Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE GRASPING RAPTOR

Facility

$600.00

Hospital Charge Code	270646647
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

DEVICE GRASPING RAPTOR

Facility

$600.00

Hospital Charge Code	270646647
Hospital Revenue Code	272
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

DEVICE GRASPING TALON

Facility

$680.00

Hospital Charge Code	270647220
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

DEVICE GRASPING TALON

Facility

$680.00

Hospital Charge Code	270647220
Hospital Revenue Code	272
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.00
Rate for Payer: Oxford Commercial	$136.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$136.00
Rate for Payer: UnitedHealthcare Community & State	$16.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

DEVICE GUIDE WIRE TORQUE TD500

Facility

$25.00

Hospital Charge Code	270654971V
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

DEVICE GUIDE WIRE TORQUE TD500

Facility

$25.00

Hospital Charge Code	270654971V
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

DEVICE HIP DISTRACTION ATHE

Facility

$4,875.00

Hospital Charge Code	270667791
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

DEVICE HIP DISTRACTION ATHE

Facility

$4,875.00

Hospital Charge Code	270667791
Hospital Revenue Code	272
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.50
Rate for Payer: Oxford Commercial	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Commercial	$975.00
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

DEVICE HMD TARGET 5.0 38152150

Facility

$690.45

Hospital Charge Code	270621063
Hospital Revenue Code	272
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

DEVICE HMD TARGET 5.0 38152150

Facility

$690.45

Hospital Charge Code	270621063
Hospital Revenue Code	272
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$138.09
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$138.09
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

DEVICE HMD TARGET 5.5 38152155

Facility

$690.45

Hospital Charge Code	270621064
Hospital Revenue Code	272
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

DEVICE HMD TARGET 5.5 38152155

Facility

$690.45

Hospital Charge Code	270621064
Hospital Revenue Code	272
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$138.09
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$138.09
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

DEVICE INFLATION ENCORE

Facility

$188.90

Hospital Charge Code	270623273
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$28.34
Rate for Payer: Qualcare PPO/HMO/WC	$28.34

DEVICE INFLATION ENCORE

Facility

$188.90

Hospital Charge Code	270623273
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$94.45
Rate for Payer: Aetna Commercial	$71.78
Rate for Payer: Aetna Medicare Advantage	$56.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.17
Rate for Payer: Cigna Commercial	$94.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.67
Rate for Payer: Oxford Commercial	$37.78
Rate for Payer: Qualcare PPO/HMO/WC	$28.34
Rate for Payer: UnitedHealthcare Commercial	$37.78
Rate for Payer: UnitedHealthcare Community & State	$4.55
Rate for Payer: Wellpoint Medicaid Managed Care	$5.01

DEVICE INFLATION ENCORE 15-106

Facility

$150.00

Hospital Charge Code	270623273C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

DEVICE INFLATION ENCORE 15-106

Facility

$150.00

Hospital Charge Code	270623273C
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

DEVICE INFLATION ENCORE 26

Facility

$359.20

Hospital Charge Code	270638580
Hospital Revenue Code	272
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$53.88

DEVICE INFLATION ENCORE 26

Facility

$359.20

Hospital Charge Code	270638580
Hospital Revenue Code	272
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$179.60
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare Advantage	$107.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.60
Rate for Payer: Cigna Commercial	$179.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.76
Rate for Payer: Oxford Commercial	$71.84
Rate for Payer: Qualcare PPO/HMO/WC	$53.88
Rate for Payer: UnitedHealthcare Commercial	$71.84
Rate for Payer: UnitedHealthcare Community & State	$8.66
Rate for Payer: Wellpoint Medicaid Managed Care	$9.52

DEVICE INFLATION ENCORE 26

Facility

$194.50

Hospital Charge Code	270623297
Hospital Revenue Code	278
Min. Negotiated Rate	$29.18
Max. Negotiated Rate	$47.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$42.79
Rate for Payer: Qualcare PPO/HMO/WC	$29.18

DEVICE INFLATION ENCORE 26

Facility

$194.50

Hospital Charge Code	270623297
Hospital Revenue Code	278
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$97.25
Rate for Payer: Aetna Commercial	$73.91
Rate for Payer: Aetna Medicare Advantage	$58.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.60
Rate for Payer: Cigna Commercial	$97.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$42.79
Rate for Payer: Qualcare PPO/HMO/WC	$29.18
Rate for Payer: UnitedHealthcare Community & State	$4.69
Rate for Payer: Wellpoint Medicaid Managed Care	$5.15

DEVICE INFLATION GASTRO 90 CM

Facility

$1,255.80

Service Code	HCPCS C1726
Hospital Charge Code	270687754
Hospital Revenue Code	278
Min. Negotiated Rate	$188.37
Max. Negotiated Rate	$303.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.28
Rate for Payer: Qualcare PPO/HMO/WC	$188.37

DEVICE INFLATION GASTRO 90 CM

Facility

$1,255.80

Service Code	HCPCS C1726
Hospital Charge Code	270687754
Hospital Revenue Code	278
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$627.90
Rate for Payer: Aetna Commercial	$477.20
Rate for Payer: Aetna Medicare Advantage	$376.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.23
Rate for Payer: Cigna Commercial	$627.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.28
Rate for Payer: Qualcare PPO/HMO/WC	$188.37
Rate for Payer: UnitedHealthcare Community & State	$30.26
Rate for Payer: Wellpoint Medicaid Managed Care	$33.28

DEVICE INFLATION LEVEEN

Facility

$209.95

Hospital Charge Code	270645619
Hospital Revenue Code	272
Min. Negotiated Rate	$31.49
Max. Negotiated Rate	$31.49
Rate for Payer: Qualcare PPO/HMO/WC	$31.49

DEVICE INFLATION LEVEEN

Facility

$209.95

Hospital Charge Code	270645619C
Hospital Revenue Code	272
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$104.97
Rate for Payer: Aetna Commercial	$79.78
Rate for Payer: Aetna Medicare Advantage	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.54
Rate for Payer: Cigna Commercial	$104.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.98
Rate for Payer: Oxford Commercial	$41.99
Rate for Payer: Qualcare PPO/HMO/WC	$31.49
Rate for Payer: UnitedHealthcare Commercial	$41.99
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.56

DEVICE INFLATION LEVEEN

Facility

$209.95

Hospital Charge Code	270645619C
Hospital Revenue Code	272
Min. Negotiated Rate	$31.49
Max. Negotiated Rate	$31.49
Rate for Payer: Qualcare PPO/HMO/WC	$31.49

Know your out-of-pocket cost for care.

All Charges