Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ZIM ACETAB 62MM 62006220

Facility

$4,717.65

Hospital Charge Code	270611866
Hospital Revenue Code	278
Min. Negotiated Rate	$707.65
Max. Negotiated Rate	$1,141.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$943.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,141.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.88
Rate for Payer: Qualcare PPO/HMO/WC	$707.65

SHELL ZIM BIP 53 5001-53

Facility

$2,482.00

Hospital Charge Code	270627234
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 ZIM BIP 53 5001-53

Facility

$2,482.00

Hospital Charge Code	270627234
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 ZIM BIPOLAR 44 500144

Facility

$2,706.20

Hospital Charge Code	270626175
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 ZIM BIPOLAR 44 500144

Facility

$2,706.20

Hospital Charge Code	270626175
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 ZIM BIPOLAR 45 500145

Facility

$2,581.35

Hospital Charge Code	270626159
Hospital Revenue Code	278
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$1,290.67
Rate for Payer: Aetna Commercial	$980.91
Rate for Payer: Aetna Medicare Advantage	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$658.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$658.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$658.24
Rate for Payer: Cigna Commercial	$1,290.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.90
Rate for Payer: Qualcare PPO/HMO/WC	$387.20
Rate for Payer: UnitedHealthcare Community & State	$62.21
Rate for Payer: Wellpoint Medicaid Managed Care	$68.41

SHELL ZIM BIPOLAR 45 500145

Facility

$2,581.35

Hospital Charge Code	270626159
Hospital Revenue Code	278
Min. Negotiated Rate	$387.20
Max. Negotiated Rate	$624.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.90
Rate for Payer: Qualcare PPO/HMO/WC	$387.20

SHELL ZIM BIPOLAR 47 500147

Facility

$2,706.20

Hospital Charge Code	270626174
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 ZIM BIPOLAR 47 500147

Facility

$2,706.20

Hospital Charge Code	270626174
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 ZIM BIPOLAR 49 500149

Facility

$2,706.20

Hospital Charge Code	270625370
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 ZIM BIPOLAR 49 500149

Facility

$2,706.20

Hospital Charge Code	270625370
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 ZIM BIPOLAR 51 500151

Facility

$2,581.35

Hospital Charge Code	270626236
Hospital Revenue Code	278
Min. Negotiated Rate	$387.20
Max. Negotiated Rate	$624.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.90
Rate for Payer: Qualcare PPO/HMO/WC	$387.20

SHELL ZIM BIPOLAR 51 500151

Facility

$2,581.35

Hospital Charge Code	270626236
Hospital Revenue Code	278
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$1,290.67
Rate for Payer: Aetna Commercial	$980.91
Rate for Payer: Aetna Medicare Advantage	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$658.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$658.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$658.24
Rate for Payer: Cigna Commercial	$1,290.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.90
Rate for Payer: Qualcare PPO/HMO/WC	$387.20
Rate for Payer: UnitedHealthcare Community & State	$62.21
Rate for Payer: Wellpoint Medicaid Managed Care	$68.41

SHELL ZIM BIPOLAR 55 500155

Facility

$2,706.20

Hospital Charge Code	270629555
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 ZIM BIPOLAR 55 500155

Facility

$2,706.20

Hospital Charge Code	270629555
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

SHEM 2MM HEAD ACRYLIC

Facility

$85.00

Hospital Charge Code	270676914
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

SHEM 2MM HEAD ACRYLIC

Facility

$85.00

Hospital Charge Code	270676914
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$17.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

SHEPARD GROMMET VENT WIRE

Facility

$66.00

Hospital Charge Code	270331993
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SHEPARD GROMMET VENT WIRE

Facility

$66.00

Hospital Charge Code	270331993
Hospital Revenue Code	272
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

SHIELD BREAST

Facility

$39.25

Hospital Charge Code	270130185
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

SHIELD BREAST

Facility

$39.25

Hospital Charge Code	270130185
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$7.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.85
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SHIELD BREAST *******

Facility

$16.00

Hospital Charge Code	8000226
Hospital Revenue Code	279
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SHIELD BREAST *******

Facility

$6.00

Hospital Charge Code	1801125
Hospital Revenue Code	279
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SHIELD BREAST *******

Facility

$6.00

Hospital Charge Code	1801125
Hospital Revenue Code	279
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SHIELD BREAST *******

Facility

$16.00

Hospital Charge Code	8000226
Hospital Revenue Code	279
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

Know your out-of-pocket cost for care.

All Charges