Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYSTEM JETSTREAM 1.6MM PV3116F

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270646322C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

SYSTEM JETSTREAM G3 PV31300

Facility

$16,125.00

Service Code	HCPCS C1757
Hospital Charge Code	270643857C
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

SYSTEM JETSTREAM G3 PV31300

Facility

$16,125.00

Service Code	HCPCS C1757
Hospital Charge Code	270643857C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

SYSTEM JETSTREAM G3SF

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270645044
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

SYSTEM JETSTREAM G3SF

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270645044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

SYSTEM JETSTREAM PV41340

Facility

$16,125.00

Hospital Charge Code	270647519C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$2,418.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

SYSTEM JETSTREAM PV41340

Facility

$16,125.00

Hospital Charge Code	270647519C
Hospital Revenue Code	272
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,837.50
Rate for Payer: Oxford Commercial	$3,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Commercial	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

SYSTEM KIT PREVENA PLUS

Facility

$3,250.00

Hospital Charge Code	270680164
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

SYSTEM KIT PREVENA PLUS

Facility

$3,250.00

Hospital Charge Code	270680164
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

SYSTEM, LIF, ILLUMINATION STER

Facility

$1,512.50

Hospital Charge Code	270702573
Hospital Revenue Code	278
Min. Negotiated Rate	$226.88
Max. Negotiated Rate	$366.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$226.88

SYSTEM, LIF, ILLUMINATION STER

Facility

$1,512.50

Hospital Charge Code	270702573
Hospital Revenue Code	278
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$756.25
Rate for Payer: Aetna Commercial	$574.75
Rate for Payer: Aetna Medicare Advantage	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.69
Rate for Payer: Cigna Commercial	$756.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$226.88
Rate for Payer: UnitedHealthcare Community & State	$36.45
Rate for Payer: Wellpoint Medicaid Managed Care	$40.08

SYSTEM LOOPOSTOMY 2 3/4

Facility

$139.25

Hospital Charge Code	270600414
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

SYSTEM LOOPOSTOMY 2 3/4

Facility

$139.25

Hospital Charge Code	270600414
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.77
Rate for Payer: Oxford Commercial	$27.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$27.85
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

SYSTEM LOOPOSTOMY SUREFIT

Facility

$155.25

Hospital Charge Code	270600415
Hospital Revenue Code	272
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.62
Rate for Payer: Aetna Commercial	$58.99
Rate for Payer: Aetna Medicare Advantage	$46.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.59
Rate for Payer: Cigna Commercial	$77.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.58
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.29
Rate for Payer: UnitedHealthcare Commercial	$31.05
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SYSTEM LOOPOSTOMY SUREFIT

Facility

$155.25

Hospital Charge Code	270600415
Hospital Revenue Code	272
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$23.29
Rate for Payer: Qualcare PPO/HMO/WC	$23.29

SYSTEM LUMBAR VALVE BROWN

Facility

$6,590.50

Hospital Charge Code	270679119
Hospital Revenue Code	272
Min. Negotiated Rate	$158.83
Max. Negotiated Rate	$3,295.25
Rate for Payer: Aetna Commercial	$2,504.39
Rate for Payer: Aetna Medicare Advantage	$1,977.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,680.58
Rate for Payer: Cigna Commercial	$3,295.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.15
Rate for Payer: Oxford Commercial	$1,318.10
Rate for Payer: Qualcare PPO/HMO/WC	$988.58
Rate for Payer: UnitedHealthcare Commercial	$1,318.10
Rate for Payer: UnitedHealthcare Community & State	$158.83
Rate for Payer: Wellpoint Medicaid Managed Care	$174.65

SYSTEM LUMBAR VALVE BROWN

Facility

$6,590.50

Hospital Charge Code	270679119
Hospital Revenue Code	272
Min. Negotiated Rate	$988.58
Max. Negotiated Rate	$988.58
Rate for Payer: Qualcare PPO/HMO/WC	$988.58

