Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CUFF TEMPA-KUFF ADULT LARGE 1

Facility

$14.10

Hospital Charge Code	270662686
Hospital Revenue Code	270
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.05
Rate for Payer: Aetna Commercial	$5.36
Rate for Payer: Aetna Medicare Advantage	$4.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.60
Rate for Payer: Cigna Commercial	$7.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.23
Rate for Payer: Oxford Commercial	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.12
Rate for Payer: UnitedHealthcare Commercial	$2.82
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

CUFF TEMPA-KUFF ADULT LARGE 1

Facility

$14.10

Hospital Charge Code	270662686
Hospital Revenue Code	270
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.12

CUFF TEMPA-KUFF ADULT SMALL 1

Facility

$13.44

Hospital Charge Code	270662688
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

CUFF TEMPA-KUFF ADULT SMALL 1

Facility

$13.44

Hospital Charge Code	270662688
Hospital Revenue Code	270
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

CUFF TOURNIQ 18IN 60-7070-103

Facility

$2,222.45

Hospital Charge Code	270611314
Hospital Revenue Code	272
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$1,111.22
Rate for Payer: Aetna Commercial	$844.53
Rate for Payer: Aetna Medicare Advantage	$666.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.72
Rate for Payer: Cigna Commercial	$1,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$666.74
Rate for Payer: Oxford Commercial	$444.49
Rate for Payer: Qualcare PPO/HMO/WC	$333.37
Rate for Payer: UnitedHealthcare Commercial	$444.49
Rate for Payer: UnitedHealthcare Community & State	$53.56
Rate for Payer: Wellpoint Medicaid Managed Care	$58.89

CUFF TOURNIQ 18IN 60-7070-103

Facility

$2,222.45

Hospital Charge Code	270611314
Hospital Revenue Code	272
Min. Negotiated Rate	$333.37
Max. Negotiated Rate	$333.37
Rate for Payer: Qualcare PPO/HMO/WC	$333.37

CUFF TOURNIQ DISP 18 2911-18

Facility

$96.90

Hospital Charge Code	270602691
Hospital Revenue Code	272
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.45
Rate for Payer: Aetna Commercial	$36.82
Rate for Payer: Aetna Medicare Advantage	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.71
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.07
Rate for Payer: Oxford Commercial	$19.38
Rate for Payer: Qualcare PPO/HMO/WC	$14.54
Rate for Payer: UnitedHealthcare Commercial	$19.38
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

CUFF TOURNIQ DISP 18 2911-18

Facility

$96.90

Hospital Charge Code	270602691
Hospital Revenue Code	272
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$14.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.54

CUFF TOURNIQ DISP 2911-34

Facility

$139.00

Hospital Charge Code	270600368
Hospital Revenue Code	272
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Oxford Commercial	$27.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Commercial	$27.80
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

CUFF TOURNIQ DISP 2911-34

Facility

$139.00

Hospital Charge Code	270600368
Hospital Revenue Code	272
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CUFF TOURNIQUET DISP 24

Facility

$355.00

Hospital Charge Code	270666472
Hospital Revenue Code	272
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.50
Rate for Payer: Oxford Commercial	$71.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Commercial	$71.00
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

CUFF TOURNIQUET DISP 24

Facility

$355.00

Hospital Charge Code	270666472
Hospital Revenue Code	272
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

CUFF TOURNIQUET PLC 12 DISP

Facility

$100.96

Hospital Charge Code	270648578
Hospital Revenue Code	272
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.48
Rate for Payer: Aetna Commercial	$38.36
Rate for Payer: Aetna Medicare Advantage	$30.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.74
Rate for Payer: Cigna Commercial	$50.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.29
Rate for Payer: Oxford Commercial	$20.19
Rate for Payer: Qualcare PPO/HMO/WC	$15.14
Rate for Payer: UnitedHealthcare Commercial	$20.19
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

CUFF TOURNIQUET PLC 12 DISP

Facility

$100.96

Hospital Charge Code	270648578
Hospital Revenue Code	272
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$15.14
Rate for Payer: Qualcare PPO/HMO/WC	$15.14

