Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VNGD SSK PSC TIB BRG 20X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270684888
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

VNGD SSK PSC TIB BRG 20X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270684888
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSK PSC TIB BRG 20X63/67

Facility

$6,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270685017
Hospital Revenue Code	278
Min. Negotiated Rate	$165.81
Max. Negotiated Rate	$3,440.00
Rate for Payer: Aetna Commercial	$2,614.40
Rate for Payer: Aetna Medicare Advantage	$2,064.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,754.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,754.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,754.40
Rate for Payer: Cigna Commercial	$3,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,513.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,032.00
Rate for Payer: UnitedHealthcare Community & State	$165.81
Rate for Payer: Wellpoint Medicaid Managed Care	$182.32

VNGD SSK PSC TIB BRG 20X63/67

Facility

$6,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270685017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.00
Max. Negotiated Rate	$1,664.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,513.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,032.00

VNGD SSK PSC TIB BRG 22 X 63/

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687531
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSK PSC TIB BRG 22 X 63/

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687531
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

VNGD SSK PSC TIB BRG 22X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270690779
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSK PSC TIB BRG 22X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270690779
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

VNGD SSKPSC TIB BRG S 20X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270690554
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSKPSC TIB BRG S 20X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270690554
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

VOICE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9171GN
Hospital Charge Code	84201174
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

VOICE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9171GN
Hospital Charge Code	84201080
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

VOICE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9171GN
Hospital Charge Code	84201080
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

VOICE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9171GN
Hospital Charge Code	84201174
Hospital Revenue Code	449
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

VOICE CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G9171GNCH
Hospital Charge Code	74204083CH
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

VOICE CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G9171GNCH
Hospital Charge Code	74204083CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Voice Current Status CI

Facility

$0.01

Service Code	HCPCS G9171GNCI
Hospital Charge Code	74204083CI
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Voice Current Status CI

Facility

$0.01

Service Code	HCPCS G9171GNCI
Hospital Charge Code	74204083CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Voice Current Status CJ

Facility

$0.01

Service Code	HCPCS G9171GNCJ
Hospital Charge Code	74204083CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Voice Current Status CJ

Facility

$0.01

Service Code	HCPCS G9171GNCJ
Hospital Charge Code	74204083CJ
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Voice Current Status CK

Facility

$0.01

Service Code	HCPCS G9171GNCK
Hospital Charge Code	74204083CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Voice Current Status CK

Facility

$0.01

Service Code	HCPCS G9171GNCK
Hospital Charge Code	74204083CK
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Voice Current Status CL

Facility

$0.01

Service Code	HCPCS G9171GNCL
Hospital Charge Code	74204083CL
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Voice Current Status CL

Facility

$0.01

Service Code	HCPCS G9171GNCL
Hospital Charge Code	74204083CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

VOICE CURRENT STATUS CM

Facility

$0.01

Service Code	HCPCS G9171GNCM
Hospital Charge Code	74204083CM
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Know your out-of-pocket cost for care.

All Charges