Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYSTEM AUTOTRANS SOLCOTRANS

Facility

$1,104.85

Hospital Charge Code	270606437
Hospital Revenue Code	272
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

SYSTEM BONE SCREW REMOVAL UNI-

Facility

$6,250.00

Hospital Charge Code	270639843
Hospital Revenue Code	272
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

SYSTEM BONE SCREW REMOVAL UNI-

Facility

$6,250.00

Hospital Charge Code	270639843
Hospital Revenue Code	272
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Commercial	$1,250.00
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

SYSTEM BX AUTO 18G 15CM 43-207

Facility

$564.00

Hospital Charge Code	270600448
Hospital Revenue Code	272
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$84.60
Rate for Payer: Qualcare PPO/HMO/WC	$84.60

SYSTEM BX AUTO 18G 15CM 43-207

Facility

$564.00

Hospital Charge Code	270600448
Hospital Revenue Code	272
Min. Negotiated Rate	$13.59
Max. Negotiated Rate	$282.00
Rate for Payer: Aetna Commercial	$214.32
Rate for Payer: Aetna Medicare Advantage	$169.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.82
Rate for Payer: Cigna Commercial	$282.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.20
Rate for Payer: Oxford Commercial	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$84.60
Rate for Payer: UnitedHealthcare Commercial	$112.80
Rate for Payer: UnitedHealthcare Community & State	$13.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.95

SYSTEM CABLE 2.0MM COB 120005

Facility

$1,110.00

Hospital Charge Code	270645421
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

SYSTEM CABLE 2.0MM COB 120005

Facility

$1,110.00

Hospital Charge Code	270645421
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

SYSTEM CHARGING

Facility

$6,450.00

Service Code	HCPCS C1820
Hospital Charge Code	270665900
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

SYSTEM CHARGING

Facility

$6,450.00

Service Code	HCPCS C1820
Hospital Charge Code	270665900
Hospital Revenue Code	278
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$2,451.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50
Rate for Payer: UnitedHealthcare Community & State	$155.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.93

SYSTEM CHARGING 37752

Facility

$11,950.00

Hospital Charge Code	270640324
Hospital Revenue Code	272
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$1,792.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

SYSTEM CHARGING 37752

Facility

$11,950.00

Hospital Charge Code	270640324
Hospital Revenue Code	272
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,585.00
Rate for Payer: Oxford Commercial	$2,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Commercial	$2,390.00
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

SYSTEM COLOS/ILEOST 45MM

Facility

$72.85

Hospital Charge Code	270600412
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

SYSTEM COLOS/ILEOST 45MM

Facility

$72.85

Hospital Charge Code	270600412
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

SYSTEM COLOS/ILEOST 70MM

Facility

$72.85

Hospital Charge Code	270600413
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

SYSTEM COLOS/ILEOST 70MM

Facility

$72.85

Hospital Charge Code	270600413
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

SYSTEM DEEP SCROTAL RETRACTION

Facility

$2,105.00

Hospital Charge Code	270641451
Hospital Revenue Code	272
Min. Negotiated Rate	$315.75
Max. Negotiated Rate	$315.75
Rate for Payer: Qualcare PPO/HMO/WC	$315.75

SYSTEM DEEP SCROTAL RETRACTION

Facility

$2,105.00

Hospital Charge Code	270641451
Hospital Revenue Code	272
Min. Negotiated Rate	$50.73
Max. Negotiated Rate	$1,052.50
Rate for Payer: Aetna Commercial	$799.90
Rate for Payer: Aetna Medicare Advantage	$631.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.77
Rate for Payer: Cigna Commercial	$1,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.50
Rate for Payer: Oxford Commercial	$421.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.75
Rate for Payer: UnitedHealthcare Commercial	$421.00
Rate for Payer: UnitedHealthcare Community & State	$50.73
Rate for Payer: Wellpoint Medicaid Managed Care	$55.78

SYSTEM DISPOSABLE AC JOINT

Facility

$4,360.00

Hospital Charge Code	270665365
Hospital Revenue Code	278
Min. Negotiated Rate	$105.08
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,656.80
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00
Rate for Payer: UnitedHealthcare Community & State	$105.08
Rate for Payer: Wellpoint Medicaid Managed Care	$115.54

SYSTEM DISPOSABLE AC JOINT

Facility

$4,360.00

Hospital Charge Code	270665365
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

SYSTEM DPY PLTLT CNC 276040103

Facility

$2,912.85

Hospital Charge Code	270628748
Hospital Revenue Code	272
Min. Negotiated Rate	$436.93
Max. Negotiated Rate	$436.93
Rate for Payer: Qualcare PPO/HMO/WC	$436.93

SYSTEM DPY PLTLT CNC 276040103

Facility

$2,912.85

Hospital Charge Code	270628748
Hospital Revenue Code	272
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$1,456.42
Rate for Payer: Aetna Commercial	$1,106.88
Rate for Payer: Aetna Medicare Advantage	$873.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.78
Rate for Payer: Cigna Commercial	$1,456.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$873.86
Rate for Payer: Oxford Commercial	$582.57
Rate for Payer: Qualcare PPO/HMO/WC	$436.93
Rate for Payer: UnitedHealthcare Commercial	$582.57
Rate for Payer: UnitedHealthcare Community & State	$70.20
Rate for Payer: Wellpoint Medicaid Managed Care	$77.19

SYSTEM FIBULINK SYNDESMOSIS

Facility

$6,016.00

Service Code	HCPCS C1713
Hospital Charge Code	270690528
Hospital Revenue Code	278
Min. Negotiated Rate	$902.40
Max. Negotiated Rate	$1,455.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,203.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,455.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,323.52
Rate for Payer: Qualcare PPO/HMO/WC	$902.40

SYSTEM FIBULINK SYNDESMOSIS

Facility

$6,016.00

Service Code	HCPCS C1713
Hospital Charge Code	270690528
Hospital Revenue Code	278
Min. Negotiated Rate	$144.99
Max. Negotiated Rate	$3,008.00
Rate for Payer: Aetna Commercial	$2,286.08
Rate for Payer: Aetna Medicare Advantage	$1,804.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,534.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,534.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,203.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,534.08
Rate for Payer: Cigna Commercial	$3,008.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,455.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,323.52
Rate for Payer: Qualcare PPO/HMO/WC	$902.40
Rate for Payer: UnitedHealthcare Community & State	$144.99
Rate for Payer: Wellpoint Medicaid Managed Care	$159.42

SYSTEM FIXATION MENISCAL ULTRA

Facility

$1,595.00

Hospital Charge Code	270656314
Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$797.50
Rate for Payer: Aetna Commercial	$606.10
Rate for Payer: Aetna Medicare Advantage	$478.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$406.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$406.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$406.73
Rate for Payer: Cigna Commercial	$797.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$478.50
Rate for Payer: Oxford Commercial	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.25
Rate for Payer: UnitedHealthcare Commercial	$319.00
Rate for Payer: UnitedHealthcare Community & State	$38.44
Rate for Payer: Wellpoint Medicaid Managed Care	$42.27

SYSTEM FIXATION MENISCAL ULTRA

Facility

$1,595.00

Hospital Charge Code	270656314
Hospital Revenue Code	272
Min. Negotiated Rate	$239.25
Max. Negotiated Rate	$239.25
Rate for Payer: Qualcare PPO/HMO/WC	$239.25

Know your out-of-pocket cost for care.

All Charges