Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,200.00
Rate for Payer: Oxford Commercial	$2,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$2,800.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$110.42
Max. Negotiated Rate	$110.42
Rate for Payer: Qualcare PPO/HMO/WC	$110.42

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$368.06
Rate for Payer: Aetna Commercial	$279.73
Rate for Payer: Aetna Medicare Advantage	$220.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.71
Rate for Payer: Cigna Commercial	$368.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.84
Rate for Payer: Oxford Commercial	$147.23
Rate for Payer: Qualcare PPO/HMO/WC	$110.42
Rate for Payer: UnitedHealthcare Commercial	$147.23
Rate for Payer: UnitedHealthcare Community & State	$17.74
Rate for Payer: Wellpoint Medicaid Managed Care	$19.51

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$123.53

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$19.85
Max. Negotiated Rate	$411.76
Rate for Payer: Aetna Commercial	$312.94
Rate for Payer: Aetna Medicare Advantage	$247.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.00
Rate for Payer: Cigna Commercial	$411.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.06
Rate for Payer: Oxford Commercial	$164.70
Rate for Payer: Qualcare PPO/HMO/WC	$123.53
Rate for Payer: UnitedHealthcare Commercial	$164.70
Rate for Payer: UnitedHealthcare Community & State	$19.85
Rate for Payer: Wellpoint Medicaid Managed Care	$21.82

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$22.92
Max. Negotiated Rate	$475.48
Rate for Payer: Aetna Commercial	$361.36
Rate for Payer: Aetna Medicare Advantage	$285.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.49
Rate for Payer: Cigna Commercial	$475.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.29
Rate for Payer: Oxford Commercial	$190.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.64
Rate for Payer: UnitedHealthcare Commercial	$190.19
Rate for Payer: UnitedHealthcare Community & State	$22.92
Rate for Payer: Wellpoint Medicaid Managed Care	$25.20

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$142.64
Rate for Payer: Qualcare PPO/HMO/WC	$142.64

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$194.97
Rate for Payer: Aetna Commercial	$148.18
Rate for Payer: Aetna Medicare Advantage	$116.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.44
Rate for Payer: Cigna Commercial	$194.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.98
Rate for Payer: Oxford Commercial	$77.99
Rate for Payer: Qualcare PPO/HMO/WC	$58.49
Rate for Payer: UnitedHealthcare Commercial	$77.99
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.33

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$58.49
Max. Negotiated Rate	$58.49
Rate for Payer: Qualcare PPO/HMO/WC	$58.49

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$1,549.35
Max. Negotiated Rate	$1,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$248.93
Max. Negotiated Rate	$5,164.50
Rate for Payer: Aetna Commercial	$3,925.02
Rate for Payer: Aetna Medicare Advantage	$3,098.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,633.89
Rate for Payer: Cigna Commercial	$5,164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,098.70
Rate for Payer: Oxford Commercial	$2,065.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35
Rate for Payer: UnitedHealthcare Commercial	$2,065.80
Rate for Payer: UnitedHealthcare Community & State	$248.93
Rate for Payer: Wellpoint Medicaid Managed Care	$273.72

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$95.07
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,499.10
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,183.50
Rate for Payer: Oxford Commercial	$789.00
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Commercial	$789.00
Rate for Payer: UnitedHealthcare Community & State	$95.07
Rate for Payer: Wellpoint Medicaid Managed Care	$104.54

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$591.75
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$423.25
Rate for Payer: Aetna Commercial	$321.67
Rate for Payer: Aetna Medicare Advantage	$253.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.86
Rate for Payer: Cigna Commercial	$423.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.95
Rate for Payer: Oxford Commercial	$169.30
Rate for Payer: Qualcare PPO/HMO/WC	$126.97
Rate for Payer: UnitedHealthcare Commercial	$169.30
Rate for Payer: UnitedHealthcare Community & State	$20.40
Rate for Payer: Wellpoint Medicaid Managed Care	$22.43

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$126.97
Max. Negotiated Rate	$126.97
Rate for Payer: Qualcare PPO/HMO/WC	$126.97

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$195.49
Rate for Payer: Aetna Commercial	$148.57
Rate for Payer: Aetna Medicare Advantage	$117.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.29
Rate for Payer: Oxford Commercial	$78.19
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$78.19
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10.36

CLIP HEMO LOK MLK LARGE

Facility

$261.28

Hospital Charge Code	270619751
Hospital Revenue Code	272
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$39.19
Rate for Payer: Qualcare PPO/HMO/WC	$39.19

CLIP HEMO LOK MLK LARGE

Facility

$261.28

Hospital Charge Code	270619751
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$130.64
Rate for Payer: Aetna Commercial	$99.29
Rate for Payer: Aetna Medicare Advantage	$78.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.38
Rate for Payer: Oxford Commercial	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$39.19
Rate for Payer: UnitedHealthcare Commercial	$52.26
Rate for Payer: UnitedHealthcare Community & State	$6.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

CLIP INSTRUMENT ENDO CLINCH II

Facility

$1,066.58

Hospital Charge Code	270670510
Hospital Revenue Code	272
Min. Negotiated Rate	$159.99
Max. Negotiated Rate	$159.99
Rate for Payer: Qualcare PPO/HMO/WC	$159.99

CLIP INSTRUMENT ENDO CLINCH II

Facility

$1,066.58

Hospital Charge Code	270670510
Hospital Revenue Code	272
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$533.29
Rate for Payer: Aetna Commercial	$405.30
Rate for Payer: Aetna Medicare Advantage	$319.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.98
Rate for Payer: Cigna Commercial	$533.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.97
Rate for Payer: Oxford Commercial	$213.32
Rate for Payer: Qualcare PPO/HMO/WC	$159.99
Rate for Payer: UnitedHealthcare Commercial	$213.32
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

CLIP IRRIGATION EMAX 2

Facility

$280.00

Hospital Charge Code	270668484
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

Know your out-of-pocket cost for care.

All Charges