Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACET TRILOGY 54 62005422

Facility

$5,996.10

Hospital Charge Code	270633726
Hospital Revenue Code	278
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$2,998.05
Rate for Payer: Aetna Commercial	$2,278.52
Rate for Payer: Aetna Medicare Advantage	$1,798.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,529.01
Rate for Payer: Cigna Commercial	$2,998.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,319.14
Rate for Payer: Qualcare PPO/HMO/WC	$899.41
Rate for Payer: UnitedHealthcare Community & State	$144.51
Rate for Payer: Wellpoint Medicaid Managed Care	$158.90

SHELL ACET TRILOGY 54 62005422

Facility

$5,996.10

Hospital Charge Code	270633726
Hospital Revenue Code	278
Min. Negotiated Rate	$899.41
Max. Negotiated Rate	$1,451.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,319.14
Rate for Payer: Qualcare PPO/HMO/WC	$899.41

SHELL ACET TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
Hospital Revenue Code	278
Min. Negotiated Rate	$883.34
Max. Negotiated Rate	$1,425.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.57
Rate for Payer: Qualcare PPO/HMO/WC	$883.34

SHELL ACET TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
Hospital Revenue Code	278
Min. Negotiated Rate	$141.92
Max. Negotiated Rate	$2,944.47
Rate for Payer: Aetna Commercial	$2,237.80
Rate for Payer: Aetna Medicare Advantage	$1,766.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.68
Rate for Payer: Cigna Commercial	$2,944.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.57
Rate for Payer: Qualcare PPO/HMO/WC	$883.34
Rate for Payer: UnitedHealthcare Community & State	$141.92
Rate for Payer: Wellpoint Medicaid Managed Care	$156.06

SHELL ACET TRY 60 CLT 62006022

Facility

$5,991.75

Hospital Charge Code	270634431
Hospital Revenue Code	278
Min. Negotiated Rate	$898.76
Max. Negotiated Rate	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,198.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,318.18
Rate for Payer: Qualcare PPO/HMO/WC	$898.76

SHELL ACET TRY 60 CLT 62006022

Facility

$5,991.75

Hospital Charge Code	270634431
Hospital Revenue Code	278
Min. Negotiated Rate	$144.40
Max. Negotiated Rate	$2,995.88
Rate for Payer: Aetna Commercial	$2,276.86
Rate for Payer: Aetna Medicare Advantage	$1,797.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,527.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,527.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,198.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,527.90
Rate for Payer: Cigna Commercial	$2,995.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,318.18
Rate for Payer: Qualcare PPO/HMO/WC	$898.76
Rate for Payer: UnitedHealthcare Community & State	$144.40
Rate for Payer: Wellpoint Medicaid Managed Care	$158.78

SHELL ACTBLR 54 RAN/BUR 106054

Facility

$4,761.65

Hospital Charge Code	270617514
Hospital Revenue Code	278
Min. Negotiated Rate	$114.76
Max. Negotiated Rate	$2,380.82
Rate for Payer: Aetna Commercial	$1,809.43
Rate for Payer: Aetna Medicare Advantage	$1,428.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,214.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,214.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$952.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,214.22
Rate for Payer: Cigna Commercial	$2,380.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,152.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,047.56
Rate for Payer: Qualcare PPO/HMO/WC	$714.25
Rate for Payer: UnitedHealthcare Community & State	$114.76
Rate for Payer: Wellpoint Medicaid Managed Care	$126.18

SHELL ACTBLR 54 RAN/BUR 106054

Facility

$4,761.65

Hospital Charge Code	270617514
Hospital Revenue Code	278
Min. Negotiated Rate	$714.25
Max. Negotiated Rate	$1,152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$952.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,152.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,047.56
Rate for Payer: Qualcare PPO/HMO/WC	$714.25

