Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BLLN SPRT NC1.25x20 SPL12520WL

Facility

$750.00

Hospital Charge Code	270650881C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BLN ADML XTR ADM050060130

Facility

$625.00

Hospital Charge Code	270640816C
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

BLN ADML XTR ADM050060130

Facility

$625.00

Hospital Charge Code	270640816C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BLN ADML XTR ADM060060130

Facility

$800.00

Hospital Charge Code	270641849C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

BLN ADML XTR ADM060060130

Facility

$800.00

Hospital Charge Code	270641849C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

BLN ADML XTRM ADM040120130

Facility

$6,975.00

Hospital Charge Code	270644094C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

BLN ADML XTRM ADM040120130

Facility

$6,975.00

Hospital Charge Code	270644094C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

BLN CATH SDS 7F10x6 75 17-741

Facility

$11,220.00

Hospital Charge Code	270639945C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,683.00
Max. Negotiated Rate	$2,715.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,715.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,468.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,683.00

BLN CATH SDS 7F10x6 75 17-741

Facility

$11,220.00

Hospital Charge Code	270639945C
Hospital Revenue Code	278
Min. Negotiated Rate	$270.40
Max. Negotiated Rate	$5,610.00
Rate for Payer: Aetna Commercial	$4,263.60
Rate for Payer: Aetna Medicare Advantage	$3,366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,861.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,861.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,861.10
Rate for Payer: Cigna Commercial	$5,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,715.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,468.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,683.00
Rate for Payer: UnitedHealthcare Community & State	$270.40
Rate for Payer: Wellpoint Medicaid Managed Care	$297.33

BLN EVRCRS PTA AB35W06200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644148C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.95
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BLN EVRCRS PTA AB35W06200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644148C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.95
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$19.60
Rate for Payer: Wellpoint Medicaid Managed Care	$21.56

BLN EVRCRS PTA AB35W07135

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644035C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BLN EVRCRS PTA AB35W07135

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644035C
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BLN NANOCROSS PTA AB14W0200801

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643956C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BLN NANOCROSS PTA AB14W0200801

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643956C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BLN NCROS PTA AB14W025080150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644144C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BLN NCROS PTA AB14W025080150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644144C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BLN PWFLEX P3 7x4 80c 4207040S

Facility

$1,325.00

Hospital Charge Code	270630472V
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

BLN PWFLEX P3 7x4 80c 4207040S

Facility

$1,325.00

Hospital Charge Code	270630472V
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BLN PWFLEX P3 7x4 80c 4207040S

Facility

$1,314.45

Hospital Charge Code	270630472
Hospital Revenue Code	278
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$657.23
Rate for Payer: Aetna Commercial	$499.49
Rate for Payer: Aetna Medicare Advantage	$394.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$335.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$335.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$335.18
Rate for Payer: Cigna Commercial	$657.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.18
Rate for Payer: Qualcare PPO/HMO/WC	$197.17
Rate for Payer: UnitedHealthcare Community & State	$31.68
Rate for Payer: Wellpoint Medicaid Managed Care	$34.83

BLN PWFLEX P3 7x4 80c 4207040S

Facility

$1,314.45

Hospital Charge Code	270630472
Hospital Revenue Code	278
Min. Negotiated Rate	$197.17
Max. Negotiated Rate	$318.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.18
Rate for Payer: Qualcare PPO/HMO/WC	$197.17

BLN PWRCRS PTA AB18W060200150

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644149C
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BLN PWRCRS PTA AB18W060200150

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644149C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BLN STERLING 5x60 39032-50601

Facility

$1,824.50

Hospital Charge Code	270641373C
Hospital Revenue Code	278
Min. Negotiated Rate	$273.68
Max. Negotiated Rate	$441.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.39
Rate for Payer: Qualcare PPO/HMO/WC	$273.68

BLN STERLING 5x60 39032-50601

Facility

$1,824.50

Hospital Charge Code	270641373C
Hospital Revenue Code	278
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$912.25
Rate for Payer: Aetna Commercial	$693.31
Rate for Payer: Aetna Medicare Advantage	$547.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.25
Rate for Payer: Cigna Commercial	$912.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.39
Rate for Payer: Qualcare PPO/HMO/WC	$273.68
Rate for Payer: UnitedHealthcare Community & State	$43.97
Rate for Payer: Wellpoint Medicaid Managed Care	$48.35

Know your out-of-pocket cost for care.

All Charges