Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR COMPONENT 28x46mm

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675059
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR COMPONENT 28x46mm

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675059
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BIPOLAR COMPONENT 28X48MM

Facility

$1,500.00

Hospital Charge Code	270669545
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BIPOLAR COMPONENT 28X48MM

Facility

$1,500.00

Hospital Charge Code	270669545
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BIPOLAR COMPONENT 28x49MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270674252
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR COMPONENT 28x49MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270674252
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BIPOLAR COMPONENT-LEFT HIP

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270676774
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

BIPOLAR COMPONENT-LEFT HIP

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270676774
Hospital Revenue Code	278
Min. Negotiated Rate	$135.19
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$135.19
Rate for Payer: Wellpoint Medicaid Managed Care	$148.65

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$152.43
Max. Negotiated Rate	$3,162.50
Rate for Payer: Aetna Commercial	$2,403.50
Rate for Payer: Aetna Medicare Advantage	$1,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,612.88
Rate for Payer: Cigna Commercial	$3,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$948.75
Rate for Payer: UnitedHealthcare Community & State	$152.43
Rate for Payer: Wellpoint Medicaid Managed Care	$167.61

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$1,530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

BIPOLAR DISORDERS

Facility

$11,537.64

Service Code	APR-DRG 7533
Min. Negotiated Rate	$11,311.41
Max. Negotiated Rate	$11,537.64
Rate for Payer: UnitedHealthcare Community & State	$11,311.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,537.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11,311.41

BIPOLAR DISORDERS

Facility

$22,924.58

Service Code	APR-DRG 7534
Min. Negotiated Rate	$22,475.08
Max. Negotiated Rate	$22,924.58
Rate for Payer: UnitedHealthcare Community & State	$22,475.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,924.58
Rate for Payer: Wellpoint Medicaid Managed Care	$22,475.08

BIPOLAR DISORDERS

Facility

$4,921.73

Service Code	APR-DRG 7531
Min. Negotiated Rate	$4,825.23
Max. Negotiated Rate	$4,921.73
Rate for Payer: UnitedHealthcare Community & State	$4,825.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,921.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4,825.23

BIPOLAR DISORDERS

Facility

$6,640.19

Service Code	APR-DRG 7532
Min. Negotiated Rate	$6,509.99
Max. Negotiated Rate	$6,640.19
Rate for Payer: UnitedHealthcare Community & State	$6,509.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,640.19
Rate for Payer: Wellpoint Medicaid Managed Care	$6,509.99

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.10
Rate for Payer: Oxford Commercial	$53.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$53.40
Rate for Payer: UnitedHealthcare Community & State	$6.43
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

BIPOLAR FORCEP REPAIR

Facility

$1,750.00

Hospital Charge Code	270657273
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BIPOLAR FORCEP REPAIR

Facility

$1,750.00

Hospital Charge Code	270657273
Hospital Revenue Code	272
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) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
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

Know your out-of-pocket cost for care.

All Charges