Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR ADD-A-VIAL PRIMARY

Facility

$7.70

Hospital Charge Code	6023121
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

CONNECTOR ADD-A-VIAL PRIMARY

Facility

$7.70

Hospital Charge Code	6023121
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

CONNECTOR ANGLE SLOT 5200-55AN

Facility

$2,321.65

Hospital Charge Code	270608046
Hospital Revenue Code	278
Min. Negotiated Rate	$55.95
Max. Negotiated Rate	$1,160.83
Rate for Payer: Aetna Commercial	$882.23
Rate for Payer: Aetna Medicare Advantage	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.02
Rate for Payer: Cigna Commercial	$1,160.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.76
Rate for Payer: Qualcare PPO/HMO/WC	$348.25
Rate for Payer: UnitedHealthcare Community & State	$55.95
Rate for Payer: Wellpoint Medicaid Managed Care	$61.52

CONNECTOR ANGLE SLOT 5200-55AN

Facility

$2,321.65

Hospital Charge Code	270608046
Hospital Revenue Code	278
Min. Negotiated Rate	$348.25
Max. Negotiated Rate	$561.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.76
Rate for Payer: Qualcare PPO/HMO/WC	$348.25

CONNECTOR ARWY W/PORT 610U5257

Facility

$5.25

Hospital Charge Code	270619411
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

CONNECTOR ARWY W/PORT 610U5257

Facility

$5.25

Hospital Charge Code	270619411
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$2.00
Rate for Payer: Aetna Medicare Advantage	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.34
Rate for Payer: Cigna Commercial	$2.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

CONNECTOR AXOGUARD 2X15MM

Facility

$10,390.00

Service Code	HCPCS C1763
Hospital Charge Code	270700135
Hospital Revenue Code	278
Min. Negotiated Rate	$1,558.50
Max. Negotiated Rate	$2,514.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,078.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,514.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,285.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,558.50

CONNECTOR AXOGUARD 2X15MM

Facility

$10,390.00

Service Code	HCPCS C1763
Hospital Charge Code	270700135
Hospital Revenue Code	278
Min. Negotiated Rate	$250.40
Max. Negotiated Rate	$5,195.00
Rate for Payer: Aetna Commercial	$3,948.20
Rate for Payer: Aetna Medicare Advantage	$3,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,649.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,649.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,649.45
Rate for Payer: Cigna Commercial	$5,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,514.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,285.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,558.50
Rate for Payer: UnitedHealthcare Community & State	$250.40
Rate for Payer: Wellpoint Medicaid Managed Care	$275.33

CONNECTOR CLAW 40-50 11-105005

Facility

$1,061.65

Hospital Charge Code	270611654
Hospital Revenue Code	272
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$530.83
Rate for Payer: Aetna Commercial	$403.43
Rate for Payer: Aetna Medicare Advantage	$318.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.72
Rate for Payer: Cigna Commercial	$530.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$212.33
Rate for Payer: Qualcare PPO/HMO/WC	$159.25
Rate for Payer: UnitedHealthcare Commercial	$212.33
Rate for Payer: UnitedHealthcare Community & State	$25.59
Rate for Payer: Wellpoint Medicaid Managed Care	$28.13

CONNECTOR CLAW 40-50 11-105005

Facility

$1,061.65

Hospital Charge Code	270611654
Hospital Revenue Code	272
Min. Negotiated Rate	$159.25
Max. Negotiated Rate	$159.25
Rate for Payer: Qualcare PPO/HMO/WC	$159.25

CONNECTOR COVER

Facility

$27.25

Hospital Charge Code	270658657
Hospital Revenue Code	270
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

CONNECTOR COVER

Facility

$27.25

Hospital Charge Code	270658657
Hospital Revenue Code	270
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

CONNECTOR CUFF 22 MMOD

Facility

$2.44

Hospital Charge Code	270651888
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.22
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

CONNECTOR CUFF 22 MMOD

Facility

$2.44

Hospital Charge Code	270651888
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CONNECTOR DIALYSIS HEMOSAFE

Facility

$1.23

Hospital Charge Code	270642494
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.62
Rate for Payer: Aetna Commercial	$0.47
Rate for Payer: Aetna Medicare Advantage	$0.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.31
Rate for Payer: Cigna Commercial	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.37
Rate for Payer: Oxford Commercial	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.18
Rate for Payer: UnitedHealthcare Commercial	$0.25
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CONNECTOR DIALYSIS HEMOSAFE

Facility

$1.23

Hospital Charge Code	270642494
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.18

CONNECTOR EVACUATOR ELLIK

Facility

$442.90

Hospital Charge Code	270655908
Hospital Revenue Code	271
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$221.45
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Aetna Medicare Advantage	$132.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.94
Rate for Payer: Cigna Commercial	$221.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.87
Rate for Payer: Oxford Commercial	$88.58
Rate for Payer: Qualcare PPO/HMO/WC	$66.44
Rate for Payer: UnitedHealthcare Commercial	$88.58
Rate for Payer: UnitedHealthcare Community & State	$10.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.74

CONNECTOR EVACUATOR ELLIK

Facility

$442.90

Hospital Charge Code	270655908
Hospital Revenue Code	271
Min. Negotiated Rate	$66.44
Max. Negotiated Rate	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.44

CONNECTOR EXTEND SLOT 5200-56

Facility

$2,445.65

Hospital Charge Code	270608047
Hospital Revenue Code	278
Min. Negotiated Rate	$366.85
Max. Negotiated Rate	$591.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$538.04
Rate for Payer: Qualcare PPO/HMO/WC	$366.85

CONNECTOR EXTEND SLOT 5200-56

Facility

$2,445.65

Hospital Charge Code	270608047
Hospital Revenue Code	278
Min. Negotiated Rate	$58.94
Max. Negotiated Rate	$1,222.83
Rate for Payer: Aetna Commercial	$929.35
Rate for Payer: Aetna Medicare Advantage	$733.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.64
Rate for Payer: Cigna Commercial	$1,222.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$538.04
Rate for Payer: Qualcare PPO/HMO/WC	$366.85
Rate for Payer: UnitedHealthcare Community & State	$58.94
Rate for Payer: Wellpoint Medicaid Managed Care	$64.81

CONNECTOR FBRJT BLENDNG SA3674

Facility

$132.50

Hospital Charge Code	270639731
Hospital Revenue Code	271
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$66.25
Rate for Payer: Aetna Commercial	$50.35
Rate for Payer: Aetna Medicare Advantage	$39.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$66.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.75
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$26.50
Rate for Payer: UnitedHealthcare Community & State	$3.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

CONNECTOR FBRJT BLENDNG SA3674

Facility

$132.50

Hospital Charge Code	270639731
Hospital Revenue Code	271
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$19.88

CONNECTOR FLEXFLO RT AGL 50370

Facility

$50.45

Hospital Charge Code	270600964
Hospital Revenue Code	272
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.13
Rate for Payer: Oxford Commercial	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

CONNECTOR FLEXFLO RT AGL 50370

Facility

$50.45

Hospital Charge Code	270600964
Hospital Revenue Code	272
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

Know your out-of-pocket cost for care.

All Charges