Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE 7 MM REG

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693117
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

CAGE 7MM REGULAR

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270690759
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CAGE 7MM REGULAR

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270690759
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
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) NJ Health	$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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

CAGE 7MX14MMX17M

Facility

$9,150.00

Hospital Charge Code	270703300
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.50
Max. Negotiated Rate	$2,214.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,214.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,013.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,372.50

CAGE 7MX14MMX17M

Facility

$9,150.00

Hospital Charge Code	270703300
Hospital Revenue Code	278
Min. Negotiated Rate	$220.51
Max. Negotiated Rate	$4,575.00
Rate for Payer: Aetna Commercial	$3,477.00
Rate for Payer: Aetna Medicare Advantage	$2,745.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,333.25
Rate for Payer: Cigna Commercial	$4,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,214.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,013.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,372.50
Rate for Payer: UnitedHealthcare Community & State	$220.51
Rate for Payer: Wellpoint Medicaid Managed Care	$242.47

CAGE 7X11MM

Facility

$6,535.00

Service Code	HCPCS L8699
Hospital Charge Code	270693042
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

CAGE 7X11MM

Facility

$6,535.00

Service Code	HCPCS L8699
Hospital Charge Code	270693042
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

CAGE 7 X 12 X 14 CM

Facility

$18,839.95

Service Code	HCPCS C1889
Hospital Charge Code	270690117
Hospital Revenue Code	278
Min. Negotiated Rate	$454.04
Max. Negotiated Rate	$9,419.98
Rate for Payer: Aetna Commercial	$7,159.18
Rate for Payer: Aetna Medicare Advantage	$5,651.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,804.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,804.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,767.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,804.19
Rate for Payer: Cigna Commercial	$9,419.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,559.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.99
Rate for Payer: UnitedHealthcare Community & State	$454.04
Rate for Payer: Wellpoint Medicaid Managed Care	$499.26

CAGE 7 X 12 X 14 CM

Facility

$18,839.95

Service Code	HCPCS C1889
Hospital Charge Code	270690117
Hospital Revenue Code	278
Min. Negotiated Rate	$2,825.99
Max. Negotiated Rate	$4,559.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,767.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,559.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.99

CAGE 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704540
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 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704540
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 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	27070454
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 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	27070454
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 8MM PEEK MONET

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693271
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

CAGE 8MM PEEK MONET

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

CAGE 8 MM ZERO PAV

Facility

$1,627.25

Service Code	HCPCS C1889
Hospital Charge Code	270692349
Hospital Revenue Code	278
Min. Negotiated Rate	$39.22
Max. Negotiated Rate	$813.62
Rate for Payer: Aetna Commercial	$618.36
Rate for Payer: Aetna Medicare Advantage	$488.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.95
Rate for Payer: Cigna Commercial	$813.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$358.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.09
Rate for Payer: UnitedHealthcare Community & State	$39.22
Rate for Payer: Wellpoint Medicaid Managed Care	$43.12

CAGE 8 MM ZERO PAV

Facility

$1,627.25

Service Code	HCPCS C1889
Hospital Charge Code	270692349
Hospital Revenue Code	278
Min. Negotiated Rate	$244.09
Max. Negotiated Rate	$393.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$358.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.09

CAGE 8X16X14MM 10DEGREE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704432
Hospital Revenue Code	279
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CAGE 8X16X14MM 10DEGREE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704432
Hospital Revenue Code	279
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

CAGE 8 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667336
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$6,451.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,865.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 8 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667336
Hospital Revenue Code	278
Min. Negotiated Rate	$642.51
Max. Negotiated Rate	$13,330.00
Rate for Payer: Aetna Commercial	$10,130.80
Rate for Payer: Aetna Medicare Advantage	$7,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,798.30
Rate for Payer: Cigna Commercial	$13,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,865.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00
Rate for Payer: UnitedHealthcare Community & State	$642.51
Rate for Payer: Wellpoint Medicaid Managed Care	$706.49

CAGE 9MM, ODEG.

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705909
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 9MM, ODEG.

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705909
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 9MM X 11 MM X 23 MM

Facility

$20,270.00

Service Code	HCPCS C1889
Hospital Charge Code	270689800
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.50
Max. Negotiated Rate	$4,905.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,905.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,459.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.50

CAGE 9MM X 11 MM X 23 MM

Facility

$20,270.00

Service Code	HCPCS C1889
Hospital Charge Code	270689800
Hospital Revenue Code	278
Min. Negotiated Rate	$488.51
Max. Negotiated Rate	$10,135.00
Rate for Payer: Aetna Commercial	$7,702.60
Rate for Payer: Aetna Medicare Advantage	$6,081.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,168.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,168.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,168.85
Rate for Payer: Cigna Commercial	$10,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,905.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,459.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.50
Rate for Payer: UnitedHealthcare Community & State	$488.51
Rate for Payer: Wellpoint Medicaid Managed Care	$537.15

Know your out-of-pocket cost for care.

All Charges