Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYSTEM LYNX SUPRAPUBIC

Facility

$6,250.00

Hospital Charge Code	270639478
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
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

SYSTEM LYNX SUPRAPUBIC

Facility

$6,250.00

Service Code	HCPCS C1771
Hospital Charge Code	270639748
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
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

SYSTEM MAX Bx 14G 10cm MC1410

Facility

$280.00

Hospital Charge Code	270628524
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

SYSTEM MAX Bx 14G 10cm MC1410

Facility

$280.00

Hospital Charge Code	270628524
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.00
Rate for Payer: Oxford Commercial	$56.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$56.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

SYSTEM MEDICATION LABELING OR

Facility

$13.87

Hospital Charge Code	270643023
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.93
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare Advantage	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.54
Rate for Payer: Cigna Commercial	$6.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.08
Rate for Payer: UnitedHealthcare Commercial	$2.77
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SYSTEM MEDICATION LABELING OR

Facility

$13.87

Hospital Charge Code	270643023
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.08

SYSTEM MEDICATION LABL OR 3033

Facility

$17.25

Hospital Charge Code	270636688
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.40
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

SYSTEM MEDICATION LABL OR 3033

Facility

$17.25

Hospital Charge Code	270636688
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

SYSTEM MYOSURE XL TISSUE

Facility

$5,500.00

Hospital Charge Code	270684280
Hospital Revenue Code	272
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,650.00
Rate for Payer: Oxford Commercial	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$1,100.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

SYSTEM MYOSURE XL TISSUE

Facility

$5,500.00

Hospital Charge Code	270684280
Hospital Revenue Code	272
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

SYSTEM ORTHODONTIC BONDING

Facility

$2,401.65

Hospital Charge Code	270610888
Hospital Revenue Code	270
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$1,200.83
Rate for Payer: Aetna Commercial	$912.63
Rate for Payer: Aetna Medicare Advantage	$720.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.42
Rate for Payer: Cigna Commercial	$1,200.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.50
Rate for Payer: Oxford Commercial	$480.33
Rate for Payer: Qualcare PPO/HMO/WC	$360.25
Rate for Payer: UnitedHealthcare Commercial	$480.33
Rate for Payer: UnitedHealthcare Community & State	$57.88
Rate for Payer: Wellpoint Medicaid Managed Care	$63.64

SYSTEM ORTHODONTIC BONDING

Facility

$2,401.65

Hospital Charge Code	270610888
Hospital Revenue Code	270
Min. Negotiated Rate	$360.25
Max. Negotiated Rate	$360.25
Rate for Payer: Qualcare PPO/HMO/WC	$360.25

SYSTEM OSTEOBOND VAC MIXING

Facility

$571.25

Hospital Charge Code	270600356
Hospital Revenue Code	270
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Qualcare PPO/HMO/WC	$85.69

SYSTEM OSTEOBOND VAC MIXING

Facility

$571.25

Hospital Charge Code	270600356
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$285.62
Rate for Payer: Aetna Commercial	$217.07
Rate for Payer: Aetna Medicare Advantage	$171.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.67
Rate for Payer: Cigna Commercial	$285.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.38
Rate for Payer: Oxford Commercial	$114.25
Rate for Payer: Qualcare PPO/HMO/WC	$85.69
Rate for Payer: UnitedHealthcare Commercial	$114.25
Rate for Payer: UnitedHealthcare Community & State	$13.77
Rate for Payer: Wellpoint Medicaid Managed Care	$15.14

SYSTEM OSTEO INTROD ADVA T05E

Facility

$5,381.65

Hospital Charge Code	270631259
Hospital Revenue Code	272
Min. Negotiated Rate	$807.25
Max. Negotiated Rate	$807.25
Rate for Payer: Qualcare PPO/HMO/WC	$807.25