SHELL AT 3 58mm HD RD CP158125

Facility

$10,090.00

Hospital Charge Code	270639959
Hospital Revenue Code	278
Min. Negotiated Rate	$243.17
Max. Negotiated Rate	$5,045.00
Rate for Payer: Aetna Commercial	$3,834.20
Rate for Payer: Aetna Medicare Advantage	$3,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,572.95
Rate for Payer: Cigna Commercial	$5,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,219.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50
Rate for Payer: UnitedHealthcare Community & State	$243.17
Rate for Payer: Wellpoint Medicaid Managed Care	$267.38

SHELL AT 3 58mm HD RD CP158125

Facility

$10,090.00

Hospital Charge Code	270639959
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.50
Max. Negotiated Rate	$2,441.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,219.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50

SHELL BIPOLAR 42mm 500142

Facility

$2,208.50

Hospital Charge Code	270633144
Hospital Revenue Code	278
Min. Negotiated Rate	$53.22
Max. Negotiated Rate	$1,104.25
Rate for Payer: Aetna Commercial	$839.23
Rate for Payer: Aetna Medicare Advantage	$662.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.17
Rate for Payer: Cigna Commercial	$1,104.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.87
Rate for Payer: Qualcare PPO/HMO/WC	$331.27
Rate for Payer: UnitedHealthcare Community & State	$53.22
Rate for Payer: Wellpoint Medicaid Managed Care	$58.53

SHELL BIPOLAR 42mm 500142

Facility

$2,208.50

Hospital Charge Code	270633144
Hospital Revenue Code	278
Min. Negotiated Rate	$331.27
Max. Negotiated Rate	$534.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.87
Rate for Payer: Qualcare PPO/HMO/WC	$331.27

SHELL BIPOLAR 43mm 500143

Facility

$2,208.50

Hospital Charge Code	270633145
Hospital Revenue Code	278
Min. Negotiated Rate	$331.27
Max. Negotiated Rate	$534.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.87
Rate for Payer: Qualcare PPO/HMO/WC	$331.27

SHELL BIPOLAR 43mm 500143

Facility

$2,208.50

Hospital Charge Code	270633145
Hospital Revenue Code	278
Min. Negotiated Rate	$53.22
Max. Negotiated Rate	$1,104.25
Rate for Payer: Aetna Commercial	$839.23
Rate for Payer: Aetna Medicare Advantage	$662.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.17
Rate for Payer: Cigna Commercial	$1,104.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.87
Rate for Payer: Qualcare PPO/HMO/WC	$331.27
Rate for Payer: UnitedHealthcare Community & State	$53.22
Rate for Payer: Wellpoint Medicaid Managed Care	$58.53

SHELL BIPOLAR METAL 41 500141

Facility

$2,482.00

Hospital Charge Code	270633290
Hospital Revenue Code	278
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$600.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$546.04
Rate for Payer: Qualcare PPO/HMO/WC	$372.30

SHELL BIPOLAR METAL 41 500141

Facility

$2,482.00

Hospital Charge Code	270633290
Hospital Revenue Code	278
Min. Negotiated Rate	$59.82
Max. Negotiated Rate	$1,241.00
Rate for Payer: Aetna Commercial	$943.16
Rate for Payer: Aetna Medicare Advantage	$744.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.91
Rate for Payer: Cigna Commercial	$1,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$546.04
Rate for Payer: Qualcare PPO/HMO/WC	$372.30
Rate for Payer: UnitedHealthcare Community & State	$59.82
Rate for Payer: Wellpoint Medicaid Managed Care	$65.77

SHELL BIPOLR METL 48OD 5001-48

Facility

$2,706.20

Hospital Charge Code	270625798
Hospital Revenue Code	278
Min. Negotiated Rate	$405.93
Max. Negotiated Rate	$654.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.36
Rate for Payer: Qualcare PPO/HMO/WC	$405.93

