Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STAND ALONE SCREW 16MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704435
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$33.56
Max. Negotiated Rate	$696.25
Rate for Payer: Aetna Commercial	$529.15
Rate for Payer: Aetna Medicare Advantage	$417.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.09
Rate for Payer: Cigna Commercial	$696.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.75
Rate for Payer: Oxford Commercial	$278.50
Rate for Payer: Qualcare PPO/HMO/WC	$208.88
Rate for Payer: UnitedHealthcare Commercial	$278.50
Rate for Payer: UnitedHealthcare Community & State	$33.56
Rate for Payer: Wellpoint Medicaid Managed Care	$36.90

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$208.88
Max. Negotiated Rate	$208.88
Rate for Payer: Qualcare PPO/HMO/WC	$208.88

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$210.71
Rate for Payer: Aetna Medicare Advantage	$166.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.40
Rate for Payer: Cigna Commercial	$277.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.17
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$13.36
Rate for Payer: Wellpoint Medicaid Managed Care	$14.69

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$83.17
Max. Negotiated Rate	$83.17
Rate for Payer: Qualcare PPO/HMO/WC	$83.17

STANDARD KIT

Facility

$2,075.00

Hospital Charge Code	270659845
Hospital Revenue Code	272
Min. Negotiated Rate	$50.01
Max. Negotiated Rate	$1,037.50
Rate for Payer: Aetna Commercial	$788.50
Rate for Payer: Aetna Medicare Advantage	$622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$529.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$529.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$529.12
Rate for Payer: Cigna Commercial	$1,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.50
Rate for Payer: Oxford Commercial	$415.00
Rate for Payer: Qualcare PPO/HMO/WC	$311.25
Rate for Payer: UnitedHealthcare Commercial	$415.00
Rate for Payer: UnitedHealthcare Community & State	$50.01
Rate for Payer: Wellpoint Medicaid Managed Care	$54.99

STANDARD KIT

Facility

$2,075.00

Hospital Charge Code	270659845
Hospital Revenue Code	272
Min. Negotiated Rate	$311.25
Max. Negotiated Rate	$311.25
Rate for Payer: Qualcare PPO/HMO/WC	$311.25

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$237.63
Max. Negotiated Rate	$4,930.12
Rate for Payer: Aetna Commercial	$3,746.89
Rate for Payer: Aetna Medicare Advantage	$2,958.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.36
Rate for Payer: Cigna Commercial	$4,930.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,169.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04
Rate for Payer: UnitedHealthcare Community & State	$237.63
Rate for Payer: Wellpoint Medicaid Managed Care	$261.30

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.04
Max. Negotiated Rate	$2,386.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,169.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04

STANDBY PROCEDURE ATS500

Facility

$1,364.00

Hospital Charge Code	270633101
Hospital Revenue Code	272
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$682.00
Rate for Payer: Aetna Commercial	$518.32
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.20
Rate for Payer: Oxford Commercial	$272.80
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Commercial	$272.80
Rate for Payer: UnitedHealthcare Community & State	$32.87
Rate for Payer: Wellpoint Medicaid Managed Care	$36.15

STANDBY PROCEDURE ATS500

Facility

$1,364.00

Hospital Charge Code	270633101
Hospital Revenue Code	272
Min. Negotiated Rate	$204.60
Max. Negotiated Rate	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$204.60

STANDING ORDER FOR CUST

Facility

$71.25

Hospital Charge Code	270603104
Hospital Revenue Code	270
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.62
Rate for Payer: Aetna Commercial	$27.07
Rate for Payer: Aetna Medicare Advantage	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.17
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$14.25
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

STANDING ORDER FOR CUST

Facility

$71.25

Hospital Charge Code	270603104
Hospital Revenue Code	270
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

STANDOFF 20MM

Facility

$232.35

Hospital Charge Code	270691901
Hospital Revenue Code	272
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$34.85
Rate for Payer: Qualcare PPO/HMO/WC	$34.85

STANDOFF 20MM

Facility

$232.35

Hospital Charge Code	270691901
Hospital Revenue Code	272
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$116.17
Rate for Payer: Aetna Commercial	$88.29
Rate for Payer: Aetna Medicare Advantage	$69.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.25
Rate for Payer: Cigna Commercial	$116.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.70
Rate for Payer: Oxford Commercial	$46.47
Rate for Payer: Qualcare PPO/HMO/WC	$34.85
Rate for Payer: UnitedHealthcare Commercial	$46.47
Rate for Payer: UnitedHealthcare Community & State	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$6.16

STANDOFF 50MM

Facility

$377.60

Hospital Charge Code	270691902
Hospital Revenue Code	272
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$188.80
Rate for Payer: Aetna Commercial	$143.49
Rate for Payer: Aetna Medicare Advantage	$113.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.29
Rate for Payer: Cigna Commercial	$188.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.28
Rate for Payer: Oxford Commercial	$75.52
Rate for Payer: Qualcare PPO/HMO/WC	$56.64
Rate for Payer: UnitedHealthcare Commercial	$75.52
Rate for Payer: UnitedHealthcare Community & State	$9.10
Rate for Payer: Wellpoint Medicaid Managed Care	$10.01

STANDOFF 50MM

Facility

$377.60

Hospital Charge Code	270691902
Hospital Revenue Code	272
Min. Negotiated Rate	$56.64
Max. Negotiated Rate	$56.64
Rate for Payer: Qualcare PPO/HMO/WC	$56.64

STAPL CURVED CUTTER REG CS40B

Facility

$2,249.25

Hospital Charge Code	270637401
Hospital Revenue Code	272
Min. Negotiated Rate	$54.21
Max. Negotiated Rate	$1,124.62
Rate for Payer: Aetna Commercial	$854.72
Rate for Payer: Aetna Medicare Advantage	$674.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.56
Rate for Payer: Cigna Commercial	$1,124.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.77
Rate for Payer: Oxford Commercial	$449.85
Rate for Payer: Qualcare PPO/HMO/WC	$337.39
Rate for Payer: UnitedHealthcare Commercial	$449.85
Rate for Payer: UnitedHealthcare Community & State	$54.21
Rate for Payer: Wellpoint Medicaid Managed Care	$59.61

STAPL CURVED CUTTER REG CS40B

Facility

$2,249.25

Hospital Charge Code	270637401
Hospital Revenue Code	272
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$337.39
Rate for Payer: Qualcare PPO/HMO/WC	$337.39

STAPLE 10MM

Facility

$4,500.00

Hospital Charge Code	270680749
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STAPLE 10MM

Facility

$4,500.00

Hospital Charge Code	270680749
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

Know your out-of-pocket cost for care.

All Charges