Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$49.22
Rate for Payer: Qualcare PPO/HMO/WC	$49.22

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

TRAY HSG

Facility

$56.65

Hospital Charge Code	270654141
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

TRAY HSG

Facility

$56.65

Hospital Charge Code	270654141
Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.32
Rate for Payer: Aetna Commercial	$21.53
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.00
Rate for Payer: Oxford Commercial	$11.33
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.33
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

TRAY HSG

Facility

$506.00

Hospital Charge Code	270655987
Hospital Revenue Code	272
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$75.90

TRAY HSG

Facility

$506.00

Hospital Charge Code	270655987
Hospital Revenue Code	272
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$253.00
Rate for Payer: Aetna Commercial	$192.28
Rate for Payer: Aetna Medicare Advantage	$151.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.03
Rate for Payer: Cigna Commercial	$253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.80
Rate for Payer: Oxford Commercial	$101.20
Rate for Payer: Qualcare PPO/HMO/WC	$75.90
Rate for Payer: UnitedHealthcare Commercial	$101.20
Rate for Payer: UnitedHealthcare Community & State	$12.19
Rate for Payer: Wellpoint Medicaid Managed Care	$13.41

TRAY HUMERAL REVERSE EXT 6MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$2,922.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,656.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

TRAY HUMERAL REVERSE EXT 6MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700196
Hospital Revenue Code	278
Min. Negotiated Rate	$291.01
Max. Negotiated Rate	$6,037.50
Rate for Payer: Aetna Commercial	$4,588.50
Rate for Payer: Aetna Medicare Advantage	$3,622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,079.12
Rate for Payer: Cigna Commercial	$6,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,656.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25
Rate for Payer: UnitedHealthcare Community & State	$291.01
Rate for Payer: Wellpoint Medicaid Managed Care	$319.99

TRAY HUMERAL STD PLUS 10 40MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694049
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TRAY HUMERAL STD PLUS 10 40MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694049
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

TRAY HYSTSALPGRAM DISP 6050T

Facility

$173.65

Hospital Charge Code	270607963
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

TRAY HYSTSALPGRAM DISP 6050T

Facility

$173.65

Hospital Charge Code	270607963
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

TRAY INSTRUMENTS POLYVAC CRANO

Facility

$1,699.35

Hospital Charge Code	270684905
Hospital Revenue Code	272
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$849.67
Rate for Payer: Aetna Commercial	$645.75
Rate for Payer: Aetna Medicare Advantage	$509.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.33
Rate for Payer: Cigna Commercial	$849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.81
Rate for Payer: Oxford Commercial	$339.87
Rate for Payer: Qualcare PPO/HMO/WC	$254.90
Rate for Payer: UnitedHealthcare Commercial	$339.87
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: Wellpoint Medicaid Managed Care	$45.03

TRAY INSTRUMENTS POLYVAC CRANO

Facility

$1,699.35

Hospital Charge Code	270684905
Hospital Revenue Code	272
Min. Negotiated Rate	$254.90
Max. Negotiated Rate	$254.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.90

TRAY INTRO PERCUTANEOUS

Facility

$269.04

Hospital Charge Code	270110051
Hospital Revenue Code	272
Min. Negotiated Rate	$40.36
Max. Negotiated Rate	$40.36
Rate for Payer: Qualcare PPO/HMO/WC	$40.36

TRAY INTRO PERCUTANEOUS

Facility

$269.04

Hospital Charge Code	270110051
Hospital Revenue Code	272
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$134.52
Rate for Payer: Aetna Commercial	$102.24
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.61
Rate for Payer: Cigna Commercial	$134.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.71
Rate for Payer: Oxford Commercial	$53.81
Rate for Payer: Qualcare PPO/HMO/WC	$40.36
Rate for Payer: UnitedHealthcare Commercial	$53.81
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.13

TRAY IRRIGATION PISTON

Facility

$6.07

Hospital Charge Code	270302231
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

TRAY IRRIGATION PISTON

Facility

$6.07

Hospital Charge Code	270302231
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TRAY IRRIGATION PISTON *****

Facility

$9.00

Hospital Charge Code	8001000
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TRAY IRRIGATION PISTON *****

Facility

$9.00

Hospital Charge Code	8001000
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TRAY KNEE ARTHROSCOPY

Facility

$295.45

Hospital Charge Code	270654114
Hospital Revenue Code	270
Min. Negotiated Rate	$44.32
Max. Negotiated Rate	$44.32
Rate for Payer: Qualcare PPO/HMO/WC	$44.32

TRAY KNEE ARTHROSCOPY

Facility

$295.45

Hospital Charge Code	270654114
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$147.72
Rate for Payer: Aetna Commercial	$112.27
Rate for Payer: Aetna Medicare Advantage	$88.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.34
Rate for Payer: Cigna Commercial	$147.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.64
Rate for Payer: Oxford Commercial	$59.09
Rate for Payer: Qualcare PPO/HMO/WC	$44.32
Rate for Payer: UnitedHealthcare Commercial	$59.09
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$7.83

Know your out-of-pocket cost for care.

All Charges