Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TELEMETRY MONITORING******

Facility

$98.00

Service Code	HCPCS 99999
Hospital Charge Code	5800016
Hospital Revenue Code	732
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

TELEMETRY MONITORING******

Facility

$98.00

Service Code	HCPCS 99999
Hospital Charge Code	5800016
Hospital Revenue Code	732
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315N
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315N
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

TELEPORT MICRO CATH 135CM 21FR

Facility

$3,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270692099
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

TELEPORT MICRO CATH 135CM 21FR

Facility

$3,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270692099
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELESCOPIC STRUT GOLD

Facility

$6,644.50

Hospital Charge Code	270702657
Hospital Revenue Code	278
Min. Negotiated Rate	$160.13
Max. Negotiated Rate	$3,322.25
Rate for Payer: Aetna Commercial	$2,524.91
Rate for Payer: Aetna Medicare Advantage	$1,993.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.35
Rate for Payer: Cigna Commercial	$3,322.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.79
Rate for Payer: Qualcare PPO/HMO/WC	$996.67
Rate for Payer: UnitedHealthcare Community & State	$160.13
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

TELESCOPIC STRUT GOLD

Facility

$6,644.50

Hospital Charge Code	270702657
Hospital Revenue Code	278
Min. Negotiated Rate	$996.67
Max. Negotiated Rate	$1,607.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.79
Rate for Payer: Qualcare PPO/HMO/WC	$996.67

TELES.STRUT LONG 177-277MM RED

Facility

$6,479.60

Hospital Charge Code	270702827
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$1,568.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.51
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELES.STRUT LONG 177-277MM RED

Facility

$6,479.60

Hospital Charge Code	270702827
Hospital Revenue Code	278
Min. Negotiated Rate	$156.16
Max. Negotiated Rate	$3,239.80
Rate for Payer: Aetna Commercial	$2,462.25
Rate for Payer: Aetna Medicare Advantage	$1,943.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,652.30
Rate for Payer: Cigna Commercial	$3,239.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.51
Rate for Payer: Qualcare PPO/HMO/WC	$971.94
Rate for Payer: UnitedHealthcare Community & State	$156.16
Rate for Payer: Wellpoint Medicaid Managed Care	$171.71

TELES.STRUT SHRT 119-161MM BLU

Facility

$6,479.60

Hospital Charge Code	270702826
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$1,568.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.51
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELES.STRUT SHRT 119-161MM BLU

Facility

$6,479.60

Hospital Charge Code	270702826
Hospital Revenue Code	278
Min. Negotiated Rate	$156.16
Max. Negotiated Rate	$3,239.80
Rate for Payer: Aetna Commercial	$2,462.25
Rate for Payer: Aetna Medicare Advantage	$1,943.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,652.30
Rate for Payer: Cigna Commercial	$3,239.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.51
Rate for Payer: Qualcare PPO/HMO/WC	$971.94
Rate for Payer: UnitedHealthcare Community & State	$156.16
Rate for Payer: Wellpoint Medicaid Managed Care	$171.71

TELETHX ISODOSE PLAN CPLX

Facility

$671.79

Service Code	HCPCS 77307
Hospital Charge Code	85000892
Hospital Revenue Code	333
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.54
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$17.80

TELETHX ISODOSE PLAN CPLX

Facility

$671.79

Service Code	HCPCS 77307
Hospital Charge Code	85000892
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.54
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$17.80

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

TELETX ISODOSE PLAN COMPLEX-PC

Facility

$414.75

Service Code	HCPCS 7731526
Hospital Charge Code	85000515
Hospital Revenue Code	333
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$62.21
Rate for Payer: Qualcare PPO/HMO/WC	$62.21

TELETX ISODOSE PLAN COMPLEX-PC

Facility

$414.75

Service Code	HCPCS 7731526
Hospital Charge Code	85000515
Hospital Revenue Code	333
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$157.60
Rate for Payer: Aetna Medicare Advantage	$124.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.76
Rate for Payer: Cigna Commercial	$207.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.42
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.21
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

TELETX ISODOSE PLAN COMPLEX-TC

Facility

$361.05

Service Code	HCPCS 77315TC
Hospital Charge Code	85000510
Hospital Revenue Code	333
Min. Negotiated Rate	$54.16
Max. Negotiated Rate	$54.16
Rate for Payer: Qualcare PPO/HMO/WC	$54.16

TELETX ISODOSE PLAN COMPLEX-TC

Facility

$361.05

Service Code	HCPCS 77315TC
Hospital Charge Code	85000510
Hospital Revenue Code	333
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$137.20
Rate for Payer: Aetna Medicare Advantage	$108.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.07
Rate for Payer: Cigna Commercial	$180.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.31
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.16
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$8.70
Rate for Payer: Wellpoint Medicaid Managed Care	$9.57

TELETX ISODOSE PLAN INTERMED-P

Facility

$280.25

Service Code	HCPCS 7731026
Hospital Charge Code	85000500
Hospital Revenue Code	333
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$84.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.46
Rate for Payer: Cigna Commercial	$140.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.08
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.04
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.43

TELETX ISODOSE PLAN INTERMED-P

Facility

$280.25

Service Code	HCPCS 7731026
Hospital Charge Code	85000500
Hospital Revenue Code	333
Min. Negotiated Rate	$42.04
Max. Negotiated Rate	$42.04
Rate for Payer: Qualcare PPO/HMO/WC	$42.04

TELETX ISODOSE PLAN INTERMED-T

Facility

$219.75

Service Code	HCPCS 77310TC
Hospital Charge Code	85000495
Hospital Revenue Code	333
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$32.96
Rate for Payer: Qualcare PPO/HMO/WC	$32.96

Know your out-of-pocket cost for care.

All Charges