SHELL BIPOLR METL 48OD 5001-48

Facility

$2,706.20

Hospital Charge Code	270625798
Hospital Revenue Code	278
Min. Negotiated Rate	$65.22
Max. Negotiated Rate	$1,353.10
Rate for Payer: Aetna Commercial	$1,028.36
Rate for Payer: Aetna Medicare Advantage	$811.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$690.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$690.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$690.08
Rate for Payer: Cigna Commercial	$1,353.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.36
Rate for Payer: Qualcare PPO/HMO/WC	$405.93
Rate for Payer: UnitedHealthcare Community & State	$65.22
Rate for Payer: Wellpoint Medicaid Managed Care	$71.71

SHELL BMT ACET 22 48MM 106048

Facility

$3,681.65

Hospital Charge Code	270615808
Hospital Revenue Code	278
Min. Negotiated Rate	$88.73
Max. Negotiated Rate	$1,840.83
Rate for Payer: Aetna Commercial	$1,399.03
Rate for Payer: Aetna Medicare Advantage	$1,104.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$736.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$938.82
Rate for Payer: Cigna Commercial	$1,840.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$809.96
Rate for Payer: Qualcare PPO/HMO/WC	$552.25
Rate for Payer: UnitedHealthcare Community & State	$88.73
Rate for Payer: Wellpoint Medicaid Managed Care	$97.56

SHELL BMT ACET 22 48MM 106048

Facility

$3,681.65

Hospital Charge Code	270615808
Hospital Revenue Code	278
Min. Negotiated Rate	$552.25
Max. Negotiated Rate	$890.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$736.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$809.96
Rate for Payer: Qualcare PPO/HMO/WC	$552.25

SHELL BMT ACET 24 56MM 106056

Facility

$5,902.45

Hospital Charge Code	270618981
Hospital Revenue Code	278
Min. Negotiated Rate	$142.25
Max. Negotiated Rate	$2,951.22
Rate for Payer: Aetna Commercial	$2,242.93
Rate for Payer: Aetna Medicare Advantage	$1,770.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,505.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,505.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,180.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,505.12
Rate for Payer: Cigna Commercial	$2,951.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,428.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,298.54
Rate for Payer: Qualcare PPO/HMO/WC	$885.37
Rate for Payer: UnitedHealthcare Community & State	$142.25
Rate for Payer: Wellpoint Medicaid Managed Care	$156.41

SHELL BMT ACET 24 56MM 106056

Facility

$5,902.45

Hospital Charge Code	270618981
Hospital Revenue Code	278
Min. Negotiated Rate	$885.37
Max. Negotiated Rate	$1,428.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,180.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,428.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,298.54
Rate for Payer: Qualcare PPO/HMO/WC	$885.37

SHELL BMT ACET 25 58MM 106058

Facility

$3,681.65

Hospital Charge Code	270613147
Hospital Revenue Code	278
Min. Negotiated Rate	$552.25
Max. Negotiated Rate	$890.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$736.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$809.96
Rate for Payer: Qualcare PPO/HMO/WC	$552.25

SHELL BMT ACET 25 58MM 106058

Facility

$3,681.65

Hospital Charge Code	270613147
Hospital Revenue Code	278
Min. Negotiated Rate	$88.73
Max. Negotiated Rate	$1,840.83
Rate for Payer: Aetna Commercial	$1,399.03
Rate for Payer: Aetna Medicare Advantage	$1,104.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$736.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$938.82
Rate for Payer: Cigna Commercial	$1,840.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$809.96
Rate for Payer: Qualcare PPO/HMO/WC	$552.25
Rate for Payer: UnitedHealthcare Community & State	$88.73
Rate for Payer: Wellpoint Medicaid Managed Care	$97.56

SHELL BMT ACET 25 60MM 107060

Facility

$5,139.25

Hospital Charge Code	270625256
Hospital Revenue Code	278
Min. Negotiated Rate	$770.89
Max. Negotiated Rate	$1,243.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,243.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,130.63
Rate for Payer: Qualcare PPO/HMO/WC	$770.89

Know your out-of-pocket cost for care.

All Charges