Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHIM 13X29MM 6DEG TI 9

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694159
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

SHIM 13X29MM 6DEG TI 9

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694159
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

SHIM 14MMX29MM 0 DEG STRL

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694286
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

SHIM 14MMX29MM 0 DEG STRL

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694286
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

SHIM 14MMX29MM 6DEG

Facility

$19,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270692918
Hospital Revenue Code	278
Min. Negotiated Rate	$478.99
Max. Negotiated Rate	$9,937.50
Rate for Payer: Aetna Commercial	$7,552.50
Rate for Payer: Aetna Medicare Advantage	$5,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,068.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,068.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,068.12
Rate for Payer: Cigna Commercial	$9,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,809.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,372.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,981.25
Rate for Payer: UnitedHealthcare Community & State	$478.99
Rate for Payer: Wellpoint Medicaid Managed Care	$526.69

SHIM 14MMX29MM 6DEG

Facility

$19,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270692918
Hospital Revenue Code	278
Min. Negotiated Rate	$2,981.25
Max. Negotiated Rate	$4,809.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,809.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,372.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,981.25

SHIM 9MM 0 DEGREE

Facility

$10,000.00

Hospital Charge Code	270702408
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM 9MM 0 DEGREE

Facility

$10,000.00

Hospital Charge Code	270702408
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHIM 9MM X3MM FH7 FLAREHAWK

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692115
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

SHIM 9MM X3MM FH7 FLAREHAWK

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692115
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

SHIM 9X12X25MM.

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703683
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHIM 9X12X25MM.

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703683
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM FLAREHAWK 10MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696485
Hospital Revenue Code	278
Min. Negotiated Rate	$577.80
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,274.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Community & State	$577.80
Rate for Payer: Wellpoint Medicaid Managed Care	$635.34

SHIM FLAREHAWK 10MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696485
Hospital Revenue Code	278
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$5,801.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,274.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

SHIM FLAREHAWK 10X29MM 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695592
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

SHIM FLAREHAWK 10X29MM 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695592
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

SHIM FLAREHAWK 12X25MM0D FH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696184
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

SHIM FLAREHAWK 12X25MM0D FH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696184
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

SHIM FLAREHAWK 14MMX23MM 0DEG

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692663
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

SHIM FLAREHAWK 14MMX23MM 0DEG

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692663
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

SHIM FLAREHAWK 14MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696483
Hospital Revenue Code	278
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$5,801.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,274.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

SHIM FLAREHAWK 14MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696483
Hospital Revenue Code	278
Min. Negotiated Rate	$577.80
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,274.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Community & State	$577.80
Rate for Payer: Wellpoint Medicaid Managed Care	$635.34

SHIM FLAREHAWK 14MMX29MM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270693444
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

SHIM FLAREHAWK 14MMX29MM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270693444
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

SHIM FLAREHAWK 14MMX29MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696846
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

Know your out-of-pocket cost for care.

All Charges