Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ST LIBER MONO 4.0x8m 38934840

Facility

$4,375.00

Hospital Charge Code	270638316
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

ST LIBER MONO 4.0x8m 38934840

Facility

$4,375.00

Hospital Charge Code	270638316
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

ST LIBERTE MONO 3.0x8 38934830

Facility

$4,375.00

Hospital Charge Code	270638594
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

ST LIBERTE MONO 3.0x8 38934830

Facility

$4,375.00

Hospital Charge Code	270638594
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

ST LIB MONO 2.75x32m 389343227

Facility

$4,375.00

Hospital Charge Code	270639377
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

ST LIB MONO 2.75x32m 389343227

Facility

$4,375.00

Hospital Charge Code	270639377
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

ST LIB MONO 4.5x28m 389342845

Facility

$4,375.00

Hospital Charge Code	270639385
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

ST LIB MONO 4.5x28m 389342845

Facility

$4,375.00

Hospital Charge Code	270639385
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

STM HIP NCK ANGL35MM SZ4 105MM

Facility

$13,604.50

Service Code	HCPCS C1776
Hospital Charge Code	270671304
Hospital Revenue Code	278
Min. Negotiated Rate	$327.87
Max. Negotiated Rate	$6,802.25
Rate for Payer: Aetna Commercial	$5,169.71
Rate for Payer: Aetna Medicare Advantage	$4,081.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,469.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,469.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,469.15
Rate for Payer: Cigna Commercial	$6,802.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,292.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,992.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.67
Rate for Payer: UnitedHealthcare Community & State	$327.87
Rate for Payer: Wellpoint Medicaid Managed Care	$360.52

STM HIP NCK ANGL35MM SZ4 105MM

Facility

$13,604.50

Service Code	HCPCS C1776
Hospital Charge Code	270671304
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.67
Max. Negotiated Rate	$3,292.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,292.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,992.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.67

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	9109125
Hospital Revenue Code	440
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	9109125
Hospital Revenue Code	440
Min. Negotiated Rate	$37.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$598.22
Rate for Payer: Aetna Medicare Advantage	$472.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.43
Rate for Payer: Cigna Commercial	$787.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.27
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$37.94
Rate for Payer: Wellpoint Medicaid Managed Care	$41.72

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	74204003
Hospital Revenue Code	440
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	74204003
Hospital Revenue Code	440
Min. Negotiated Rate	$37.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$598.22
Rate for Payer: Aetna Medicare Advantage	$472.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.43
Rate for Payer: Cigna Commercial	$787.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.27
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$37.94
Rate for Payer: Wellpoint Medicaid Managed Care	$41.72

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

STM POR 16mX160m INTEG X170316

Facility

$19,755.75

Hospital Charge Code	270636137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,963.36
Max. Negotiated Rate	$4,780.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,346.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36

STM POR 16mX160m INTEG X170316

Facility

$19,755.75

Hospital Charge Code	270636137
Hospital Revenue Code	278
Min. Negotiated Rate	$476.11
Max. Negotiated Rate	$9,877.88
Rate for Payer: Aetna Commercial	$7,507.19
Rate for Payer: Aetna Medicare Advantage	$5,926.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,037.72
Rate for Payer: Cigna Commercial	$9,877.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,346.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36
Rate for Payer: UnitedHealthcare Community & State	$476.11
Rate for Payer: Wellpoint Medicaid Managed Care	$523.53

STN PN THD TIP .125X2.5IN 2PK

Facility

$1,110.00

Service Code	HCPCS C1713
Hospital Charge Code	270679751
Hospital Revenue Code	278
Min. Negotiated Rate	$26.75
Max. Negotiated Rate	$555.00
Rate for Payer: Aetna Commercial	$421.80
Rate for Payer: Aetna Medicare Advantage	$333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$283.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$283.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$283.05
Rate for Payer: Cigna Commercial	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$244.20
Rate for Payer: Qualcare PPO/HMO/WC	$166.50
Rate for Payer: UnitedHealthcare Community & State	$26.75
Rate for Payer: Wellpoint Medicaid Managed Care	$29.41

STN PN THD TIP .125X2.5IN 2PK

Facility

$1,110.00

Service Code	HCPCS C1713
Hospital Charge Code	270679751
Hospital Revenue Code	278
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$244.20
Rate for Payer: Qualcare PPO/HMO/WC	$166.50

STNT GRFT AFX BA25-70/120-30

Facility

$57,900.00

Hospital Charge Code	270660506C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

STNT GRFT AFX BA25-70/120-30

Facility

$57,900.00

Hospital Charge Code	270660506C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STNT HRCLK6.5X15X80 1011501-15

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270646394C
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STNT HRCLK6.5X15X80 1011501-15

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270646394C
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

STNT HRCULNK PLS 1008020-15

Facility

$4,750.00

Hospital Charge Code	280644282V
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

Know your out-of-pocket cost for care.

All Charges