Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEET SURGIKOS ADHERENT ******

Facility

$18.00

Hospital Charge Code	1600808
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SHEET SURGIKOS ADHERENT ******

Facility

$18.00

Hospital Charge Code	1600808
Hospital Revenue Code	272
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SHEET THYROID DRAPE 89251

Facility

$71.25

Hospital Charge Code	270600898
Hospital Revenue Code	272
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

SHEET THYROID DRAPE 89251

Facility

$71.25

Hospital Charge Code	270600898
Hospital Revenue Code	272
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.62
Rate for Payer: Aetna Commercial	$27.07
Rate for Payer: Aetna Medicare Advantage	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.17
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

SHEET WADDING 4X6 YDS

Facility

$9.65

Hospital Charge Code	270061441
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SHEET WADDING 4X6 YDS

Facility

$9.65

Hospital Charge Code	270061441
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SHEET WADDING 6X6 YDS

Facility

$12.85

Hospital Charge Code	270061442
Hospital Revenue Code	279
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SHEET WADDING 6X6 YDS

Facility

$12.85

Hospital Charge Code	270061442
Hospital Revenue Code	279
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

SHEET XMD SILASTIC 2X2 1532510

Facility

$83.00

Hospital Charge Code	270624855
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

SHEET XMD SILASTIC 2X2 1532510

Facility

$83.00

Hospital Charge Code	270624855
Hospital Revenue Code	272
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

SHELL

Facility

$8,660.65

Hospital Charge Code	270657085
Hospital Revenue Code	278
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$3,291.05
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10
Rate for Payer: UnitedHealthcare Community & State	$208.72
Rate for Payer: Wellpoint Medicaid Managed Care	$229.51

SHELL

Facility

$8,660.65

Hospital Charge Code	270657085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

SHELL3 HOLE 50MM

Facility

$15,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270688361
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL3 HOLE 50MM

Facility

$15,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270688361
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 FINNED 52E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680806
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

SHELL 3 HOLE G7 FINNED 52E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680806
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHELL 3 HOLE G7 OSSEOTI

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 OSSEOTI

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688596
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL 3 HOLE G7 OSSEOTI 52 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688345
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 OSSEOTI 52 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688345
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL 52x38 M2A METAL RD118852

Facility

$14,235.25

Hospital Charge Code	270632847
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.29
Max. Negotiated Rate	$3,444.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,847.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,444.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,131.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,135.29

SHELL 52x38 M2A METAL RD118852

Facility

$14,235.25

Hospital Charge Code	270632847
Hospital Revenue Code	278
Min. Negotiated Rate	$343.07
Max. Negotiated Rate	$7,117.62
Rate for Payer: Aetna Commercial	$5,409.40
Rate for Payer: Aetna Medicare Advantage	$4,270.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,629.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,629.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,847.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,629.99
Rate for Payer: Cigna Commercial	$7,117.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,444.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,131.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,135.29
Rate for Payer: UnitedHealthcare Community & State	$343.07
Rate for Payer: Wellpoint Medicaid Managed Care	$377.23

SHELL 54x38 M2A METAL RD118854

Facility

$13,178.45

Hospital Charge Code	270631463
Hospital Revenue Code	278
Min. Negotiated Rate	$317.60
Max. Negotiated Rate	$6,589.23
Rate for Payer: Aetna Commercial	$5,007.81
Rate for Payer: Aetna Medicare Advantage	$3,953.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,635.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,360.50
Rate for Payer: Cigna Commercial	$6,589.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,976.77
Rate for Payer: UnitedHealthcare Community & State	$317.60
Rate for Payer: Wellpoint Medicaid Managed Care	$349.23

SHELL 54x38 M2A METAL RD118854

Facility

$13,178.45

Hospital Charge Code	270631463
Hospital Revenue Code	278
Min. Negotiated Rate	$1,976.77
Max. Negotiated Rate	$3,189.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,635.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,976.77

SHELL 60MM TRIDENT ACETABULAR

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270695458
Hospital Revenue Code	278
Min. Negotiated Rate	$164.08
Max. Negotiated Rate	$3,404.07
Rate for Payer: Aetna Commercial	$2,587.10
Rate for Payer: Aetna Medicare Advantage	$2,042.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.08
Rate for Payer: Cigna Commercial	$3,404.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,497.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22
Rate for Payer: UnitedHealthcare Community & State	$164.08
Rate for Payer: Wellpoint Medicaid Managed Care	$180.42

Know your out-of-pocket cost for care.

All Charges