Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CABLE MONO PYRENEES 28 MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690740
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

CABLE MONO PYRENEES 28 MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690740
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

CABLE MULTI FUNCTION

Facility

$492.75

Hospital Charge Code	270665808
Hospital Revenue Code	270
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$246.38
Rate for Payer: Aetna Commercial	$187.25
Rate for Payer: Aetna Medicare Advantage	$147.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.65
Rate for Payer: Cigna Commercial	$246.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.82
Rate for Payer: Oxford Commercial	$98.55
Rate for Payer: Qualcare PPO/HMO/WC	$73.91
Rate for Payer: UnitedHealthcare Commercial	$98.55
Rate for Payer: UnitedHealthcare Community & State	$11.88
Rate for Payer: Wellpoint Medicaid Managed Care	$13.06

CABLE MULTI FUNCTION

Facility

$492.75

Hospital Charge Code	270665808
Hospital Revenue Code	270
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$73.91
Rate for Payer: Qualcare PPO/HMO/WC	$73.91

CABLE MULTILEAD TRAIL

Facility

$1,100.00

Hospital Charge Code	270668331
Hospital Revenue Code	272
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.00
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$220.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

CABLE MULTILEAD TRAIL

Facility

$1,100.00

Hospital Charge Code	270668331
Hospital Revenue Code	272
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

CABLE OR

Facility

$750.00

Hospital Charge Code	270673088
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CABLE OR

Facility

$750.00

Hospital Charge Code	270673088
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CABLE OR 2x8

Facility

$750.00

Hospital Charge Code	270673090
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CABLE OR 2x8

Facility

$750.00

Hospital Charge Code	270673090
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CABLE PACING EXT DISP 4051L

Facility

$65.40

Hospital Charge Code	270648892C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

CABLE PACING EXT DISP 4051L

Facility

$65.40

Hospital Charge Code	270648892C
Hospital Revenue Code	272
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

CABLE PUCK TRAIL

Facility

$1,250.00

Hospital Charge Code	270683891
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

CABLE PUCK TRAIL

Facility

$1,250.00

Hospital Charge Code	270683891
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

CABLE PULSE OX

Facility

$584.00

Hospital Charge Code	270665807
Hospital Revenue Code	270
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$292.00
Rate for Payer: Aetna Commercial	$221.92
Rate for Payer: Aetna Medicare Advantage	$175.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.92
Rate for Payer: Cigna Commercial	$292.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.20
Rate for Payer: Oxford Commercial	$116.80
Rate for Payer: Qualcare PPO/HMO/WC	$87.60
Rate for Payer: UnitedHealthcare Commercial	$116.80
Rate for Payer: UnitedHealthcare Community & State	$14.07
Rate for Payer: Wellpoint Medicaid Managed Care	$15.48

CABLE PULSE OX

Facility

$584.00

Hospital Charge Code	270665807
Hospital Revenue Code	270
Min. Negotiated Rate	$87.60
Max. Negotiated Rate	$87.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.60

CABLE RDY CABLE ASSY 1.8MMX635

Facility

$2,112.50

Hospital Charge Code	270683823
Hospital Revenue Code	278
Min. Negotiated Rate	$50.91
Max. Negotiated Rate	$1,056.25
Rate for Payer: Aetna Commercial	$802.75
Rate for Payer: Aetna Medicare Advantage	$633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.69
Rate for Payer: Cigna Commercial	$1,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.75
Rate for Payer: Qualcare PPO/HMO/WC	$316.88
Rate for Payer: UnitedHealthcare Community & State	$50.91
Rate for Payer: Wellpoint Medicaid Managed Care	$55.98

CABLE RDY CABLE ASSY 1.8MMX635

Facility

$2,112.50

Hospital Charge Code	270683823
Hospital Revenue Code	278
Min. Negotiated Rate	$316.88
Max. Negotiated Rate	$511.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.75
Rate for Payer: Qualcare PPO/HMO/WC	$316.88

CABLE READY GTR 1.8MM X 635MM

Facility

$1,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270688598
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

CABLE READY GTR 1.8MM X 635MM

Facility

$1,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270688598
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

CABLE SILICONE BIPOLAR

Facility

$775.00

Hospital Charge Code	270665573
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CABLE SILICONE BIPOLAR

Facility

$775.00

Hospital Charge Code	270665573
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

CABLES INTEGRAL LONG GTR 23X12

Facility

$13,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,028.00
Max. Negotiated Rate	$3,271.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,704.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,271.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,974.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,028.00

CABLES INTEGRAL LONG GTR 23X12

Facility

$13,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690781
Hospital Revenue Code	278
Min. Negotiated Rate	$325.83
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$5,137.60
Rate for Payer: Aetna Medicare Advantage	$4,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,447.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,447.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,447.60
Rate for Payer: Cigna Commercial	$6,760.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,271.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,974.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,028.00
Rate for Payer: UnitedHealthcare Community & State	$325.83
Rate for Payer: Wellpoint Medicaid Managed Care	$358.28

CABLE SLEEVE 3.0MM

Facility

$5,050.00

Hospital Charge Code	270662021
Hospital Revenue Code	278
Min. Negotiated Rate	$121.70
Max. Negotiated Rate	$2,525.00
Rate for Payer: Aetna Commercial	$1,919.00
Rate for Payer: Aetna Medicare Advantage	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.75
Rate for Payer: Cigna Commercial	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.00
Rate for Payer: Qualcare PPO/HMO/WC	$757.50
Rate for Payer: UnitedHealthcare Community & State	$121.70
Rate for Payer: Wellpoint Medicaid Managed Care	$133.82

Know your out-of-pocket cost for care.

All Charges