Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHIM FLAREHAWK 14MMX29MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696846
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

SHIM FLAREHAWK 14MMX29MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694807
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

SHIM FLAREHAWK 14MMX29MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694807
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

SHIM FLAREHAWK 14X25MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697853
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

SHIM FLAREHAWK 14X25MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697853
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

SHIM SPLIT , 12X25MM 9DEG

Facility

$10,000.00

Hospital Charge Code	270702896
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 SPLIT , 12X25MM 9DEG

Facility

$10,000.00

Hospital Charge Code	270702896
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

SHIRLEY SUMP DRAIN

Facility

$66.00

Hospital Charge Code	270332574
Hospital Revenue Code	278
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SHIRLEY SUMP DRAIN

Facility

$66.00

Hospital Charge Code	270332574
Hospital Revenue Code	278
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) NJ Health	$13.20
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	$15.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

SHIRT I GOT MY 1ST HUG

Facility

$26.45

Hospital Charge Code	270130190
Hospital Revenue Code	270
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

SHIRT I GOT MY 1ST HUG

Facility

$26.45

Hospital Charge Code	270130190
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SHOCKWAVE C2 IVL CATH 2.5X12MM

Facility

$23,500.00

Hospital Charge Code	270702773
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

SHOCKWAVE C2 IVL CATH 2.5X12MM

Facility

$23,500.00

Hospital Charge Code	270702773
Hospital Revenue Code	278
Min. Negotiated Rate	$566.35
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$566.35
Rate for Payer: Wellpoint Medicaid Managed Care	$622.75

SHOCKWAVE C2 IVL CATH 3.0X12MM

Facility

$23,500.00

Hospital Charge Code	270702774
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

SHOCKWAVE C2 IVL CATH 3.0X12MM

Facility

$23,500.00

Hospital Charge Code	270702774
Hospital Revenue Code	278
Min. Negotiated Rate	$566.35
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$566.35
Rate for Payer: Wellpoint Medicaid Managed Care	$622.75

SHOCKWAVE C2 IVL CATH 3.5X12MM

Facility

$23,500.00

Hospital Charge Code	270702775
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

SHOCKWAVE C2 IVL CATH 3.5X12MM

Facility

$23,500.00

Hospital Charge Code	270702775
Hospital Revenue Code	278
Min. Negotiated Rate	$566.35
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$566.35
Rate for Payer: Wellpoint Medicaid Managed Care	$622.75

SHOCKWAVE C2 IVL CATH 4.0X12MM

Facility

$23,500.00

Hospital Charge Code	270702776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

SHOCKWAVE C2 IVL CATH 4.0X12MM

Facility

$23,500.00

Hospital Charge Code	270702776
Hospital Revenue Code	278
Min. Negotiated Rate	$566.35
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$566.35
Rate for Payer: Wellpoint Medicaid Managed Care	$622.75

SHOE CAST CUSH LG CL TOE

Facility

$38.00

Hospital Charge Code	270302725
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

SHOE CAST CUSH LG CL TOE

Facility

$38.00

Hospital Charge Code	270302725
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

SHOE CAST CUSH MED CL TOE

Facility

$35.95

Hospital Charge Code	270302721
Hospital Revenue Code	270
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$17.98
Rate for Payer: Aetna Commercial	$13.66
Rate for Payer: Aetna Medicare Advantage	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.17
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$7.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$7.19
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SHOE CAST CUSH MED CL TOE

Facility

$35.95

Hospital Charge Code	270302721
Hospital Revenue Code	270
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.39

SHOE CAST CUSH SM CL TOE

Facility

$24.85

Hospital Charge Code	270302720
Hospital Revenue Code	270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SHOE CAST CUSH SM CL TOE

Facility

$24.85

Hospital Charge Code	270302720
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

Know your out-of-pocket cost for care.

All Charges