Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STONEBASKET G07313

Facility

$2,198.75

Hospital Charge Code	270635185C
Hospital Revenue Code	272
Min. Negotiated Rate	$52.99
Max. Negotiated Rate	$1,099.38
Rate for Payer: Aetna Commercial	$835.52
Rate for Payer: Aetna Medicare Advantage	$659.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$560.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$560.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$560.68
Rate for Payer: Cigna Commercial	$1,099.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.62
Rate for Payer: Oxford Commercial	$439.75
Rate for Payer: Qualcare PPO/HMO/WC	$329.81
Rate for Payer: UnitedHealthcare Commercial	$439.75
Rate for Payer: UnitedHealthcare Community & State	$52.99
Rate for Payer: Wellpoint Medicaid Managed Care	$58.27

STONEBASKET G07313

Facility

$2,389.35

Hospital Charge Code	270635185
Hospital Revenue Code	272
Min. Negotiated Rate	$57.58
Max. Negotiated Rate	$1,194.67
Rate for Payer: Aetna Commercial	$907.95
Rate for Payer: Aetna Medicare Advantage	$716.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$609.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$609.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$609.28
Rate for Payer: Cigna Commercial	$1,194.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$716.80
Rate for Payer: Oxford Commercial	$477.87
Rate for Payer: Qualcare PPO/HMO/WC	$358.40
Rate for Payer: UnitedHealthcare Commercial	$477.87
Rate for Payer: UnitedHealthcare Community & State	$57.58
Rate for Payer: Wellpoint Medicaid Managed Care	$63.32

STONEBASKET G07313

Facility

$2,198.75

Hospital Charge Code	270635185C
Hospital Revenue Code	272
Min. Negotiated Rate	$329.81
Max. Negotiated Rate	$329.81
Rate for Payer: Qualcare PPO/HMO/WC	$329.81

STONE CRYSTALOGRAPH***

Facility

$42.00

Service Code	HCPCS 82365
Hospital Charge Code	3030798
Hospital Revenue Code	309
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

STONE CRYSTALOGRAPH***

Facility

$42.00

Service Code	HCPCS 82365
Hospital Charge Code	3030798
Hospital Revenue Code	309
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

STONETOME MCV 1 3511

Facility

$1,992.85

Hospital Charge Code	270604754
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 1 3511

Facility

$1,992.85

Hospital Charge Code	270604754
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 20MM 3521

Facility

$2,261.65

Hospital Charge Code	270615962
Hospital Revenue Code	272
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$1,130.83
Rate for Payer: Aetna Commercial	$859.43
Rate for Payer: Aetna Medicare Advantage	$678.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.72
Rate for Payer: Cigna Commercial	$1,130.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.50
Rate for Payer: Oxford Commercial	$452.33
Rate for Payer: Qualcare PPO/HMO/WC	$339.25
Rate for Payer: UnitedHealthcare Commercial	$452.33
Rate for Payer: UnitedHealthcare Community & State	$54.51
Rate for Payer: Wellpoint Medicaid Managed Care	$59.93

STONETOME MCV 20MM 3521

Facility

$2,261.65

Hospital Charge Code	270615962
Hospital Revenue Code	272
Min. Negotiated Rate	$339.25
Max. Negotiated Rate	$339.25
Rate for Payer: Qualcare PPO/HMO/WC	$339.25

STONETOME MCV 20MM BALLN 3515

Facility

$1,992.85

Hospital Charge Code	270601180
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 20MM BALLN 3515

Facility

$1,992.85

Hospital Charge Code	270601180
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 2 3512

Facility

$1,992.85

Hospital Charge Code	270604755
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 2 3512

Facility

$1,992.85

Hospital Charge Code	270604755
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 30MM BALLN 3519

Facility

$2,953.65

Hospital Charge Code	270601179
Hospital Revenue Code	270
Min. Negotiated Rate	$71.18
Max. Negotiated Rate	$1,476.83
Rate for Payer: Aetna Commercial	$1,122.39
Rate for Payer: Aetna Medicare Advantage	$886.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$753.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$753.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$753.18
Rate for Payer: Cigna Commercial	$1,476.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$886.10
Rate for Payer: Oxford Commercial	$590.73
Rate for Payer: Qualcare PPO/HMO/WC	$443.05
Rate for Payer: UnitedHealthcare Commercial	$590.73
Rate for Payer: UnitedHealthcare Community & State	$71.18
Rate for Payer: Wellpoint Medicaid Managed Care	$78.27

STONETOME MCV 30MM BALLN 3519

Facility

$2,953.65

Hospital Charge Code	270601179
Hospital Revenue Code	270
Min. Negotiated Rate	$443.05
Max. Negotiated Rate	$443.05
Rate for Payer: Qualcare PPO/HMO/WC	$443.05

STONETOME MCV 3 3513

Facility

$1,992.85

Hospital Charge Code	270604756
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 3 3513

Facility

$1,992.85

Hospital Charge Code	270604756
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 4 3514

Facility

$1,992.85

Hospital Charge Code	270604757
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 4 3514

Facility

$1,992.85

Hospital Charge Code	270604757
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 5 3515

Facility

$1,992.85

Hospital Charge Code	270604758
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 5 3515

Facility

$1,992.85

Hospital Charge Code	270604758
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 6 3516

Facility

$1,992.85

Hospital Charge Code	270604759
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 6 3516

Facility

$1,992.85

Hospital Charge Code	270604759
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 7 3517

Facility

$1,992.85

Hospital Charge Code	270604760
Hospital Revenue Code	270
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.86
Rate for Payer: Oxford Commercial	$398.57
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$398.57
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

STONETOME MCV 7 3517

Facility

$1,992.85

Hospital Charge Code	270604760
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

Know your out-of-pocket cost for care.

All Charges