CUFF TOURNIQUET PLC 30 DISP

Facility

$139.92

Hospital Charge Code	270639239
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$69.96
Rate for Payer: Aetna Commercial	$53.17
Rate for Payer: Aetna Medicare Advantage	$41.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.68
Rate for Payer: Cigna Commercial	$69.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.98
Rate for Payer: Oxford Commercial	$27.98
Rate for Payer: Qualcare PPO/HMO/WC	$20.99
Rate for Payer: UnitedHealthcare Commercial	$27.98
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

CUFF TOURNIQUET PLC 30 DISP

Facility

$139.92

Hospital Charge Code	270639239
Hospital Revenue Code	272
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$20.99
Rate for Payer: Qualcare PPO/HMO/WC	$20.99

CUFUNGUS,RESP

Facility

$222.00

Service Code	HCPCS 87102
Hospital Charge Code	38479083
Hospital Revenue Code	309
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.30

CUFUNGUS,RESP

Facility

$222.00

Service Code	HCPCS 87102
Hospital Charge Code	38479083
Hospital Revenue Code	309
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare Advantage	$27.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.36
Rate for Payer: Cigna Commercial	$111.00
Rate for Payer: Cigna Medicare Advantage	$8.41
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Medicare Advantage	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

CU INDEX

Facility

$933.75

Service Code	HCPCS 86352
Hospital Charge Code	3038150
Hospital Revenue Code	302
Min. Negotiated Rate	$140.06
Max. Negotiated Rate	$140.06
Rate for Payer: Qualcare PPO/HMO/WC	$140.06

CU INDEX

Facility

$933.75

Service Code	HCPCS 86352
Hospital Charge Code	3038150
Hospital Revenue Code	302
Min. Negotiated Rate	$24.74
Max. Negotiated Rate	$490.41
Rate for Payer: Aetna Commercial	$369.54
Rate for Payer: Aetna Medicare Advantage	$440.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$135.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.41
Rate for Payer: Cigna Commercial	$466.88
Rate for Payer: Cigna Medicare Advantage	$135.86
Rate for Payer: Clover Medicare Advantage	$129.07
Rate for Payer: EmblemHealth Commercial	$407.58
Rate for Payer: Humana Medicare Advantage	$139.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$135.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.06
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$108.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$135.86
Rate for Payer: Wellcare Medicare Advantage	$135.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.74

CULT,FUNG'HAIR'DK,NAIL W/KOH I

Facility

$29.10

Service Code	HCPCS 87220
Hospital Charge Code	3990157B
Hospital Revenue Code	309
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$14.55
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

CULT,FUNG'HAIR'DK,NAIL W/KOH I

Facility

$29.10

Service Code	HCPCS 87220
Hospital Charge Code	3990157B
Hospital Revenue Code	309
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$4.37
Rate for Payer: Qualcare PPO/HMO/WC	$4.37

CULT,FUNG'HAIR'DK,NAIL W/KOH I

Facility

$53.00

Service Code	HCPCS 87101
Hospital Charge Code	3990157A
Hospital Revenue Code	309
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

CULT,FUNG'HAIR'DK,NAIL W/KOH I

Facility

$53.00

Service Code	HCPCS 87101
Hospital Charge Code	3990157A
Hospital Revenue Code	309
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.97
Rate for Payer: Aetna Medicare Advantage	$24.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.83
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: Cigna Medicare Advantage	$7.71
Rate for Payer: Clover Medicare Advantage	$7.32
Rate for Payer: EmblemHealth Commercial	$23.13
Rate for Payer: Humana Medicare Advantage	$7.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.71
Rate for Payer: Wellcare Medicare Advantage	$7.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

CULT,FUNGUS,TISSUE

Facility

$222.00

Service Code	HCPCS 87102
Hospital Charge Code	38479082
Hospital Revenue Code	309
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.30

Know your out-of-pocket cost for care.

All Charges