SYSTEM OSTEO INTROD ADVA T05E

Facility

$5,381.65

Hospital Charge Code	270631259
Hospital Revenue Code	272
Min. Negotiated Rate	$129.70
Max. Negotiated Rate	$2,690.82
Rate for Payer: Aetna Commercial	$2,045.03
Rate for Payer: Aetna Medicare Advantage	$1,614.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,372.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,372.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,372.32
Rate for Payer: Cigna Commercial	$2,690.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,614.49
Rate for Payer: Oxford Commercial	$1,076.33
Rate for Payer: Qualcare PPO/HMO/WC	$807.25
Rate for Payer: UnitedHealthcare Commercial	$1,076.33
Rate for Payer: UnitedHealthcare Community & State	$129.70
Rate for Payer: Wellpoint Medicaid Managed Care	$142.61

SYSTEM OSTEO INTROD SZ 3 T05D

Facility

$5,133.65

Hospital Charge Code	270633787
Hospital Revenue Code	272
Min. Negotiated Rate	$770.05
Max. Negotiated Rate	$770.05
Rate for Payer: Qualcare PPO/HMO/WC	$770.05

SYSTEM OSTEO INTROD SZ 3 T05D

Facility

$5,133.65

Hospital Charge Code	270633787
Hospital Revenue Code	272
Min. Negotiated Rate	$123.72
Max. Negotiated Rate	$2,566.82
Rate for Payer: Aetna Commercial	$1,950.79
Rate for Payer: Aetna Medicare Advantage	$1,540.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.08
Rate for Payer: Cigna Commercial	$2,566.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,540.10
Rate for Payer: Oxford Commercial	$1,026.73
Rate for Payer: Qualcare PPO/HMO/WC	$770.05
Rate for Payer: UnitedHealthcare Commercial	$1,026.73
Rate for Payer: UnitedHealthcare Community & State	$123.72
Rate for Payer: Wellpoint Medicaid Managed Care	$136.04

SYSTEM PEEK ACHILLES SPEEDBRID

Facility

$9,975.00

Hospital Charge Code	270682874
Hospital Revenue Code	272
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,992.50
Rate for Payer: Oxford Commercial	$1,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Commercial	$1,995.00
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

SYSTEM PEEK ACHILLES SPEEDBRID

Facility

$9,975.00

Hospital Charge Code	270682874
Hospital Revenue Code	272
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$1,496.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

SYSTEM PENUMBRA ENGINE

Facility

$30,000.00

Hospital Charge Code	270689720
Hospital Revenue Code	272
Min. Negotiated Rate	$723.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,000.00
Rate for Payer: Oxford Commercial	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Commercial	$6,000.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

SYSTEM PENUMBRA ENGINE

Facility

$30,000.00

Hospital Charge Code	270689720
Hospital Revenue Code	272
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

SYSTEMPIPELINE SHIELD 3.5X16MM

Facility

$93,765.00

Service Code	HCPCS C1889
Hospital Charge Code	270700365S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,259.74
Max. Negotiated Rate	$46,882.50
Rate for Payer: Aetna Commercial	$35,630.70
Rate for Payer: Aetna Medicare Advantage	$28,129.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,910.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,910.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,753.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,910.08
Rate for Payer: Cigna Commercial	$46,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,691.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,628.30
Rate for Payer: Qualcare PPO/HMO/WC	$14,064.75
Rate for Payer: UnitedHealthcare Community & State	$2,259.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,484.77

SYSTEMPIPELINE SHIELD 3.5X16MM

Facility

$93,765.00

Service Code	HCPCS C1889
Hospital Charge Code	270700365S
Hospital Revenue Code	278
Min. Negotiated Rate	$14,064.75
Max. Negotiated Rate	$22,691.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,753.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,691.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,628.30
Rate for Payer: Qualcare PPO/HMO/WC	$14,064.75

SYSTEM RETRACTOR TLC 8201175

Facility

$625.00

Hospital Charge Code	270633800
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

Know your out-of-pocket cost for care.

All Charges