Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYS DEVICE CLOSURE RAD ARTERY

Facility

$135.00

Service Code	HCPCS C1760
Hospital Charge Code	270658210
Hospital Revenue Code	278
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

SYS DEVICE CLOSURE RAD ARTERY

Facility

$135.00

Service Code	HCPCS C1760
Hospital Charge Code	270658210
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

SYS FIX LAP 36 CM DEV W/30 FST

Facility

$1,975.00

Hospital Charge Code	270644532
Hospital Revenue Code	272
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) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

SYS FIX LAP 36 CM DEV W/30 FST

Facility

$1,975.00

Hospital Charge Code	270644532
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

SYS JETSTREAM 2.1-3.0 PV31300

Facility

$16,625.00

Hospital Charge Code	270643857V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,493.75
Max. Negotiated Rate	$4,023.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,023.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,657.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,493.75

SYS JETSTREAM 2.1-3.0 PV31300

Facility

$16,625.00

Hospital Charge Code	270643857V
Hospital Revenue Code	278
Min. Negotiated Rate	$400.66
Max. Negotiated Rate	$8,312.50
Rate for Payer: Aetna Commercial	$6,317.50
Rate for Payer: Aetna Medicare Advantage	$4,987.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,239.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,239.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,239.38
Rate for Payer: Cigna Commercial	$8,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,023.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,657.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,493.75
Rate for Payer: UnitedHealthcare Community & State	$400.66
Rate for Payer: Wellpoint Medicaid Managed Care	$440.56

SYS PARTIAL KNEE FEMORAL SMALL

Facility

$20,345.00

Hospital Charge Code	270645452
Hospital Revenue Code	278
Min. Negotiated Rate	$3,051.75
Max. Negotiated Rate	$4,923.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,923.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,475.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.75

SYS PARTIAL KNEE FEMORAL SMALL

Facility

$20,345.00

Hospital Charge Code	270645452
Hospital Revenue Code	278
Min. Negotiated Rate	$490.31
Max. Negotiated Rate	$10,172.50
Rate for Payer: Aetna Commercial	$7,731.10
Rate for Payer: Aetna Medicare Advantage	$6,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,187.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,187.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,187.98
Rate for Payer: Cigna Commercial	$10,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,923.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,475.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.75
Rate for Payer: UnitedHealthcare Community & State	$490.31
Rate for Payer: Wellpoint Medicaid Managed Care	$539.14

SYS PLUS BONE CEMENT DELIVERY

Facility

$3,250.00

Hospital Charge Code	270650181
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

SYS PLUS BONE CEMENT DELIVERY

Facility

$3,250.00

Hospital Charge Code	270650181
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

SYS SMALL BONE FIXATION

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270652902
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SYS SMALL BONE FIXATION

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270652902
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

SYS SUPPORT AVAULTA 486010

Facility

$7,688.00

Hospital Charge Code	27063632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,153.20
Max. Negotiated Rate	$1,860.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,537.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,691.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20

SYS SUPPORT AVAULTA 486010

Facility

$7,688.00

Hospital Charge Code	27063632
Hospital Revenue Code	278
Min. Negotiated Rate	$185.28
Max. Negotiated Rate	$3,844.00
Rate for Payer: Aetna Commercial	$2,921.44
Rate for Payer: Aetna Medicare Advantage	$2,306.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,537.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,960.44
Rate for Payer: Cigna Commercial	$3,844.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,691.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20
Rate for Payer: UnitedHealthcare Community & State	$185.28
Rate for Payer: Wellpoint Medicaid Managed Care	$203.73

SYS SUPPORT AVLTA BISYN 486010

Facility

$7,688.00

Hospital Charge Code	270636320
Hospital Revenue Code	272
Min. Negotiated Rate	$1,153.20
Max. Negotiated Rate	$1,153.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20

