Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CA 27.29, I

Facility

$143.05

Service Code	HCPCS 86300
Hospital Charge Code	39990029A
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CA 27.29, I

Facility

$143.05

Service Code	HCPCS 86300
Hospital Charge Code	39990029A
Hospital Revenue Code	306
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

CA 27.29, II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990029B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CA 27.29, II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990029B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

CA 27.29 (SERUM)

Facility

$240.00

Service Code	HCPCS 86300
Hospital Charge Code	3007234
Hospital Revenue Code	302
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CA 27.29 (SERUM)

Facility

$240.00

Service Code	HCPCS 86300
Hospital Charge Code	3007234
Hospital Revenue Code	302
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CA 72-4

Facility

$218.45

Service Code	HCPCS 86316
Hospital Charge Code	3031317
Hospital Revenue Code	302
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

CA 72-4

Facility

$218.45

Service Code	HCPCS 86316
Hospital Charge Code	3031317
Hospital Revenue Code	302
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

CABEZA FEMORAL28MM+5 12/14CONE

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270696053
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

CABEZA FEMORAL28MM+5 12/14CONE

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270696053
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

CABLE 12 PIN 3/5 LEAD ECG

Facility

$371.25

Hospital Charge Code	270647388
Hospital Revenue Code	272
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$55.69
Rate for Payer: Qualcare PPO/HMO/WC	$55.69

CABLE 12 PIN 3/5 LEAD ECG

Facility

$371.25

Hospital Charge Code	270647388
Hospital Revenue Code	272
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$185.62
Rate for Payer: Aetna Commercial	$141.07
Rate for Payer: Aetna Medicare Advantage	$111.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.67
Rate for Payer: Cigna Commercial	$185.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.38
Rate for Payer: Oxford Commercial	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$55.69
Rate for Payer: UnitedHealthcare Commercial	$74.25
Rate for Payer: UnitedHealthcare Community & State	$8.95
Rate for Payer: Wellpoint Medicaid Managed Care	$9.84

CABLE 1.7MM WITH CRIMP 750MM

Facility

$2,631.55

Service Code	HCPCS C1713
Hospital Charge Code	270634208
Hospital Revenue Code	278
Min. Negotiated Rate	$394.73
Max. Negotiated Rate	$636.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$526.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$636.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$578.94
Rate for Payer: Qualcare PPO/HMO/WC	$394.73

CABLE 1.7MM WITH CRIMP 750MM

Facility

$2,631.55

Service Code	HCPCS C1713
Hospital Charge Code	270634208
Hospital Revenue Code	278
Min. Negotiated Rate	$63.42
Max. Negotiated Rate	$1,315.78
Rate for Payer: Aetna Commercial	$999.99
Rate for Payer: Aetna Medicare Advantage	$789.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$671.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$671.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$526.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$671.05
Rate for Payer: Cigna Commercial	$1,315.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$636.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$578.94
Rate for Payer: Qualcare PPO/HMO/WC	$394.73
Rate for Payer: UnitedHealthcare Community & State	$63.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.74

CABLE 1DOUBLE 2 CRIMPS

Facility

$1,627.50

Hospital Charge Code	270670521
Hospital Revenue Code	278
Min. Negotiated Rate	$244.12
Max. Negotiated Rate	$393.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$358.05
Rate for Payer: Qualcare PPO/HMO/WC	$244.12

CABLE 1DOUBLE 2 CRIMPS

Facility

$1,627.50

Hospital Charge Code	270670521
Hospital Revenue Code	278
Min. Negotiated Rate	$39.22
Max. Negotiated Rate	$813.75
Rate for Payer: Aetna Commercial	$618.45
Rate for Payer: Aetna Medicare Advantage	$488.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.01
Rate for Payer: Cigna Commercial	$813.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$358.05
Rate for Payer: Qualcare PPO/HMO/WC	$244.12
Rate for Payer: UnitedHealthcare Community & State	$39.22
Rate for Payer: Wellpoint Medicaid Managed Care	$43.13

CABLE 1X16 MM

Facility

$1,000.00

Hospital Charge Code	270701877
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CABLE 1X16 MM

Facility

$1,000.00

Hospital Charge Code	270701877
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CABLE ASSY C/C 1.8mm x 559mm

Facility

$1,537.00

Hospital Charge Code	270627500
Hospital Revenue Code	272
Min. Negotiated Rate	$37.04
Max. Negotiated Rate	$768.50
Rate for Payer: Aetna Commercial	$584.06
Rate for Payer: Aetna Medicare Advantage	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.94
Rate for Payer: Cigna Commercial	$768.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.10
Rate for Payer: Oxford Commercial	$307.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.55
Rate for Payer: UnitedHealthcare Commercial	$307.40
Rate for Payer: UnitedHealthcare Community & State	$37.04
Rate for Payer: Wellpoint Medicaid Managed Care	$40.73

CABLE ASSY C/C 1.8mm x 559mm

Facility

$1,537.00

Hospital Charge Code	270627500
Hospital Revenue Code	272
Min. Negotiated Rate	$230.55
Max. Negotiated Rate	$230.55
Rate for Payer: Qualcare PPO/HMO/WC	$230.55

CABLE BEAD ALLOY 1.6MM

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Charge Code	270669266
Hospital Revenue Code	278
Min. Negotiated Rate	$436.50
Max. Negotiated Rate	$704.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.20
Rate for Payer: Qualcare PPO/HMO/WC	$436.50

CABLE BEAD ALLOY 1.6MM

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Charge Code	270669266
Hospital Revenue Code	278
Min. Negotiated Rate	$70.13
Max. Negotiated Rate	$1,455.00
Rate for Payer: Aetna Commercial	$1,105.80
Rate for Payer: Aetna Medicare Advantage	$873.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.05
Rate for Payer: Cigna Commercial	$1,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.20
Rate for Payer: Qualcare PPO/HMO/WC	$436.50
Rate for Payer: UnitedHealthcare Community & State	$70.13
Rate for Payer: Wellpoint Medicaid Managed Care	$77.11

CABLE BEAD ALLOY 2MM

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Charge Code	270669265
Hospital Revenue Code	278
Min. Negotiated Rate	$70.13
Max. Negotiated Rate	$1,455.00
Rate for Payer: Aetna Commercial	$1,105.80
Rate for Payer: Aetna Medicare Advantage	$873.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.05
Rate for Payer: Cigna Commercial	$1,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.20
Rate for Payer: Qualcare PPO/HMO/WC	$436.50
Rate for Payer: UnitedHealthcare Community & State	$70.13
Rate for Payer: Wellpoint Medicaid Managed Care	$77.11

CABLE BEAD ALLOY 2MM

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Charge Code	270669265
Hospital Revenue Code	278
Min. Negotiated Rate	$436.50
Max. Negotiated Rate	$704.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.20
Rate for Payer: Qualcare PPO/HMO/WC	$436.50

CABLE BMT SS 2 750 350800

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270627428
Hospital Revenue Code	278
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

Know your out-of-pocket cost for care.

All Charges