Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SEED IMPLANT

Facility

$62.50

Hospital Charge Code	270613879
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$12.50
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

SEED IMPLANT

Facility

$62.50

Hospital Charge Code	270613879
Hospital Revenue Code	270
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

SEED IMPLANT IBT IS-12501

Facility

$178.45

Hospital Charge Code	270617741
Hospital Revenue Code	272
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$89.22
Rate for Payer: Aetna Commercial	$67.81
Rate for Payer: Aetna Medicare Advantage	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.53
Rate for Payer: Oxford Commercial	$35.69
Rate for Payer: Qualcare PPO/HMO/WC	$26.77
Rate for Payer: UnitedHealthcare Commercial	$35.69
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4.73

SEED IMPLANT IBT IS-12501

Facility

$178.45

Hospital Charge Code	270617741
Hospital Revenue Code	272
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$26.77
Rate for Payer: Qualcare PPO/HMO/WC	$26.77

SEED PALLADIUM 103K 200LINK

Facility

$361.25

Hospital Charge Code	270646147
Hospital Revenue Code	278
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$180.62
Rate for Payer: Aetna Commercial	$137.28
Rate for Payer: Aetna Medicare Advantage	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.12
Rate for Payer: Cigna Commercial	$180.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$79.47
Rate for Payer: Qualcare PPO/HMO/WC	$54.19
Rate for Payer: UnitedHealthcare Community & State	$8.71
Rate for Payer: Wellpoint Medicaid Managed Care	$9.57

SEED PALLADIUM 103K 200LINK

Facility

$361.25

Hospital Charge Code	270646147
Hospital Revenue Code	278
Min. Negotiated Rate	$54.19
Max. Negotiated Rate	$87.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$79.47
Rate for Payer: Qualcare PPO/HMO/WC	$54.19

SEEDS IODINE PRELOADED I125

Facility

$75.00

Hospital Charge Code	270636489
Hospital Revenue Code	278
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

SEEDS IODINE PRELOADED I125

Facility

$75.00

Hospital Charge Code	270636489
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$1,451.06
Max. Negotiated Rate	$30,105.00
Rate for Payer: Aetna Commercial	$22,879.80
Rate for Payer: Aetna Medicare Advantage	$18,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,353.55
Rate for Payer: Cigna Commercial	$30,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,246.20
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50
Rate for Payer: UnitedHealthcare Community & State	$1,451.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1,595.57

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$9,031.50
Max. Negotiated Rate	$14,570.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,246.20
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50

SEGMENT MDT BIF 28 16 X2816165

Facility

$39,984.85

Hospital Charge Code	270629596
Hospital Revenue Code	278
Min. Negotiated Rate	$963.63
Max. Negotiated Rate	$19,992.42
Rate for Payer: Aetna Commercial	$15,194.24
Rate for Payer: Aetna Medicare Advantage	$11,995.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,196.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,196.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,996.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,196.14
Rate for Payer: Cigna Commercial	$19,992.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,676.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,796.67
Rate for Payer: Qualcare PPO/HMO/WC	$5,997.73
Rate for Payer: UnitedHealthcare Community & State	$963.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1,059.60

SEGMENT MDT BIF 28 16 X2816165

Facility

$39,984.85

Hospital Charge Code	270629596
Hospital Revenue Code	278
Min. Negotiated Rate	$5,997.73
Max. Negotiated Rate	$9,676.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,996.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,676.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,796.67
Rate for Payer: Qualcare PPO/HMO/WC	$5,997.73

SEGMENT MDT FEM ILIAC R2414165

Facility

$37,750.00

Hospital Charge Code	270623298
Hospital Revenue Code	278
Min. Negotiated Rate	$5,662.50
Max. Negotiated Rate	$9,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50

SEGMENT MDT FEM ILIAC R2414165

Facility

$37,750.00

Hospital Charge Code	270623298
Hospital Revenue Code	278
Min. Negotiated Rate	$909.77
Max. Negotiated Rate	$18,875.00
Rate for Payer: Aetna Commercial	$14,345.00
Rate for Payer: Aetna Medicare Advantage	$11,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,626.25
Rate for Payer: Cigna Commercial	$18,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50
Rate for Payer: UnitedHealthcare Community & State	$909.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1,000.38

