Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONTRAST VISIPAQUE 320MG/1ML

Facility

$5.96

Hospital Charge Code	270642100C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

CONTRAST VISIPAQUE 320MG/1ML

Facility

$5.96

Hospital Charge Code	270642100C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CONTRAST VISIPAQUE 320mg 200ml

Facility

$393.73

Hospital Charge Code	270642173
Hospital Revenue Code	272
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$196.87
Rate for Payer: Aetna Commercial	$149.62
Rate for Payer: Aetna Medicare Advantage	$118.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.40
Rate for Payer: Cigna Commercial	$196.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.12
Rate for Payer: Oxford Commercial	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$59.06
Rate for Payer: UnitedHealthcare Commercial	$78.75
Rate for Payer: UnitedHealthcare Community & State	$9.49
Rate for Payer: Wellpoint Medicaid Managed Care	$10.43

CONTRAST VISIPAQUE 320mg 200ml

Facility

$393.73

Hospital Charge Code	270642173
Hospital Revenue Code	272
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$59.06
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$62.28
Rate for Payer: Aetna Commercial	$47.33
Rate for Payer: Aetna Medicare Advantage	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.76
Rate for Payer: Cigna Commercial	$62.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.37
Rate for Payer: Oxford Commercial	$24.91
Rate for Payer: Qualcare PPO/HMO/WC	$18.68
Rate for Payer: UnitedHealthcare Commercial	$24.91
Rate for Payer: UnitedHealthcare Community & State	$3.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.30

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$18.68
Rate for Payer: Qualcare PPO/HMO/WC	$18.68

CONTROL FLOW CSF W/ BIO GLIDE

Facility

$4,137.65

Hospital Charge Code	270612860
Hospital Revenue Code	272
Min. Negotiated Rate	$99.72
Max. Negotiated Rate	$2,068.82
Rate for Payer: Aetna Commercial	$1,572.31
Rate for Payer: Aetna Medicare Advantage	$1,241.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,055.10
Rate for Payer: Cigna Commercial	$2,068.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.30
Rate for Payer: Oxford Commercial	$827.53
Rate for Payer: Qualcare PPO/HMO/WC	$620.65
Rate for Payer: UnitedHealthcare Commercial	$827.53
Rate for Payer: UnitedHealthcare Community & State	$99.72
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

CONTROL FLOW CSF W/ BIO GLIDE

Facility

$4,137.65

Hospital Charge Code	270612860
Hospital Revenue Code	272
Min. Negotiated Rate	$620.65
Max. Negotiated Rate	$620.65
Rate for Payer: Qualcare PPO/HMO/WC	$620.65

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$185.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$185.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.50
Rate for Payer: Oxford Commercial	$185.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$185.00
Rate for Payer: UnitedHealthcare Community & State	$22.29
Rate for Payer: Wellpoint Medicaid Managed Care	$24.51

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$195.81
Rate for Payer: Wellpoint Medicaid Managed Care	$215.31

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$16.79
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) NJ Health	$65.05
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	$208.95
Rate for Payer: Oxford Commercial	$139.30
Rate for Payer: Qualcare PPO/HMO/WC	$104.47
Rate for Payer: UnitedHealthcare Commercial	$139.30
Rate for Payer: UnitedHealthcare Community & State	$16.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

CONTROL NASAL HEMORRHAGE, ANT

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	2500364
Hospital Revenue Code	761
Min. Negotiated Rate	$10.66
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) NJ Health	$65.05
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	$132.74
Rate for Payer: Oxford Commercial	$88.49
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Commercial	$88.49
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

CONTROL NASAL HEMORRHAGE, ANT

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	2500364
Hospital Revenue Code	761
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$11.16
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) NJ Health	$65.05
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	$138.90
Rate for Payer: Oxford Commercial	$92.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Commercial	$92.60
Rate for Payer: UnitedHealthcare Community & State	$11.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.27

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$2,312.88
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,312.88
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.14
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$54.87

Know your out-of-pocket cost for care.

All Charges