Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
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

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
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

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
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

CAGE 14X17X6

Facility

$35,505.00

Service Code	HCPCS C1889
Hospital Charge Code	270693295
Hospital Revenue Code	278
Min. Negotiated Rate	$855.67
Max. Negotiated Rate	$17,752.50
Rate for Payer: Aetna Commercial	$13,491.90
Rate for Payer: Aetna Medicare Advantage	$10,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,053.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,053.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,053.77
Rate for Payer: Cigna Commercial	$17,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,592.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,811.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,325.75
Rate for Payer: UnitedHealthcare Community & State	$855.67
Rate for Payer: Wellpoint Medicaid Managed Care	$940.88

CAGE 14X17X6

Facility

$35,505.00

Service Code	HCPCS C1889
Hospital Charge Code	270693295
Hospital Revenue Code	278
Min. Negotiated Rate	$5,325.75
Max. Negotiated Rate	$8,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,592.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,811.10
Rate for Payer: Qualcare PPO/HMO/WC	$5,325.75

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

CAGE 16X14MM 7DEG 7H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704846
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

CAGE 16X14MM 7DEG 7H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704846
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CAGE 16X14MM 7DEG 8H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704843
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CAGE 16X14MM 7DEG 8H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704843
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

CAGE 17X13.5 17 X 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

CAGE 17X13.5 17 X 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692105
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

CAGE 17X13.5 X6 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692106
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

CAGE 17X13.5 X6 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692106
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

CAGE 17 X 14 .5MM CAGE 1

Facility

$16,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688529
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

CAGE 17 X 14 .5MM CAGE 1

Facility

$16,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688529
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

CAGE 17 X 14 .5MM CAGE 8

Facility

$16,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688530
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

CAGE 17 X 14 .5MM CAGE 8

Facility

$16,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688530
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

CAGE 22WX55LX16H

Facility

$29,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270703888
Hospital Revenue Code	278
Min. Negotiated Rate	$710.95
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$710.95
Rate for Payer: Wellpoint Medicaid Managed Care	$781.75

CAGE 22WX55LX16H

Facility

$29,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270703888
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

CAGE 22X50 12D X12MM

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695937
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.50
Max. Negotiated Rate	$9,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50

CAGE 22X50 12D X12MM

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695937
Hospital Revenue Code	278
Min. Negotiated Rate	$982.08
Max. Negotiated Rate	$20,375.00
Rate for Payer: Aetna Commercial	$15,485.00
Rate for Payer: Aetna Medicare Advantage	$12,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,391.25
Rate for Payer: Cigna Commercial	$20,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50
Rate for Payer: UnitedHealthcare Community & State	$982.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.88

CAGE 22X50X12MM 12D

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697299
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.50
Max. Negotiated Rate	$9,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50

CAGE 22X50X12MM 12D

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697299
Hospital Revenue Code	278
Min. Negotiated Rate	$982.08
Max. Negotiated Rate	$20,375.00
Rate for Payer: Aetna Commercial	$15,485.00
Rate for Payer: Aetna Medicare Advantage	$12,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,391.25
Rate for Payer: Cigna Commercial	$20,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50
Rate for Payer: UnitedHealthcare Community & State	$982.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.88

Know your out-of-pocket cost for care.

All Charges