Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE BONE BIOPSY SZ 2 F07A

Facility

$650.00

Hospital Charge Code	270637759
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

DEVICE BONE FILLER SZ #3 F04B

Facility

$545.65

Hospital Charge Code	270631260
Hospital Revenue Code	272
Min. Negotiated Rate	$81.85
Max. Negotiated Rate	$81.85
Rate for Payer: Qualcare PPO/HMO/WC	$81.85

DEVICE BONE FILLER SZ #3 F04B

Facility

$545.65

Hospital Charge Code	270631260
Hospital Revenue Code	272
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$272.82
Rate for Payer: Aetna Commercial	$207.35
Rate for Payer: Aetna Medicare Advantage	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.14
Rate for Payer: Cigna Commercial	$272.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.69
Rate for Payer: Oxford Commercial	$109.13
Rate for Payer: Qualcare PPO/HMO/WC	$81.85
Rate for Payer: UnitedHealthcare Commercial	$109.13
Rate for Payer: UnitedHealthcare Community & State	$13.15
Rate for Payer: Wellpoint Medicaid Managed Care	$14.46

DEVICE BREZR RX INFLATION 6666

Facility

$372.00

Hospital Charge Code	270630323
Hospital Revenue Code	272
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

DEVICE BREZR RX INFLATION 6666

Facility

$372.00

Hospital Charge Code	270630323
Hospital Revenue Code	272
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

DEVICE CAPIO SLIM SUT CAPT SNG

Facility

$2,802.45

Hospital Charge Code	270616239
Hospital Revenue Code	278
Min. Negotiated Rate	$67.54
Max. Negotiated Rate	$1,401.22
Rate for Payer: Aetna Commercial	$1,064.93
Rate for Payer: Aetna Medicare Advantage	$840.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$560.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.62
Rate for Payer: Cigna Commercial	$1,401.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$616.54
Rate for Payer: Qualcare PPO/HMO/WC	$420.37
Rate for Payer: UnitedHealthcare Community & State	$67.54
Rate for Payer: Wellpoint Medicaid Managed Care	$74.26

DEVICE CAPIO SLIM SUT CAPT SNG

Facility

$2,802.45

Hospital Charge Code	270616239
Hospital Revenue Code	278
Min. Negotiated Rate	$420.37
Max. Negotiated Rate	$678.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$560.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$616.54
Rate for Payer: Qualcare PPO/HMO/WC	$420.37

DEVICE CAPIO SLIM SUT CAPTURG

Facility

$2,480.00

Hospital Charge Code	270676958
Hospital Revenue Code	272
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.00
Rate for Payer: Oxford Commercial	$496.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Commercial	$496.00
Rate for Payer: UnitedHealthcare Community & State	$59.77
Rate for Payer: Wellpoint Medicaid Managed Care	$65.72

DEVICE CAPIO SLIM SUT CAPTURG

Facility

$2,480.00

Hospital Charge Code	270676958
Hospital Revenue Code	272
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

DEVICECAPTIVATOR EMR STD

Facility

$1,490.00

Hospital Charge Code	270677012
Hospital Revenue Code	272
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$745.00
Rate for Payer: Aetna Commercial	$566.20
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.00
Rate for Payer: Oxford Commercial	$298.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Commercial	$298.00
Rate for Payer: UnitedHealthcare Community & State	$35.91
Rate for Payer: Wellpoint Medicaid Managed Care	$39.48

DEVICECAPTIVATOR EMR STD

Facility

$1,490.00

Hospital Charge Code	270677012
Hospital Revenue Code	272
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

DEVICE CELLECT RETENTION

Facility

$3,127.00

Hospital Charge Code	270657933
Hospital Revenue Code	278
Min. Negotiated Rate	$469.05
Max. Negotiated Rate	$756.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.94
Rate for Payer: Qualcare PPO/HMO/WC	$469.05

DEVICE CELLECT RETENTION

Facility

$3,127.00

Hospital Charge Code	270657933
Hospital Revenue Code	278
Min. Negotiated Rate	$75.36
Max. Negotiated Rate	$1,563.50
Rate for Payer: Aetna Commercial	$1,188.26
Rate for Payer: Aetna Medicare Advantage	$938.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$797.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$797.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$797.38
Rate for Payer: Cigna Commercial	$1,563.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.94
Rate for Payer: Qualcare PPO/HMO/WC	$469.05
Rate for Payer: UnitedHealthcare Community & State	$75.36
Rate for Payer: Wellpoint Medicaid Managed Care	$82.87

DEVICE CLIP QIK FIX HX200U135A

Facility

$281.65

Hospital Charge Code	270627692
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

DEVICE CLIP QIK FIX HX200U135A

Facility

$281.65

Hospital Charge Code	270627692
Hospital Revenue Code	272
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

DEVICE ENSEAL 5mm x 35cm

Facility

$2,125.00

Hospital Charge Code	270639785
Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$318.75
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

DEVICE ENSEAL 5mm x 35cm

Facility

$2,125.00

Hospital Charge Code	270639785
Hospital Revenue Code	272
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Commercial	$425.00
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

DEVICE EXPRESS FILTRATION P

Facility

$5,725.00

Service Code	HCPCS C1783
Hospital Charge Code	270659750
Hospital Revenue Code	278
Min. Negotiated Rate	$137.97
Max. Negotiated Rate	$2,862.50
Rate for Payer: Aetna Commercial	$2,175.50
Rate for Payer: Aetna Medicare Advantage	$1,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,459.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,459.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,459.88
Rate for Payer: Cigna Commercial	$2,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,259.50
Rate for Payer: Qualcare PPO/HMO/WC	$858.75
Rate for Payer: UnitedHealthcare Community & State	$137.97
Rate for Payer: Wellpoint Medicaid Managed Care	$151.71

DEVICE EXPRESS FILTRATION P

Facility

$5,725.00

Service Code	HCPCS C1783
Hospital Charge Code	270659750
Hospital Revenue Code	278
Min. Negotiated Rate	$858.75
Max. Negotiated Rate	$1,385.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,259.50
Rate for Payer: Qualcare PPO/HMO/WC	$858.75

DEVICE FIXATION 15 FAST OPTIFI

Facility

$2,375.00

Hospital Charge Code	270685694
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

DEVICE FIXATION 15 FAST OPTIFI

Facility

$2,375.00

Hospital Charge Code	270685694
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

DEVICE FLIPCUTTER 9.0MM

Facility

$3,375.00

Hospital Charge Code	270675323
Hospital Revenue Code	272
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$675.00
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

DEVICE FLIPCUTTER 9.0MM

Facility

$3,375.00

Hospital Charge Code	270675323
Hospital Revenue Code	272
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

DEVICE FORCE TRIVERSE

Facility

$169.25

Hospital Charge Code	270668208
Hospital Revenue Code	272
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$25.39
Rate for Payer: Qualcare PPO/HMO/WC	$25.39

DEVICE FORCE TRIVERSE

Facility

$169.25

Hospital Charge Code	270668208
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$84.62
Rate for Payer: Aetna Commercial	$64.31
Rate for Payer: Aetna Medicare Advantage	$50.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.16
Rate for Payer: Cigna Commercial	$84.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.77
Rate for Payer: Oxford Commercial	$33.85
Rate for Payer: Qualcare PPO/HMO/WC	$25.39
Rate for Payer: UnitedHealthcare Commercial	$33.85
Rate for Payer: UnitedHealthcare Community & State	$4.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.49

Know your out-of-pocket cost for care.

All Charges