Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHUNT CARTID BYPASS 14f 007755

Facility

$421.65

Hospital Charge Code	270629720
Hospital Revenue Code	278
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$210.82
Rate for Payer: Aetna Commercial	$160.23
Rate for Payer: Aetna Medicare Advantage	$126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.52
Rate for Payer: Cigna Commercial	$210.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.76
Rate for Payer: Qualcare PPO/HMO/WC	$63.25
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: Wellpoint Medicaid Managed Care	$11.17

SHUNT CERTAS VALVE PLUS

Facility

$31,470.00

Service Code	HCPCS L8699
Hospital Charge Code	270701951
Hospital Revenue Code	278
Min. Negotiated Rate	$4,720.50
Max. Negotiated Rate	$7,615.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,294.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,615.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,923.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,720.50

SHUNT CERTAS VALVE PLUS

Facility

$31,470.00

Service Code	HCPCS L8699
Hospital Charge Code	270701951
Hospital Revenue Code	278
Min. Negotiated Rate	$758.43
Max. Negotiated Rate	$15,735.00
Rate for Payer: Aetna Commercial	$11,958.60
Rate for Payer: Aetna Medicare Advantage	$9,441.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,024.85
Rate for Payer: Cigna Commercial	$15,735.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,615.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,923.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,720.50
Rate for Payer: UnitedHealthcare Community & State	$758.43
Rate for Payer: Wellpoint Medicaid Managed Care	$833.96

SHUNT LUMBAR PERITONEAL CSF

Facility

$3,550.00

Hospital Charge Code	270662447
Hospital Revenue Code	278
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$1,775.00
Rate for Payer: Aetna Commercial	$1,349.00
Rate for Payer: Aetna Medicare Advantage	$1,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$905.25
Rate for Payer: Cigna Commercial	$1,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$859.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$781.00
Rate for Payer: Qualcare PPO/HMO/WC	$532.50
Rate for Payer: UnitedHealthcare Community & State	$85.56
Rate for Payer: Wellpoint Medicaid Managed Care	$94.08

SHUNT LUMBAR PERITONEAL CSF

Facility

$3,550.00

Hospital Charge Code	270662447
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$859.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$859.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$781.00
Rate for Payer: Qualcare PPO/HMO/WC	$532.50

SHUNT VALVE HIGH PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696361
Hospital Revenue Code	278
Min. Negotiated Rate	$133.84
Max. Negotiated Rate	$2,776.80
Rate for Payer: Aetna Commercial	$2,110.37
Rate for Payer: Aetna Medicare Advantage	$1,666.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.17
Rate for Payer: Cigna Commercial	$2,776.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04
Rate for Payer: UnitedHealthcare Community & State	$133.84
Rate for Payer: Wellpoint Medicaid Managed Care	$147.17

SHUNT VALVE HIGH PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696361
Hospital Revenue Code	278
Min. Negotiated Rate	$833.04
Max. Negotiated Rate	$1,343.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04

SHUNT VALVE LOW PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696365
Hospital Revenue Code	278
Min. Negotiated Rate	$133.84
Max. Negotiated Rate	$2,776.80
Rate for Payer: Aetna Commercial	$2,110.37
Rate for Payer: Aetna Medicare Advantage	$1,666.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.17
Rate for Payer: Cigna Commercial	$2,776.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04
Rate for Payer: UnitedHealthcare Community & State	$133.84
Rate for Payer: Wellpoint Medicaid Managed Care	$147.17

SHUNT VALVE LOW PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696365
Hospital Revenue Code	278
Min. Negotiated Rate	$833.04
Max. Negotiated Rate	$1,343.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04

SHUNT VALVE MED PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696362
Hospital Revenue Code	278
Min. Negotiated Rate	$833.04
Max. Negotiated Rate	$1,343.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04

SHUNT VALVE MED PRESS IMP

Facility

$5,553.60

Service Code	HCPCS L8699
Hospital Charge Code	270696362
Hospital Revenue Code	278
Min. Negotiated Rate	$133.84
Max. Negotiated Rate	$2,776.80
Rate for Payer: Aetna Commercial	$2,110.37
Rate for Payer: Aetna Medicare Advantage	$1,666.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.17
Rate for Payer: Cigna Commercial	$2,776.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.79
Rate for Payer: Qualcare PPO/HMO/WC	$833.04
Rate for Payer: UnitedHealthcare Community & State	$133.84
Rate for Payer: Wellpoint Medicaid Managed Care	$147.17

