Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL CLUSTER-HOLE 52MM

Facility

$10,850.00

Hospital Charge Code	270676367
Hospital Revenue Code	278
Min. Negotiated Rate	$1,627.50
Max. Negotiated Rate	$2,625.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,387.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50

SHELL CLUSTER-HOLE 52MM

Facility

$10,850.00

Hospital Charge Code	270676367
Hospital Revenue Code	278
Min. Negotiated Rate	$261.49
Max. Negotiated Rate	$5,425.00
Rate for Payer: Aetna Commercial	$4,123.00
Rate for Payer: Aetna Medicare Advantage	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,766.75
Rate for Payer: Cigna Commercial	$5,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,387.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$261.49
Rate for Payer: Wellpoint Medicaid Managed Care	$287.52

SHELL CLUST TRID PSL HA 50MM E

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270695125
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.64
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

SHELL CLUST TRID PSL HA 50MM E

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270695125
Hospital Revenue Code	278
Min. Negotiated Rate	$114.11
Max. Negotiated Rate	$2,367.38
Rate for Payer: Aetna Commercial	$1,799.20
Rate for Payer: Aetna Medicare Advantage	$1,420.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.36
Rate for Payer: Cigna Commercial	$2,367.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.64
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$114.11
Rate for Payer: Wellpoint Medicaid Managed Care	$125.47

SHELL DRM US ACTBLR 0100214160

Facility

$16,095.05

Hospital Charge Code	270639260
Hospital Revenue Code	278
Min. Negotiated Rate	$2,414.26
Max. Negotiated Rate	$3,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,219.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,895.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,540.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,414.26

SHELL DRM US ACTBLR 0100214160

Facility

$16,095.05

Hospital Charge Code	270639260
Hospital Revenue Code	278
Min. Negotiated Rate	$387.89
Max. Negotiated Rate	$8,047.52
Rate for Payer: Aetna Commercial	$6,116.12
Rate for Payer: Aetna Medicare Advantage	$4,828.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,104.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,104.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,219.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,104.24
Rate for Payer: Cigna Commercial	$8,047.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,895.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,540.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,414.26
Rate for Payer: UnitedHealthcare Community & State	$387.89
Rate for Payer: Wellpoint Medicaid Managed Care	$426.52

SHELL DUROM US ACET 0100214156

Facility

$16,899.80

Hospital Charge Code	270638717
Hospital Revenue Code	278
Min. Negotiated Rate	$2,534.97
Max. Negotiated Rate	$4,089.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,379.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,717.96
Rate for Payer: Qualcare PPO/HMO/WC	$2,534.97

SHELL DUROM US ACET 0100214156

Facility

$16,899.80

Hospital Charge Code	270638717
Hospital Revenue Code	278
Min. Negotiated Rate	$407.29
Max. Negotiated Rate	$8,449.90
Rate for Payer: Aetna Commercial	$6,421.92
Rate for Payer: Aetna Medicare Advantage	$5,069.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,309.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,309.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,379.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,309.45
Rate for Payer: Cigna Commercial	$8,449.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,717.96
Rate for Payer: Qualcare PPO/HMO/WC	$2,534.97
Rate for Payer: UnitedHealthcare Community & State	$407.29
Rate for Payer: Wellpoint Medicaid Managed Care	$447.84

SHELL FEM CEMT 16x145 78531621

Facility

$11,316.75

Hospital Charge Code	270633435
Hospital Revenue Code	278
Min. Negotiated Rate	$1,697.51
Max. Negotiated Rate	$2,738.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,263.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,738.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,489.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.51

SHELL FEM CEMT 16x145 78531621

Facility

$11,316.75

Hospital Charge Code	270633435
Hospital Revenue Code	278
Min. Negotiated Rate	$272.73
Max. Negotiated Rate	$5,658.38
Rate for Payer: Aetna Commercial	$4,300.36
Rate for Payer: Aetna Medicare Advantage	$3,395.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,885.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,885.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,263.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,885.77
Rate for Payer: Cigna Commercial	$5,658.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,738.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,489.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.51
Rate for Payer: UnitedHealthcare Community & State	$272.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.89

SHELL FINNED G7 4 HOLE 58G

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270683725
Hospital Revenue Code	278
Min. Negotiated Rate	$872.66
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$13,759.80
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50
Rate for Payer: UnitedHealthcare Community & State	$872.66
Rate for Payer: Wellpoint Medicaid Managed Care	$959.57

SHELL FINNED G7 4 HOLE 58G

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270683725
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

SHELL FLAREHAWK 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL FLAREHAWK 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695593
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

SHELLFLAREHAWKLORDOT29MMTIH9

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270694806
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELLFLAREHAWKLORDOT29MMTIH9

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270694806
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

SHELL FLAREHAWK LRD TI H9 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692662
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

SHELL FLAREHAWK LRD TI H9 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692662
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL FLAREHAWK TALL 25MM TIH9

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697489
Hospital Revenue Code	278
Min. Negotiated Rate	$596.48
Max. Negotiated Rate	$12,375.00
Rate for Payer: Aetna Commercial	$9,405.00
Rate for Payer: Aetna Medicare Advantage	$7,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,311.25
Rate for Payer: Cigna Commercial	$12,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50
Rate for Payer: UnitedHealthcare Community & State	$596.48
Rate for Payer: Wellpoint Medicaid Managed Care	$655.88

SHELL FLAREHAWK TALL 25MM TIH9

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697489
Hospital Revenue Code	278
Min. Negotiated Rate	$3,712.50
Max. Negotiated Rate	$5,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50

SHELLFLAREHAWKTALL29MMTIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697265
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

SHELLFLAREHAWKTALL29MMTIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697265
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL FLAREHAWK TI H9 25MM

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696484
Hospital Revenue Code	278
Min. Negotiated Rate	$596.48
Max. Negotiated Rate	$12,375.00
Rate for Payer: Aetna Commercial	$9,405.00
Rate for Payer: Aetna Medicare Advantage	$7,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,311.25
Rate for Payer: Cigna Commercial	$12,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50
Rate for Payer: UnitedHealthcare Community & State	$596.48
Rate for Payer: Wellpoint Medicaid Managed Care	$655.88

SHELL FLAREHAWK TI H9 25MM

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696484
Hospital Revenue Code	278
Min. Negotiated Rate	$3,712.50
Max. Negotiated Rate	$5,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50

SHELL FREEDOM CONSTR 36MM TAPE

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692924
Hospital Revenue Code	278
Min. Negotiated Rate	$190.87
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$190.87
Rate for Payer: Wellpoint Medicaid Managed Care	$209.88

Know your out-of-pocket cost for care.

All Charges