Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE BENGAL CAGE 5MM

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270683533
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 BENGAL CAGE 5MM

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270683533
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 BENGAL STACK STD LOR 32MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270674899
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

CAGE BENGAL STACK STD LOR 32MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270674899
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

CAGE BENGAL STACK STD LOR 38MM

Facility

$23,830.00

Hospital Charge Code	270666239
Hospital Revenue Code	278
Min. Negotiated Rate	$574.30
Max. Negotiated Rate	$11,915.00
Rate for Payer: Aetna Commercial	$9,055.40
Rate for Payer: Aetna Medicare Advantage	$7,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,076.65
Rate for Payer: Cigna Commercial	$11,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50
Rate for Payer: UnitedHealthcare Community & State	$574.30
Rate for Payer: Wellpoint Medicaid Managed Care	$631.50

CAGE BENGAL STACK STD LOR 38MM

Facility

$23,830.00

Hospital Charge Code	270666239
Hospital Revenue Code	278
Min. Negotiated Rate	$3,574.50
Max. Negotiated Rate	$5,766.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50

CAGE BENGAL STACK STD LOR 40MM

Facility

$23,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270665834
Hospital Revenue Code	278
Min. Negotiated Rate	$574.30
Max. Negotiated Rate	$11,915.00
Rate for Payer: Aetna Commercial	$9,055.40
Rate for Payer: Aetna Medicare Advantage	$7,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,076.65
Rate for Payer: Cigna Commercial	$11,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50
Rate for Payer: UnitedHealthcare Community & State	$574.30
Rate for Payer: Wellpoint Medicaid Managed Care	$631.50

CAGE BENGAL STACK STD LOR 40MM

Facility

$23,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270665834
Hospital Revenue Code	278
Min. Negotiated Rate	$3,574.50
Max. Negotiated Rate	$5,766.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50

CAGE BENGAL STACK STD LOR 44MM

Facility

$23,830.00

Hospital Charge Code	270676203
Hospital Revenue Code	278
Min. Negotiated Rate	$574.30
Max. Negotiated Rate	$11,915.00
Rate for Payer: Aetna Commercial	$9,055.40
Rate for Payer: Aetna Medicare Advantage	$7,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,076.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,076.65
Rate for Payer: Cigna Commercial	$11,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50
Rate for Payer: UnitedHealthcare Community & State	$574.30
Rate for Payer: Wellpoint Medicaid Managed Care	$631.50

CAGE BENGAL STACK STD LOR 44MM

Facility

$23,830.00

Hospital Charge Code	270676203
Hospital Revenue Code	278
Min. Negotiated Rate	$3,574.50
Max. Negotiated Rate	$5,766.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,766.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,242.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,574.50

CAGE BENGAL STD 4MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270667000
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 BENGAL STD 4MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270667000
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 BENGAL STD 5MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663102
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 BENGAL STD 5MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663102
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 BENGAL STD 6MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270665072
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 BENGAL STD 6MM 7DEG

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270665072
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 BLACKHAWK TI 16X16X6 6 H

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695158
Hospital Revenue Code	278
Min. Negotiated Rate	$572.38
Max. Negotiated Rate	$11,875.00
Rate for Payer: Aetna Commercial	$9,025.00
Rate for Payer: Aetna Medicare Advantage	$7,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,056.25
Rate for Payer: Cigna Commercial	$11,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50
Rate for Payer: UnitedHealthcare Community & State	$572.38
Rate for Payer: Wellpoint Medicaid Managed Care	$629.38

CAGE BLACKHAWK TI 16X16X6 6 H

Facility

$23,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695158
Hospital Revenue Code	278
Min. Negotiated Rate	$3,562.50
Max. Negotiated Rate	$5,747.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,747.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50

CAGE BNGEL 30MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270686288
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

CAGE BNGEL 30MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270686288
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

CAGE BNGEL 32MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270686289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

CAGE BNGEL 32MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270686289
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

CAGE CALIX LORDOT 11X14X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694502
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

CAGE CALIX LORDOT 11X14X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694502
Hospital Revenue Code	278
Min. Negotiated Rate	$584.42
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$584.42
Rate for Payer: Wellpoint Medicaid Managed Care	$642.62

CAGE CERES-C 15X12X8MM 10D

Facility

$6,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696388
Hospital Revenue Code	278
Min. Negotiated Rate	$149.42
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,364.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$149.42
Rate for Payer: Wellpoint Medicaid Managed Care	$164.30

Know your out-of-pocket cost for care.

All Charges