Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STUARTNATAL 1+1/TAB

Facility

$4.00

Service Code	NDC 904531360
Hospital Charge Code	60633924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

STUARTNATAL 1+1/TAB

Facility

$4.00

Service Code	NDC 904531360
Hospital Charge Code	60633924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

STUNT MEDIUM STANDARD SYSTEM

Facility

$1,975.00

Hospital Charge Code	270655418
Hospital Revenue Code	278
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$477.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

STUNT MEDIUM STANDARD SYSTEM

Facility

$1,975.00

Hospital Charge Code	270655418
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

STURE PASSER KNEE SCORPION

Facility

$14,995.00

Hospital Charge Code	270682510
Hospital Revenue Code	272
Min. Negotiated Rate	$361.38
Max. Negotiated Rate	$7,497.50
Rate for Payer: Aetna Commercial	$5,698.10
Rate for Payer: Aetna Medicare Advantage	$4,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,823.72
Rate for Payer: Cigna Commercial	$7,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,498.50
Rate for Payer: Oxford Commercial	$2,999.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25
Rate for Payer: UnitedHealthcare Commercial	$2,999.00
Rate for Payer: UnitedHealthcare Community & State	$361.38
Rate for Payer: Wellpoint Medicaid Managed Care	$397.37

STURE PASSER KNEE SCORPION

Facility

$14,995.00

Hospital Charge Code	270682510
Hospital Revenue Code	272
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$2,249.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

ST USE OF SPEECH DEVI SVC

Facility

$299.00

Service Code	HCPCS 92609GN
Hospital Charge Code	74204025
Hospital Revenue Code	440
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

ST USE OF SPEECH DEVI SVC

Facility

$299.00

Service Code	HCPCS 92609GN
Hospital Charge Code	74204025
Hospital Revenue Code	440
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$113.62
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

ST VIABAHN10mm5cm75cm VB100501

Facility

$10,168.00

Hospital Charge Code	270634781
Hospital Revenue Code	278
Min. Negotiated Rate	$245.05
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,863.84
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20
Rate for Payer: UnitedHealthcare Community & State	$245.05
Rate for Payer: Wellpoint Medicaid Managed Care	$269.45

ST VIABAHN10mm5cm75cm VB100501

Facility

$10,168.00

Hospital Charge Code	270634781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,236.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

ST VIABAHN10mm5cm75cm VB100501

Facility

$11,685.00

Hospital Charge Code	270634781V
Hospital Revenue Code	278
Min. Negotiated Rate	$281.61
Max. Negotiated Rate	$5,842.50
Rate for Payer: Aetna Commercial	$4,440.30
Rate for Payer: Aetna Medicare Advantage	$3,505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,979.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,979.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,337.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,979.68
Rate for Payer: Cigna Commercial	$5,842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,827.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,570.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,752.75
Rate for Payer: UnitedHealthcare Community & State	$281.61
Rate for Payer: Wellpoint Medicaid Managed Care	$309.65

ST VIABAHN10mm5cm75cm VB100501

Facility

$11,685.00

Hospital Charge Code	270634781V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,752.75
Max. Negotiated Rate	$2,827.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,337.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,827.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,570.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,752.75

ST VIABAHN8mm10cm75cmVBB081001

Facility

$12,648.00

Hospital Charge Code	270633718V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,897.20
Max. Negotiated Rate	$3,060.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,529.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,060.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,782.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.20

ST VIABAHN8mm10cm75cmVBB081001

Facility

$12,648.00

Hospital Charge Code	270633718
Hospital Revenue Code	278
Min. Negotiated Rate	$1,897.20
Max. Negotiated Rate	$3,060.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,529.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,060.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,782.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.20

ST VIABAHN8mm10cm75cmVBB081001

Facility

$12,648.00

Hospital Charge Code	270633718
Hospital Revenue Code	278
Min. Negotiated Rate	$304.82
Max. Negotiated Rate	$6,324.00
Rate for Payer: Aetna Commercial	$4,806.24
Rate for Payer: Aetna Medicare Advantage	$3,794.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,225.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,225.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,529.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,225.24
Rate for Payer: Cigna Commercial	$6,324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,060.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,782.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.20
Rate for Payer: UnitedHealthcare Community & State	$304.82
Rate for Payer: Wellpoint Medicaid Managed Care	$335.17

ST VIABAHN8mm10cm75cmVBB081001

Facility

$12,648.00

Hospital Charge Code	270633718V
Hospital Revenue Code	278
Min. Negotiated Rate	$304.82
Max. Negotiated Rate	$6,324.00
Rate for Payer: Aetna Commercial	$4,806.24
Rate for Payer: Aetna Medicare Advantage	$3,794.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,225.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,225.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,529.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,225.24
Rate for Payer: Cigna Commercial	$6,324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,060.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,782.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.20
Rate for Payer: UnitedHealthcare Community & State	$304.82
Rate for Payer: Wellpoint Medicaid Managed Care	$335.17

STYLET 2 COIL

Facility

$3,190.00

Hospital Charge Code	270703108
Hospital Revenue Code	278
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$1,595.00
Rate for Payer: Aetna Commercial	$1,212.20
Rate for Payer: Aetna Medicare Advantage	$957.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$813.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$813.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$813.45
Rate for Payer: Cigna Commercial	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$478.50
Rate for Payer: UnitedHealthcare Community & State	$76.88
Rate for Payer: Wellpoint Medicaid Managed Care	$84.53

STYLET 2 COIL

Facility

$3,190.00

Hospital Charge Code	270703108
Hospital Revenue Code	278
Min. Negotiated Rate	$478.50
Max. Negotiated Rate	$771.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$638.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$771.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$478.50

STYLET 6094-45 J PACING

Facility

$200.00

Hospital Charge Code	270690886
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

STYLET 6094-45 J PACING

Facility

$200.00

Hospital Charge Code	270690886
Hospital Revenue Code	272
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

STYLET CLEANING 1.25MM CANN

Facility

$321.00

Hospital Charge Code	270676257
Hospital Revenue Code	272
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$160.50
Rate for Payer: Aetna Commercial	$121.98
Rate for Payer: Aetna Medicare Advantage	$96.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.86
Rate for Payer: Cigna Commercial	$160.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.30
Rate for Payer: Oxford Commercial	$64.20
Rate for Payer: Qualcare PPO/HMO/WC	$48.15
Rate for Payer: UnitedHealthcare Commercial	$64.20
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.51

STYLET CLEANING 1.25MM CANN

Facility

$321.00

Hospital Charge Code	270676257
Hospital Revenue Code	272
Min. Negotiated Rate	$48.15
Max. Negotiated Rate	$48.15
Rate for Payer: Qualcare PPO/HMO/WC	$48.15

STYLET FALLER 650MM

Facility

$350.00

Hospital Charge Code	270674111
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

STYLET FALLER 650MM

Facility

$350.00

Hospital Charge Code	270674111
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

STYLET GLBL

Facility

$180.00

Hospital Charge Code	270671558
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

Know your out-of-pocket cost for care.

All Charges