Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE DRILL MEAS 8163-01-005

Facility

$850.00

Hospital Charge Code	270658917
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

SLEEVE DRILL MEAS 8163-01-005

Facility

$850.00

Hospital Charge Code	270658917
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SLEEVE DRILL MEASURING

Facility

$1,870.00

Hospital Charge Code	270648249
Hospital Revenue Code	272
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$280.50

SLEEVE DRILL MEASURING

Facility

$1,870.00

Hospital Charge Code	270648249
Hospital Revenue Code	272
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$935.00
Rate for Payer: Aetna Commercial	$710.60
Rate for Payer: Aetna Medicare Advantage	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.85
Rate for Payer: Cigna Commercial	$935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.00
Rate for Payer: Oxford Commercial	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.50
Rate for Payer: UnitedHealthcare Commercial	$374.00
Rate for Payer: UnitedHealthcare Community & State	$45.07
Rate for Payer: Wellpoint Medicaid Managed Care	$49.55

SLEEVE FEM ADAPTER 0MM NECK

Facility

$547.05

Service Code	HCPCS C1776
Hospital Charge Code	270697131
Hospital Revenue Code	278
Min. Negotiated Rate	$82.06
Max. Negotiated Rate	$132.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.35
Rate for Payer: Qualcare PPO/HMO/WC	$82.06

SLEEVE FEM ADAPTER 0MM NECK

Facility

$547.05

Service Code	HCPCS C1776
Hospital Charge Code	270697131
Hospital Revenue Code	278
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$273.52
Rate for Payer: Aetna Commercial	$207.88
Rate for Payer: Aetna Medicare Advantage	$164.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.50
Rate for Payer: Cigna Commercial	$273.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.35
Rate for Payer: Qualcare PPO/HMO/WC	$82.06
Rate for Payer: UnitedHealthcare Community & State	$13.18
Rate for Payer: Wellpoint Medicaid Managed Care	$14.50

SLEEVE FEM HD BIOLOX OPT1 TPR

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694752
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

SLEEVE FEM HD BIOLOX OPT1 TPR

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694752
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SLEEVE FEM NCK BIOLOX TYP1 3MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695938
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SLEEVE FEM NCK BIOLOX TYP1 3MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695938
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

SLEEVE FEM NECK ADJ STD V40

Facility

$9,195.00

Service Code	HCPCS C1776
Hospital Charge Code	270693840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,379.25
Max. Negotiated Rate	$2,225.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,839.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,225.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,022.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,379.25

SLEEVE FEM NECK ADJ STD V40

Facility

$9,195.00

Service Code	HCPCS C1776
Hospital Charge Code	270693840
Hospital Revenue Code	278
Min. Negotiated Rate	$221.60
Max. Negotiated Rate	$4,597.50
Rate for Payer: Aetna Commercial	$3,494.10
Rate for Payer: Aetna Medicare Advantage	$2,758.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,344.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,344.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,839.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,344.72
Rate for Payer: Cigna Commercial	$4,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,225.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,022.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,379.25
Rate for Payer: UnitedHealthcare Community & State	$221.60
Rate for Payer: Wellpoint Medicaid Managed Care	$243.67

SLEEVE FOR OR GOWN 89791****

Facility

$4.80

Hospital Charge Code	270600162
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna Commercial	$1.82
Rate for Payer: Aetna Medicare Advantage	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.22
Rate for Payer: Cigna Commercial	$2.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Oxford Commercial	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$0.96
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SLEEVE FOR OR GOWN 89791****

Facility

$4.80

Hospital Charge Code	270600162
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

SLEEVE GASTRECTOMY

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600166
Hospital Revenue Code	361
Min. Negotiated Rate	$3,484.40
Max. Negotiated Rate	$72,290.54
Rate for Payer: Aetna Commercial	$54,940.81
Rate for Payer: Aetna Medicare Advantage	$43,374.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,971.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,120.00
Rate for Payer: Cigna Commercial	$72,290.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43,374.33
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$3,484.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3,831.40

SLEEVE GASTRECTOMY

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600166
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

SLEEVE GAS.W HIATAL HERNIA REP

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600167
Hospital Revenue Code	361
Min. Negotiated Rate	$3,484.40
Max. Negotiated Rate	$72,290.54
Rate for Payer: Aetna Commercial	$54,940.81
Rate for Payer: Aetna Medicare Advantage	$43,374.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,971.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,120.00
Rate for Payer: Cigna Commercial	$72,290.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43,374.33
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$3,484.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3,831.40

SLEEVE GAS.W HIATAL HERNIA REP

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600167
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$91.19
Rate for Payer: Qualcare PPO/HMO/WC	$91.19

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$303.95
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Aetna Medicare Advantage	$182.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.01
Rate for Payer: Cigna Commercial	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.37
Rate for Payer: Oxford Commercial	$121.58
Rate for Payer: Qualcare PPO/HMO/WC	$91.19
Rate for Payer: UnitedHealthcare Commercial	$121.58
Rate for Payer: UnitedHealthcare Community & State	$14.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.11

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$46.34
Max. Negotiated Rate	$961.50
Rate for Payer: Aetna Commercial	$730.74
Rate for Payer: Aetna Medicare Advantage	$576.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.37
Rate for Payer: Cigna Commercial	$961.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$576.90
Rate for Payer: Oxford Commercial	$384.60
Rate for Payer: Qualcare PPO/HMO/WC	$288.45
Rate for Payer: UnitedHealthcare Commercial	$384.60
Rate for Payer: UnitedHealthcare Community & State	$46.34
Rate for Payer: Wellpoint Medicaid Managed Care	$50.96

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$288.45
Max. Negotiated Rate	$288.45
Rate for Payer: Qualcare PPO/HMO/WC	$288.45

SLEEVE IRRIGATION ASPIRATION T

Facility

$615.00

Hospital Charge Code	270655840
Hospital Revenue Code	271
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$233.70
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.82
Rate for Payer: Cigna Commercial	$307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.50
Rate for Payer: Oxford Commercial	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$123.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: Wellpoint Medicaid Managed Care	$16.30

SLEEVE IRRIGATION ASPIRATION T

Facility

$615.00

Hospital Charge Code	270655840
Hospital Revenue Code	271
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.29
Rate for Payer: Aetna Commercial	$11.62
Rate for Payer: Aetna Medicare Advantage	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.80
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.17
Rate for Payer: Oxford Commercial	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

Know your out-of-pocket cost for care.

All Charges