SYS SUPPORT AVLTA BISYN 486010

Facility

$7,688.00

Hospital Charge Code	270636320
Hospital Revenue Code	272
Min. Negotiated Rate	$185.28
Max. Negotiated Rate	$3,844.00
Rate for Payer: Aetna Commercial	$2,921.44
Rate for Payer: Aetna Medicare Advantage	$2,306.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,960.44
Rate for Payer: Cigna Commercial	$3,844.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,306.40
Rate for Payer: Oxford Commercial	$1,537.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20
Rate for Payer: UnitedHealthcare Commercial	$1,537.60
Rate for Payer: UnitedHealthcare Community & State	$185.28
Rate for Payer: Wellpoint Medicaid Managed Care	$203.73

SYSTEM ACCUMIX MIXING

Facility

$1,350.00

Hospital Charge Code	270678976
Hospital Revenue Code	272
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

SYSTEM ACCUMIX MIXING

Facility

$1,350.00

Hospital Charge Code	270678976
Hospital Revenue Code	272
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.00
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$270.00
Rate for Payer: UnitedHealthcare Community & State	$32.53
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

SYSTEM AMS SACRL COLPO 7240360

Facility

$4,935.25

Hospital Charge Code	270626670
Hospital Revenue Code	272
Min. Negotiated Rate	$740.29
Max. Negotiated Rate	$740.29
Rate for Payer: Qualcare PPO/HMO/WC	$740.29

SYSTEM AMS SACRL COLPO 7240360

Facility

$4,935.25

Hospital Charge Code	270626670
Hospital Revenue Code	272
Min. Negotiated Rate	$118.94
Max. Negotiated Rate	$2,467.62
Rate for Payer: Aetna Commercial	$1,875.39
Rate for Payer: Aetna Medicare Advantage	$1,480.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.49
Rate for Payer: Cigna Commercial	$2,467.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.58
Rate for Payer: Oxford Commercial	$987.05
Rate for Payer: Qualcare PPO/HMO/WC	$740.29
Rate for Payer: UnitedHealthcare Commercial	$987.05
Rate for Payer: UnitedHealthcare Community & State	$118.94
Rate for Payer: Wellpoint Medicaid Managed Care	$130.78

SYSTEM ASPIRATION SEPARATOR 12

Facility

$9,725.00

Hospital Charge Code	270689718
Hospital Revenue Code	272
Min. Negotiated Rate	$1,458.75
Max. Negotiated Rate	$1,458.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75

SYSTEM ASPIRATION SEPARATOR 12

Facility

$9,725.00

Hospital Charge Code	270689718
Hospital Revenue Code	272
Min. Negotiated Rate	$234.37
Max. Negotiated Rate	$4,862.50
Rate for Payer: Aetna Commercial	$3,695.50
Rate for Payer: Aetna Medicare Advantage	$2,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,479.88
Rate for Payer: Cigna Commercial	$4,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.50
Rate for Payer: Oxford Commercial	$1,945.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75
Rate for Payer: UnitedHealthcare Commercial	$1,945.00
Rate for Payer: UnitedHealthcare Community & State	$234.37
Rate for Payer: Wellpoint Medicaid Managed Care	$257.71

SYSTEM AUTOTRANSFUSION

Facility

$1,679.25

Hospital Charge Code	270600339
Hospital Revenue Code	270
Min. Negotiated Rate	$251.89
Max. Negotiated Rate	$251.89
Rate for Payer: Qualcare PPO/HMO/WC	$251.89

SYSTEM AUTOTRANSFUSION

Facility

$1,679.25

Hospital Charge Code	270600339
Hospital Revenue Code	270
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$839.62
Rate for Payer: Aetna Commercial	$638.12
Rate for Payer: Aetna Medicare Advantage	$503.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.21
Rate for Payer: Cigna Commercial	$839.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.77
Rate for Payer: Oxford Commercial	$335.85
Rate for Payer: Qualcare PPO/HMO/WC	$251.89
Rate for Payer: UnitedHealthcare Commercial	$335.85
Rate for Payer: UnitedHealthcare Community & State	$40.47
Rate for Payer: Wellpoint Medicaid Managed Care	$44.50

SYSTEM AUTOTRANS SOLCOTRANS

Facility

$1,104.85

Hospital Charge Code	270606437
Hospital Revenue Code	272
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$419.84
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.45
Rate for Payer: Oxford Commercial	$220.97
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Commercial	$220.97
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

Know your out-of-pocket cost for care.

All Charges