Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR TRANSVERSE 35-42MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698268
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

CONNECTOR TRANSVERSE 35-42MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698268
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

CONNECTOR URETERAL CATHETER

Facility

$7.50

Hospital Charge Code	270655912
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

CONNECTOR URETERAL CATHETER

Facility

$7.50

Hospital Charge Code	270655912
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

CONNECTOR Y 6 IN 1 STER 366

Facility

$33.65

Hospital Charge Code	270607253
Hospital Revenue Code	272
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

CONNECTOR Y 6 IN 1 STER 366

Facility

$33.65

Hospital Charge Code	270607253
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

CONNECTOR Y RENASYS KIT

Facility

$21.83

Hospital Charge Code	270649380
Hospital Revenue Code	272
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.91
Rate for Payer: Aetna Commercial	$8.30
Rate for Payer: Aetna Medicare Advantage	$6.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.57
Rate for Payer: Cigna Commercial	$10.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.55
Rate for Payer: Oxford Commercial	$4.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.37
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

CONNECTOR Y RENASYS KIT

Facility

$21.83

Hospital Charge Code	270649380
Hospital Revenue Code	272
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.21
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.88
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

CONNECTOR Y UNIVERSAL WD20

Facility

$72.85

Hospital Charge Code	270605805
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

CONNECTOR Y UNIVERSAL WD20

Facility

$72.85

Hospital Charge Code	270605805
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

CONNECTR BMT CLW55-65 11105008

Facility

$2,465.65

Hospital Charge Code	270611653
Hospital Revenue Code	278
Min. Negotiated Rate	$59.42
Max. Negotiated Rate	$1,232.83
Rate for Payer: Aetna Commercial	$936.95
Rate for Payer: Aetna Medicare Advantage	$739.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$628.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$628.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$493.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$628.74
Rate for Payer: Cigna Commercial	$1,232.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$542.44
Rate for Payer: Qualcare PPO/HMO/WC	$369.85
Rate for Payer: UnitedHealthcare Community & State	$59.42
Rate for Payer: Wellpoint Medicaid Managed Care	$65.34

CONNECTR BMT CLW55-65 11105008

Facility

$2,465.65

Hospital Charge Code	270611653
Hospital Revenue Code	278
Min. Negotiated Rate	$369.85
Max. Negotiated Rate	$596.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$493.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$542.44
Rate for Payer: Qualcare PPO/HMO/WC	$369.85

CONNEDTOR 5 IN 1 STERILE

Facility

$5.43

Hospital Charge Code	270650406
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

CONNEDTOR 5 IN 1 STERILE

Facility

$5.43

Hospital Charge Code	270650406
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

CONN TISSUE MASSON STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005288
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CONN TISSUE MASSON STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005288
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$126.47
Max. Negotiated Rate	$126.47
Rate for Payer: Qualcare PPO/HMO/WC	$126.47

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.57
Rate for Payer: Aetna Commercial	$320.40
Rate for Payer: Aetna Medicare Advantage	$252.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.00
Rate for Payer: Cigna Commercial	$421.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.94
Rate for Payer: Oxford Commercial	$168.63
Rate for Payer: Qualcare PPO/HMO/WC	$126.47
Rate for Payer: UnitedHealthcare Commercial	$168.63
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

Know your out-of-pocket cost for care.

All Charges