Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALN MAV MON 2.75x12 389281227

Facility

$1,295.00

Hospital Charge Code	270638417C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN NINJA OTW 225x10 563FX022

Facility

$880.00

Hospital Charge Code	270637412
Hospital Revenue Code	272
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.00
Rate for Payer: Oxford Commercial	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Commercial	$176.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

BALN NINJA OTW 225x10 563FX022

Facility

$880.00

Hospital Charge Code	270637412
Hospital Revenue Code	272
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

BALN NINJA OTW 225x15 563FX122

Facility

$880.00

Hospital Charge Code	270637720
Hospital Revenue Code	272
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.00
Rate for Payer: Oxford Commercial	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Commercial	$176.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

BALN NINJA OTW 225x15 563FX122

Facility

$880.00

Hospital Charge Code	270637720
Hospital Revenue Code	272
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

BALN QUAN MON 4 5x12 380801245

Facility

$1,295.00

Hospital Charge Code	270640730C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN QUAN MON 4 5x12 380801245

Facility

$1,295.00

Hospital Charge Code	270640730C
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALN QUAN MONO 5.0x8 380800850

Facility

$1,295.00

Hospital Charge Code	270640731
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALN QUAN MONO 5.0x8 380800850

Facility

$1,295.00

Hospital Charge Code	270640731
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN REPL G TUBE PEG 24 G22231

Facility

$240.87

Hospital Charge Code	270641342
Hospital Revenue Code	272
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$36.13
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

BALN REPL G TUBE PEG 24 G22231

Facility

$240.87

Hospital Charge Code	270641342
Hospital Revenue Code	272
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.44
Rate for Payer: Aetna Commercial	$91.53
Rate for Payer: Aetna Medicare Advantage	$72.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.26
Rate for Payer: Oxford Commercial	$48.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Commercial	$48.17
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.38

BALN SP OTW 1 5x10 SPR1510WA63

Facility

$2,000.00

Hospital Charge Code	270637300V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

BALN SP OTW 1 5x10 SPR1510WA63

Facility

$2,000.00

Hospital Charge Code	270637300V
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

BALN SPRT RX2.0x06 NCSP2006X

Facility

$750.00

Hospital Charge Code	270651183C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

BALN SPRT RX2.0x06 NCSP2006X

Facility

$750.00

Hospital Charge Code	270651183C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALN SPRT RX2.0x09 NCSP2009X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651185C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

BALN SPRT RX2.0x09 NCSP2009X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651185C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALN SPRT RX2.0x12 NCSP2012X

Facility

$525.00

Service Code	HCPCS C1725
Hospital Charge Code	270651186C
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

BALN SPRT RX2.0x12 NCSP2012X

Facility

$525.00

Service Code	HCPCS C1725
Hospital Charge Code	270651186C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

BALN SPRT RX2.0x15 NCSP2015X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651187C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALN SPRT RX2.0x15 NCSP2015X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651187C
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

BALN SPRT RX2.0x21 NCSP2021X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651188C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALN SPRT RX2.0x21 NCSP2021X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651188C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

BALN SPRT RX2.25x06 NCSP22506X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651189C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALN SPRT RX2.25x06 NCSP22506X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651189C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

Know your out-of-pocket cost for care.

All Charges