SHUNT VCP DELTA L1 130CM

Facility

$9,366.05

Service Code	HCPCS L8699
Hospital Charge Code	270694798
Hospital Revenue Code	278
Min. Negotiated Rate	$225.72
Max. Negotiated Rate	$4,683.02
Rate for Payer: Aetna Commercial	$3,559.10
Rate for Payer: Aetna Medicare Advantage	$2,809.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,388.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,388.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,873.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,388.34
Rate for Payer: Cigna Commercial	$4,683.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,266.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,060.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.91
Rate for Payer: UnitedHealthcare Community & State	$225.72
Rate for Payer: Wellpoint Medicaid Managed Care	$248.20

SHUNT VCP DELTA L1 130CM

Facility

$9,366.05

Service Code	HCPCS L8699
Hospital Charge Code	270694798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.91
Max. Negotiated Rate	$2,266.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,873.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,266.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,060.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.91

SHUNT VP DELTA ASSY SM LEV 1.5

Facility

$10,665.60

Service Code	HCPCS C1729
Hospital Charge Code	270693250
Hospital Revenue Code	278
Min. Negotiated Rate	$257.04
Max. Negotiated Rate	$5,332.80
Rate for Payer: Aetna Commercial	$4,052.93
Rate for Payer: Aetna Medicare Advantage	$3,199.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,719.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,719.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,133.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,719.73
Rate for Payer: Cigna Commercial	$5,332.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,581.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,346.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,599.84
Rate for Payer: UnitedHealthcare Community & State	$257.04
Rate for Payer: Wellpoint Medicaid Managed Care	$282.64

SHUNT VP DELTA ASSY SM LEV 1.5

Facility

$10,665.60

Service Code	HCPCS C1729
Hospital Charge Code	270693250
Hospital Revenue Code	278
Min. Negotiated Rate	$1,599.84
Max. Negotiated Rate	$2,581.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,133.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,581.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,346.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,599.84

SHUR CLENS WOUND CLEANSER*****

Facility

$9.00

Hospital Charge Code	8004012
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

SHUR CLENS WOUND CLEANSER*****

Facility

$9.00

Hospital Charge Code	8004012
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SHURFIT TPLIF2C 7MMX29MM

Facility

$22,100.00

Service Code	HCPCS C1889
Hospital Charge Code	270695749
Hospital Revenue Code	278
Min. Negotiated Rate	$3,315.00
Max. Negotiated Rate	$5,348.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,348.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,862.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,315.00

SHURFIT TPLIF2C 7MMX29MM

Facility

$22,100.00

Service Code	HCPCS C1889
Hospital Charge Code	270695749
Hospital Revenue Code	278
Min. Negotiated Rate	$532.61
Max. Negotiated Rate	$11,050.00
Rate for Payer: Aetna Commercial	$8,398.00
Rate for Payer: Aetna Medicare Advantage	$6,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,635.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,635.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,635.50
Rate for Payer: Cigna Commercial	$11,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,348.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,862.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,315.00
Rate for Payer: UnitedHealthcare Community & State	$532.61
Rate for Payer: Wellpoint Medicaid Managed Care	$585.65

SIALIC ACID

Facility

$95.00

Service Code	HCPCS 84275
Hospital Charge Code	38477116
Hospital Revenue Code	301
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

SIALIC ACID

Facility

$95.00

Service Code	HCPCS 84275
Hospital Charge Code	38477116
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: Aetna Medicare Advantage	$43.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.51
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare Advantage	$13.44
Rate for Payer: Clover Medicare Advantage	$12.77
Rate for Payer: EmblemHealth Commercial	$40.32
Rate for Payer: Humana Medicare Advantage	$13.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.44
Rate for Payer: Wellcare Medicare Advantage	$13.44
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

SICKLE CELL

Facility

$208.00

Service Code	HCPCS 85660
Hospital Charge Code	38473018
Hospital Revenue Code	305
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna Medicare Advantage	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: Cigna Medicare Advantage	$5.51
Rate for Payer: Clover Medicare Advantage	$5.23
Rate for Payer: EmblemHealth Commercial	$16.53
Rate for Payer: Humana Medicare Advantage	$5.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.51
Rate for Payer: Wellcare Medicare Advantage	$5.51
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

SICKLE CELL

Facility

$208.00

Service Code	HCPCS 85660
Hospital Charge Code	38473018
Hospital Revenue Code	305
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

SICKLE CELL ANEMIA CRISIS

Facility

$6,282.69

Service Code	APR-DRG 6621
Min. Negotiated Rate	$6,159.50
Max. Negotiated Rate	$6,282.69
Rate for Payer: UnitedHealthcare Community & State	$6,159.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,282.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6,159.50

SICKLE CELL ANEMIA CRISIS

Facility

$25,834.24

Service Code	APR-DRG 6624
Min. Negotiated Rate	$25,327.69
Max. Negotiated Rate	$25,834.24
Rate for Payer: UnitedHealthcare Community & State	$25,327.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,834.24
Rate for Payer: Wellpoint Medicaid Managed Care	$25,327.69

Know your out-of-pocket cost for care.

All Charges