Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE NOVASURE DISPOSABLE

Facility

$4,750.00

Hospital Charge Code	270637493
Hospital Revenue Code	272
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.00
Rate for Payer: Oxford Commercial	$950.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$950.00
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

DEVICE NOVASURE DISPOSABLE

Facility

$4,750.00

Hospital Charge Code	270637493
Hospital Revenue Code	272
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

DEVICE OLM LIGATE 2.8 HX20U1B

Facility

$1,985.65

Hospital Charge Code	270625195
Hospital Revenue Code	272
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$992.83
Rate for Payer: Aetna Commercial	$754.55
Rate for Payer: Aetna Medicare Advantage	$595.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.34
Rate for Payer: Cigna Commercial	$992.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.70
Rate for Payer: Oxford Commercial	$397.13
Rate for Payer: Qualcare PPO/HMO/WC	$297.85
Rate for Payer: UnitedHealthcare Commercial	$397.13
Rate for Payer: UnitedHealthcare Community & State	$47.85
Rate for Payer: Wellpoint Medicaid Managed Care	$52.62

DEVICE OLM LIGATE 2.8 HX20U1B

Facility

$1,985.65

Hospital Charge Code	270625195
Hospital Revenue Code	272
Min. Negotiated Rate	$297.85
Max. Negotiated Rate	$297.85
Rate for Payer: Qualcare PPO/HMO/WC	$297.85

DEVICE POLYP REMOVAL MYOSURE

Facility

$3,466.67

Hospital Charge Code	270662591
Hospital Revenue Code	272
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$520.00

DEVICE POLYP REMOVAL MYOSURE

Facility

$3,466.67

Hospital Charge Code	270662591
Hospital Revenue Code	272
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$1,733.34
Rate for Payer: Aetna Commercial	$1,317.33
Rate for Payer: Aetna Medicare Advantage	$1,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$884.00
Rate for Payer: Cigna Commercial	$1,733.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.00
Rate for Payer: Oxford Commercial	$693.33
Rate for Payer: Qualcare PPO/HMO/WC	$520.00
Rate for Payer: UnitedHealthcare Commercial	$693.33
Rate for Payer: UnitedHealthcare Community & State	$83.55
Rate for Payer: Wellpoint Medicaid Managed Care	$91.87

DEVICE POWER PORT 8FR

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270657913
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

DEVICE POWER PORT 8FR

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270657913
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

DEVICE PRESS MONITR K05L1L5A

Facility

$495.00

Hospital Charge Code	270631600
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

DEVICE PRESS MONITR K05L1L5A

Facility

$495.00

Hospital Charge Code	270631600
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

DEVICE PUSH - PULL REDUCTION

Facility

$1,041.35

Hospital Charge Code	270639429
Hospital Revenue Code	272
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$156.20
Rate for Payer: Qualcare PPO/HMO/WC	$156.20

DEVICE PUSH - PULL REDUCTION

Facility

$1,041.35

Hospital Charge Code	270639429
Hospital Revenue Code	272
Min. Negotiated Rate	$25.10
Max. Negotiated Rate	$520.67
Rate for Payer: Aetna Commercial	$395.71
Rate for Payer: Aetna Medicare Advantage	$312.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.54
Rate for Payer: Cigna Commercial	$520.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.40
Rate for Payer: Oxford Commercial	$208.27
Rate for Payer: Qualcare PPO/HMO/WC	$156.20
Rate for Payer: UnitedHealthcare Commercial	$208.27
Rate for Payer: UnitedHealthcare Community & State	$25.10
Rate for Payer: Wellpoint Medicaid Managed Care	$27.60

DEVICE PUSH PULL REDUCTION

Facility

$1,100.05

Hospital Charge Code	270649704
Hospital Revenue Code	272
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.02
Rate for Payer: Aetna Commercial	$418.02
Rate for Payer: Aetna Medicare Advantage	$330.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.51
Rate for Payer: Cigna Commercial	$550.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.01
Rate for Payer: Oxford Commercial	$220.01
Rate for Payer: Qualcare PPO/HMO/WC	$165.01
Rate for Payer: UnitedHealthcare Commercial	$220.01
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

DEVICE PUSH PULL REDUCTION

Facility

$1,100.05

Hospital Charge Code	270649704
Hospital Revenue Code	272
Min. Negotiated Rate	$165.01
Max. Negotiated Rate	$165.01
Rate for Payer: Qualcare PPO/HMO/WC	$165.01

DEVICE REVASCULARIZATION 3D

Facility

$24,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968N
Hospital Revenue Code	278
Min. Negotiated Rate	$601.29
Max. Negotiated Rate	$12,475.00
Rate for Payer: Aetna Commercial	$9,481.00
Rate for Payer: Aetna Medicare Advantage	$7,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,362.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,362.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,362.25
Rate for Payer: Cigna Commercial	$12,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,037.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,489.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,742.50
Rate for Payer: UnitedHealthcare Community & State	$601.29
Rate for Payer: Wellpoint Medicaid Managed Care	$661.17

DEVICE REVASCULARIZATION 3D

Facility

$26,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$13,475.00
Rate for Payer: Aetna Commercial	$10,241.00
Rate for Payer: Aetna Medicare Advantage	$8,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,872.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,872.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,872.25
Rate for Payer: Cigna Commercial	$13,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,521.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,929.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,042.50
Rate for Payer: UnitedHealthcare Community & State	$649.50
Rate for Payer: Wellpoint Medicaid Managed Care	$714.17

DEVICE REVASCULARIZATION 3D

Facility

$24,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968N
Hospital Revenue Code	278
Min. Negotiated Rate	$3,742.50
Max. Negotiated Rate	$6,037.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,037.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,489.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,742.50

DEVICE REVASCULARIZATION 3D

Facility

$26,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968
Hospital Revenue Code	278
Min. Negotiated Rate	$4,042.50
Max. Negotiated Rate	$6,521.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,521.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,929.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,042.50

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590N
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590S
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526N
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

Know your out-of-pocket cost for care.

All Charges