Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CLIP LIGATING 2200 MEDIUM

Facility

$59.35

Hospital Charge Code	270673283
Hospital Revenue Code	272
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.90

CLIP LIGATING 2200 MEDIUM

Facility

$59.35

Hospital Charge Code	270673283
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$29.68
Rate for Payer: Aetna Commercial	$22.55
Rate for Payer: Aetna Medicare Advantage	$17.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.13
Rate for Payer: Cigna Commercial	$29.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.80
Rate for Payer: Oxford Commercial	$11.87
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$11.87
Rate for Payer: UnitedHealthcare Community & State	$1.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1.57

CLIP LIGATING MED/6/BX

Facility

$20.10

Hospital Charge Code	270661328
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna Commercial	$7.64
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.13
Rate for Payer: Cigna Commercial	$10.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02
Rate for Payer: UnitedHealthcare Commercial	$4.02
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CLIP LIGATING MED/6/BX

Facility

$20.10

Hospital Charge Code	270661328
Hospital Revenue Code	272
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02

CLIP LIGAT RESOLUTION 360ULTRA

Facility

$1,127.50

Service Code	HCPCS L8699
Hospital Charge Code	270692937
Hospital Revenue Code	278
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$563.75
Rate for Payer: Aetna Commercial	$428.45
Rate for Payer: Aetna Medicare Advantage	$338.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.51
Rate for Payer: Cigna Commercial	$563.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$169.12
Rate for Payer: UnitedHealthcare Community & State	$27.17
Rate for Payer: Wellpoint Medicaid Managed Care	$29.88

CLIP LIGAT RESOLUTION 360ULTRA

Facility

$1,127.50

Service Code	HCPCS L8699
Hospital Charge Code	270692937
Hospital Revenue Code	278
Min. Negotiated Rate	$169.12
Max. Negotiated Rate	$272.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$169.12

CLIP OLYMPUS ENDO HX600-090

Facility

$76.85

Hospital Charge Code	270618133
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: Aetna Medicare Advantage	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.60
Rate for Payer: Cigna Commercial	$38.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.05
Rate for Payer: Oxford Commercial	$15.37
Rate for Payer: Qualcare PPO/HMO/WC	$11.53
Rate for Payer: UnitedHealthcare Commercial	$15.37
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

CLIP OLYMPUS ENDO HX600-090

Facility

$76.85

Hospital Charge Code	270618133
Hospital Revenue Code	270
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

CLIP OLYMPUS ENDO HX600-135

Facility

$76.85

Hospital Charge Code	270618134
Hospital Revenue Code	270
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

CLIP OLYMPUS ENDO HX600-135

Facility

$76.85

Hospital Charge Code	270618134
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: Aetna Medicare Advantage	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.60
Rate for Payer: Cigna Commercial	$38.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.05
Rate for Payer: Oxford Commercial	$15.37
Rate for Payer: Qualcare PPO/HMO/WC	$11.53
Rate for Payer: UnitedHealthcare Commercial	$15.37
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

CLIPPER CORD CLAMP REMOVR 9441

Facility

$119.25

Hospital Charge Code	270600468
Hospital Revenue Code	272
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$59.62
Rate for Payer: Aetna Commercial	$45.31
Rate for Payer: Aetna Medicare Advantage	$35.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.41
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$23.85
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

CLIPPER CORD CLAMP REMOVR 9441

Facility

$119.25

Hospital Charge Code	270600468
Hospital Revenue Code	272
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

CLIPPER PREP DISP

Facility

$13.13

Hospital Charge Code	270649373
Hospital Revenue Code	272
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

CLIPPER PREP DISP

Facility

$13.13

Hospital Charge Code	270649373
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.94
Rate for Payer: Oxford Commercial	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.63
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

CLIPPER SURGICAL HANDLE

Facility

$182.90

Hospital Charge Code	270651870
Hospital Revenue Code	272
Min. Negotiated Rate	$27.43
Max. Negotiated Rate	$27.43
Rate for Payer: Qualcare PPO/HMO/WC	$27.43

CLIPPER SURGICAL HANDLE

Facility

$182.90

Hospital Charge Code	270651870
Hospital Revenue Code	272
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$91.45
Rate for Payer: Aetna Commercial	$69.50
Rate for Payer: Aetna Medicare Advantage	$54.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.64
Rate for Payer: Cigna Commercial	$91.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.87
Rate for Payer: Oxford Commercial	$36.58
Rate for Payer: Qualcare PPO/HMO/WC	$27.43
Rate for Payer: UnitedHealthcare Commercial	$36.58
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

CLIP PLACEMENT PERCUTANEOUS

Facility

$867.00

Hospital Charge Code	75190115
Hospital Revenue Code	361
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.10
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$22.98

CLIP PLACEMENT PERCUTANEOUS

Facility

$867.00

Hospital Charge Code	75190115
Hospital Revenue Code	361
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

CLIP RESOLUTION M00522612

Facility

$800.00

Hospital Charge Code	270635097
Hospital Revenue Code	272
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

CLIP RESOLUTION M00522612

Facility

$800.00

Hospital Charge Code	270635097
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

CLIPS 360 RESOLUTION

Facility

$1,027.50

Hospital Charge Code	270677227
Hospital Revenue Code	272
Min. Negotiated Rate	$154.12
Max. Negotiated Rate	$154.12
Rate for Payer: Qualcare PPO/HMO/WC	$154.12

CLIPS 360 RESOLUTION

Facility

$1,027.50

Hospital Charge Code	270677227
Hospital Revenue Code	272
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$513.75
Rate for Payer: Aetna Commercial	$390.45
Rate for Payer: Aetna Medicare Advantage	$308.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.01
Rate for Payer: Cigna Commercial	$513.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.25
Rate for Payer: Oxford Commercial	$205.50
Rate for Payer: Qualcare PPO/HMO/WC	$154.12
Rate for Payer: UnitedHealthcare Commercial	$205.50
Rate for Payer: UnitedHealthcare Community & State	$24.76
Rate for Payer: Wellpoint Medicaid Managed Care	$27.23

CLIPS FOR IRRIGATION TUBE SET

Facility

$84.00

Hospital Charge Code	270674705
Hospital Revenue Code	272
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

CLIPS FOR IRRIGATION TUBE SET

Facility

$84.00

Hospital Charge Code	270674705
Hospital Revenue Code	272
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

Know your out-of-pocket cost for care.

All Charges