Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEINMANN 3/16

Facility

$21.85

Service Code	HCPCS C1713
Hospital Charge Code	270684581
Hospital Revenue Code	278
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.28

STEINMANN 5/32

Facility

$21.85

Service Code	HCPCS C1713
Hospital Charge Code	270684580
Hospital Revenue Code	278
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.93
Rate for Payer: Aetna Commercial	$8.30
Rate for Payer: Aetna Medicare Advantage	$6.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.57
Rate for Payer: Cigna Commercial	$10.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

STEINMANN 5/32

Facility

$21.85

Service Code	HCPCS C1713
Hospital Charge Code	270684580
Hospital Revenue Code	278
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.28

STEINMANN 7/64

Facility

$13.80

Service Code	HCPCS C1713
Hospital Charge Code	270684577
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna Medicare Advantage	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

STEINMANN 7/64

Facility

$13.80

Service Code	HCPCS C1713
Hospital Charge Code	270684577
Hospital Revenue Code	278
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

STEINMANN 9/64

Facility

$17.25

Service Code	HCPCS C1713
Hospital Charge Code	270684579
Hospital Revenue Code	278
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

STEINMANN 9/64

Facility

$17.25

Service Code	HCPCS C1713
Hospital Charge Code	270684579
Hospital Revenue Code	278
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.40
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

STEINMANN PIN WITH 5.0MM

Facility

$594.00

Hospital Charge Code	270663423
Hospital Revenue Code	272
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$297.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna Medicare Advantage	$178.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.47
Rate for Payer: Cigna Commercial	$297.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.20
Rate for Payer: Oxford Commercial	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$89.10
Rate for Payer: UnitedHealthcare Commercial	$118.80
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: Wellpoint Medicaid Managed Care	$15.74

STEINMANN PIN WITH 5.0MM

Facility

$594.00

Hospital Charge Code	270663423
Hospital Revenue Code	272
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$89.10
Rate for Payer: Qualcare PPO/HMO/WC	$89.10

STEINMAN PIN 2MM

Facility

$23.10

Hospital Charge Code	270699578
Hospital Revenue Code	279
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.46

STEINMAN PIN 2MM

Facility

$23.10

Hospital Charge Code	270699578
Hospital Revenue Code	279
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.55
Rate for Payer: Aetna Commercial	$8.78
Rate for Payer: Aetna Medicare Advantage	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.89
Rate for Payer: Cigna Commercial	$11.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.93
Rate for Payer: Oxford Commercial	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.46
Rate for Payer: UnitedHealthcare Commercial	$4.62
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

STEINMON PIN

Facility

$44.00

Hospital Charge Code	270335001
Hospital Revenue Code	278
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

STEINMON PIN

Facility

$44.00

Hospital Charge Code	270335001
Hospital Revenue Code	278
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

STE LIBE MONO 3.5x16m389341635

Facility

$1,250.00

Hospital Charge Code	270638225
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STE LIBE MONO 3.5x16m389341635

Facility

$1,250.00

Hospital Charge Code	270638225
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

STE LIB MONO 3.0x32m 389343230

Facility

$4,375.00

Hospital Charge Code	270639378
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

STE LIB MONO 3.0x32m 389343230

Facility

$4,375.00

Hospital Charge Code	270639378
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STEM 10MM STD COMP PRIM

Facility

$20,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270699795
Hospital Revenue Code	278
Min. Negotiated Rate	$3,018.75
Max. Negotiated Rate	$4,870.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,870.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,427.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,018.75

STEM 10MM STD COMP PRIM

Facility

$20,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270699795
Hospital Revenue Code	278
Min. Negotiated Rate	$485.01
Max. Negotiated Rate	$10,062.50
Rate for Payer: Aetna Commercial	$7,647.50
Rate for Payer: Aetna Medicare Advantage	$6,037.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.88
Rate for Payer: Cigna Commercial	$10,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,870.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,427.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,018.75
Rate for Payer: UnitedHealthcare Community & State	$485.01
Rate for Payer: Wellpoint Medicaid Managed Care	$533.31

STEM 10 MM X 0 MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685943
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

STEM 10 MM X 0 MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

STEM 10mmX6.MM

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682765
Hospital Revenue Code	278
Min. Negotiated Rate	$260.88
Max. Negotiated Rate	$5,412.50
Rate for Payer: Aetna Commercial	$4,113.50
Rate for Payer: Aetna Medicare Advantage	$3,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,760.38
Rate for Payer: Cigna Commercial	$5,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75
Rate for Payer: UnitedHealthcare Community & State	$260.88
Rate for Payer: Wellpoint Medicaid Managed Care	$286.86

STEM 10mmX6.MM

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.75
Max. Negotiated Rate	$2,619.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75

STEM 11 130 DEG TI CANN 380mm

Facility

$9,942.75

Service Code	HCPCS C1776
Hospital Charge Code	270678866
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.41
Max. Negotiated Rate	$2,406.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41

STEM 11 130 DEG TI CANN 380mm

Facility

$9,942.75

Service Code	HCPCS C1776
Hospital Charge Code	270678866
Hospital Revenue Code	278
Min. Negotiated Rate	$239.62
Max. Negotiated Rate	$4,971.38
Rate for Payer: Aetna Commercial	$3,778.24
Rate for Payer: Aetna Medicare Advantage	$2,982.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.40
Rate for Payer: Cigna Commercial	$4,971.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41
Rate for Payer: UnitedHealthcare Community & State	$239.62
Rate for Payer: Wellpoint Medicaid Managed Care	$263.48

Know your out-of-pocket cost for care.

All Charges