRUB TOP 2PKT MISTY ENCORE

Facility

$26.25

Hospital Charge Code	270658926
Hospital Revenue Code	270
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$3.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.94

SCRUB TOP 2PKT MISTY ENCORE

Facility

$22.80

Hospital Charge Code	270658927
Hospital Revenue Code	270
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$3.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.42

SCRUB TOP 2PKT MISTY ENCORE

Facility

$26.25

Hospital Charge Code	270658926
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.12
Rate for Payer: Aetna Commercial	$9.97
Rate for Payer: Aetna Medicare Advantage	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.69
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.88
Rate for Payer: Oxford Commercial	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.94
Rate for Payer: UnitedHealthcare Commercial	$5.25
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.65

Hospital Charge Code	270658925
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.82
Rate for Payer: Aetna Commercial	$7.47
Rate for Payer: Aetna Medicare Advantage	$5.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.01
Rate for Payer: Cigna Commercial	$9.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.89
Rate for Payer: Oxford Commercial	$3.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.95
Rate for Payer: UnitedHealthcare Commercial	$3.93
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.00

Hospital Charge Code	270658923
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SCRW 2.0m x6m CORT SELF401.936

Facility

$210.85

Hospital Charge Code	270635601
Hospital Revenue Code	278
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$51.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.39
Rate for Payer: Qualcare PPO/HMO/WC	$31.63

SCRW 2.0m x6m CORT SELF401.936

Facility

$210.85

Hospital Charge Code	270635601
Hospital Revenue Code	278
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$105.42
Rate for Payer: Aetna Commercial	$80.12
Rate for Payer: Aetna Medicare Advantage	$63.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.77
Rate for Payer: Cigna Commercial	$105.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.39
Rate for Payer: Qualcare PPO/HMO/WC	$31.63
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

SCRW 2.0X36 LAG CANNULATED

Facility

$1,575.00

Hospital Charge Code	270648908
Hospital Revenue Code	278
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

SCRW 2.0X36 LAG CANNULATED

Facility

$1,575.00

Hospital Charge Code	270648908
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$15.41
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$243.05
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.71
Rate for Payer: Qualcare PPO/HMO/WC	$95.94
Rate for Payer: UnitedHealthcare Community & State	$15.41
Rate for Payer: Wellpoint Medicaid Managed Care	$16.95

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.71
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.71
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

Know your out-of-pocket cost for care.

All Charges