SYSTEM LUMBAR VALVE GREEN

Facility

$6,590.50

Hospital Charge Code	270679117
Hospital Revenue Code	272
Min. Negotiated Rate	$988.58
Max. Negotiated Rate	$988.58
Rate for Payer: Qualcare PPO/HMO/WC	$988.58

SYSTEM LUMBAR VALVE GREEN

Facility

$6,590.50

Hospital Charge Code	270679117
Hospital Revenue Code	272
Min. Negotiated Rate	$158.83
Max. Negotiated Rate	$3,295.25
Rate for Payer: Aetna Commercial	$2,504.39
Rate for Payer: Aetna Medicare Advantage	$1,977.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,680.58
Rate for Payer: Cigna Commercial	$3,295.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.15
Rate for Payer: Oxford Commercial	$1,318.10
Rate for Payer: Qualcare PPO/HMO/WC	$988.58
Rate for Payer: UnitedHealthcare Commercial	$1,318.10
Rate for Payer: UnitedHealthcare Community & State	$158.83
Rate for Payer: Wellpoint Medicaid Managed Care	$174.65

SYSTEM LUMBAR VALVE WHITE

Facility

$6,590.50

Hospital Charge Code	270679118
Hospital Revenue Code	272
Min. Negotiated Rate	$988.58
Max. Negotiated Rate	$988.58
Rate for Payer: Qualcare PPO/HMO/WC	$988.58

SYSTEM LUMBAR VALVE WHITE

Facility

$6,590.50

Hospital Charge Code	270679118
Hospital Revenue Code	272
Min. Negotiated Rate	$158.83
Max. Negotiated Rate	$3,295.25
Rate for Payer: Aetna Commercial	$2,504.39
Rate for Payer: Aetna Medicare Advantage	$1,977.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,680.58
Rate for Payer: Cigna Commercial	$3,295.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.15
Rate for Payer: Oxford Commercial	$1,318.10
Rate for Payer: Qualcare PPO/HMO/WC	$988.58
Rate for Payer: UnitedHealthcare Commercial	$1,318.10
Rate for Payer: UnitedHealthcare Community & State	$158.83
Rate for Payer: Wellpoint Medicaid Managed Care	$174.65

SYSTEM LUMBAR VALVE YELLOW

Facility

$6,590.50

Hospital Charge Code	270679116
Hospital Revenue Code	272
Min. Negotiated Rate	$158.83
Max. Negotiated Rate	$3,295.25
Rate for Payer: Aetna Commercial	$2,504.39
Rate for Payer: Aetna Medicare Advantage	$1,977.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,680.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,680.58
Rate for Payer: Cigna Commercial	$3,295.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.15
Rate for Payer: Oxford Commercial	$1,318.10
Rate for Payer: Qualcare PPO/HMO/WC	$988.58
Rate for Payer: UnitedHealthcare Commercial	$1,318.10
Rate for Payer: UnitedHealthcare Community & State	$158.83
Rate for Payer: Wellpoint Medicaid Managed Care	$174.65

SYSTEM LUMBAR VALVE YELLOW

Facility

$6,590.50

Hospital Charge Code	270679116
Hospital Revenue Code	272
Min. Negotiated Rate	$988.58
Max. Negotiated Rate	$988.58
Rate for Payer: Qualcare PPO/HMO/WC	$988.58

SYSTEM LYNX SUPRAPUBIC

Facility

$6,250.00

Hospital Charge Code	270639478
Hospital Revenue Code	278
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) NJ Health	$1,250.00
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	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

SYSTEM LYNX SUPRAPUBIC

Facility

$6,250.00

Service Code	HCPCS C1771
Hospital Charge Code	270639748
Hospital Revenue Code	278
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) NJ Health	$1,250.00
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	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

Know your out-of-pocket cost for care.

All Charges