SEGMENTS BI 26x15 YRBRX2615165

Facility

$37,448.00

Hospital Charge Code	270631397
Hospital Revenue Code	278
Min. Negotiated Rate	$902.50
Max. Negotiated Rate	$18,724.00
Rate for Payer: Aetna Commercial	$14,230.24
Rate for Payer: Aetna Medicare Advantage	$11,234.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,549.24
Rate for Payer: Cigna Commercial	$18,724.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,238.56
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20
Rate for Payer: UnitedHealthcare Community & State	$902.50
Rate for Payer: Wellpoint Medicaid Managed Care	$992.37

SEGMENTS BI 26x15 YRBRX2615165

Facility

$37,448.00

Hospital Charge Code	270631397
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$9,062.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,238.56
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEGMENTS BIFURCATED 28X16X135

Facility

$37,448.00

Hospital Charge Code	270631577
Hospital Revenue Code	278
Min. Negotiated Rate	$902.50
Max. Negotiated Rate	$18,724.00
Rate for Payer: Aetna Commercial	$14,230.24
Rate for Payer: Aetna Medicare Advantage	$11,234.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,549.24
Rate for Payer: Cigna Commercial	$18,724.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,238.56
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20
Rate for Payer: UnitedHealthcare Community & State	$902.50
Rate for Payer: Wellpoint Medicaid Managed Care	$992.37

SEGMENTS BIFURCATED 28X16X135

Facility

$37,448.00

Hospital Charge Code	270631577
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$9,062.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,238.56
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEIZURE

Facility

$23,675.31

Service Code	APR-DRG 0534
Min. Negotiated Rate	$23,211.09
Max. Negotiated Rate	$23,675.31
Rate for Payer: UnitedHealthcare Community & State	$23,211.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,675.31
Rate for Payer: Wellpoint Medicaid Managed Care	$23,211.09

SEIZURE

Facility

$10,514.99

Service Code	APR-DRG 0533
Min. Negotiated Rate	$10,308.81
Max. Negotiated Rate	$10,514.99
Rate for Payer: UnitedHealthcare Community & State	$10,308.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,514.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10,308.81

SEIZURE

Facility

$5,921.35

Service Code	APR-DRG 0531
Min. Negotiated Rate	$5,805.25
Max. Negotiated Rate	$5,921.35
Rate for Payer: UnitedHealthcare Community & State	$5,805.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,921.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5,805.25

SEIZURE

Facility

$7,698.57

Service Code	APR-DRG 0532
Min. Negotiated Rate	$7,547.62
Max. Negotiated Rate	$7,698.57
Rate for Payer: UnitedHealthcare Community & State	$7,547.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,698.57
Rate for Payer: Wellpoint Medicaid Managed Care	$7,547.62

SEIZURES WITH MCC

Facility

$64,734.63

Service Code	MSDRG 100
Min. Negotiated Rate	$19,710.87
Max. Negotiated Rate	$64,734.63
Rate for Payer: Aetna Commercial	$44,737.38
Rate for Payer: Aetna Medicare Advantage	$64,734.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,748.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,056.78
Rate for Payer: Cigna Commercial	$36,245.28
Rate for Payer: Cigna Medicare Advantage	$20,748.28
Rate for Payer: Clover Medicare Advantage	$19,710.87
Rate for Payer: EmblemHealth Commercial	$62,244.84
Rate for Payer: Humana Medicare Advantage	$21,370.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,748.28
Rate for Payer: Oxford Commercial	$26,049.96
Rate for Payer: UnitedHealthcare Commercial	$45,679.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,748.28
Rate for Payer: Wellcare Medicare Advantage	$20,748.28

SEIZURES WITHOUT MCC

Facility

$31,307.58

Service Code	MSDRG 101
Min. Negotiated Rate	$9,532.76
Max. Negotiated Rate	$31,307.58
Rate for Payer: Aetna Commercial	$21,769.20
Rate for Payer: Aetna Medicare Advantage	$31,307.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,034.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$16,891.26
Rate for Payer: Cigna Medicare Advantage	$10,034.48
Rate for Payer: Clover Medicare Advantage	$9,532.76
Rate for Payer: EmblemHealth Commercial	$30,103.44
Rate for Payer: Humana Medicare Advantage	$10,335.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,034.48
Rate for Payer: Oxford Commercial	$12,139.97
Rate for Payer: UnitedHealthcare Commercial	$21,287.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,034.48
Rate for Payer: Wellcare Medicare Advantage	$10,034.48

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	411036015
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

Know your out-of-pocket cost for care.

All Charges