Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAY FOLEY W/18FR CATH

Facility

$107.14

Hospital Charge Code	270302239
Hospital Revenue Code	272
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.57
Rate for Payer: Aetna Commercial	$40.71
Rate for Payer: Aetna Medicare Advantage	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.32
Rate for Payer: Cigna Commercial	$53.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.14
Rate for Payer: Oxford Commercial	$21.43
Rate for Payer: Qualcare PPO/HMO/WC	$16.07
Rate for Payer: UnitedHealthcare Commercial	$21.43
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

TRAY FOLEY W/18FR CATH

Facility

$107.14

Hospital Charge Code	270302239
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$16.07
Rate for Payer: Qualcare PPO/HMO/WC	$16.07

TRAY FOLEY W/18FR CATHETER

Facility

$174.00

Hospital Charge Code	270331128
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

TRAY FOLEY W/18FR CATHETER

Facility

$174.00

Hospital Charge Code	270331128
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

TRAY FOLEY W/CATH *******

Facility

$118.00

Hospital Charge Code	8003477
Hospital Revenue Code	272
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

TRAY FOLEY W/CATH *******

Facility

$118.00

Hospital Charge Code	8003477
Hospital Revenue Code	272
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

TRAY FOLEY W/O CATH

Facility

$18.45

Hospital Charge Code	270302233
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

TRAY FOLEY W/O CATH

Facility

$18.45

Hospital Charge Code	270302233
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$7.01
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

TRAY FOLEY W/O CATHETER

Facility

$34.57

Hospital Charge Code	270649270
Hospital Revenue Code	272
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

TRAY FOLEY W/O CATHETER

Facility

$34.57

Hospital Charge Code	270649270
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.29
Rate for Payer: Aetna Commercial	$13.14
Rate for Payer: Aetna Medicare Advantage	$10.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.37
Rate for Payer: Oxford Commercial	$6.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.91
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

TRAY FOLEY W/URINE METER 16FR

Facility

$84.57

Hospital Charge Code	270639722
Hospital Revenue Code	272
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$12.69
Rate for Payer: Qualcare PPO/HMO/WC	$12.69

TRAY FOLEY W/URINE METER 16FR

Facility

$84.57

Hospital Charge Code	270639722
Hospital Revenue Code	272
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.28
Rate for Payer: Aetna Commercial	$32.14
Rate for Payer: Aetna Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.57
Rate for Payer: Cigna Commercial	$42.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.37
Rate for Payer: Oxford Commercial	$16.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.69
Rate for Payer: UnitedHealthcare Commercial	$16.91
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

TRAY FOLEY W/URINE METER 18FR

Facility

$107.00

Hospital Charge Code	270639723
Hospital Revenue Code	272
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

TRAY FOLEY W/URINE METER 18FR

Facility

$107.00

Hospital Charge Code	270639723
Hospital Revenue Code	272
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

TRAY GBA OSTEOTOMY INSTR RENT

Facility

$3,793.65

Hospital Charge Code	270616691
Hospital Revenue Code	272
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$1,896.83
Rate for Payer: Aetna Commercial	$1,441.59
Rate for Payer: Aetna Medicare Advantage	$1,138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$967.38
Rate for Payer: Cigna Commercial	$1,896.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.10
Rate for Payer: Oxford Commercial	$758.73
Rate for Payer: Qualcare PPO/HMO/WC	$569.05
Rate for Payer: UnitedHealthcare Commercial	$758.73
Rate for Payer: UnitedHealthcare Community & State	$91.43
Rate for Payer: Wellpoint Medicaid Managed Care	$100.53

TRAY GBA OSTEOTOMY INSTR RENT

Facility

$3,793.65

Hospital Charge Code	270616691
Hospital Revenue Code	272
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$569.05
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

TRAY GENERAL LAPAROSCOPY

Facility

$559.65

Hospital Charge Code	270654112
Hospital Revenue Code	272
Min. Negotiated Rate	$83.95
Max. Negotiated Rate	$83.95
Rate for Payer: Qualcare PPO/HMO/WC	$83.95

TRAY GENERAL LAPAROSCOPY

Facility

$559.65

Hospital Charge Code	270654112
Hospital Revenue Code	272
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$279.82
Rate for Payer: Aetna Commercial	$212.67
Rate for Payer: Aetna Medicare Advantage	$167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.71
Rate for Payer: Cigna Commercial	$279.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.90
Rate for Payer: Oxford Commercial	$111.93
Rate for Payer: Qualcare PPO/HMO/WC	$83.95
Rate for Payer: UnitedHealthcare Commercial	$111.93
Rate for Payer: UnitedHealthcare Community & State	$13.49
Rate for Payer: Wellpoint Medicaid Managed Care	$14.83

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
Hospital Revenue Code	278
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) NJ Health	$1,100.00
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	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
Hospital Revenue Code	278
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) NJ Health	$1,100.00
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	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
Hospital Revenue Code	278
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) NJ Health	$1,100.00
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	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$164.07
Rate for Payer: Aetna Commercial	$124.70
Rate for Payer: Aetna Medicare Advantage	$98.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.68
Rate for Payer: Cigna Commercial	$164.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.44
Rate for Payer: Oxford Commercial	$65.63
Rate for Payer: Qualcare PPO/HMO/WC	$49.22
Rate for Payer: UnitedHealthcare Commercial	$65.63
Rate for Payer: UnitedHealthcare Community & State	$7.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.70

Know your out-of-pocket cost for care.

All Charges