Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE TORQUE

Facility

$22.50

Hospital Charge Code	270636399
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEVICE TORQUE

Facility

$22.50

Hospital Charge Code	270636399
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DEVICE TORQUE 91400300

Facility

$29.85

Hospital Charge Code	270632533
Hospital Revenue Code	272
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$4.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.48

DEVICE TORQUE 91400300

Facility

$29.85

Hospital Charge Code	270632533
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.93
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.61
Rate for Payer: Cigna Commercial	$14.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.96
Rate for Payer: Oxford Commercial	$5.97
Rate for Payer: Qualcare PPO/HMO/WC	$4.48
Rate for Payer: UnitedHealthcare Commercial	$5.97
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DEVICE TORQUE ALCOTT

Facility

$80.00

Hospital Charge Code	270660229
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

DEVICE TORQUE ALCOTT

Facility

$80.00

Hospital Charge Code	270660229
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DEVICE VSS SEALING DUETT 2200

Facility

$980.00

Hospital Charge Code	270626503
Hospital Revenue Code	272
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$147.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

DEVICE VSS SEALING DUETT 2200

Facility

$980.00

Hospital Charge Code	270626503
Hospital Revenue Code	272
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$372.40
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.00
Rate for Payer: Oxford Commercial	$196.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.00
Rate for Payer: UnitedHealthcare Commercial	$196.00
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: Wellpoint Medicaid Managed Care	$25.97

DEVICE WEB17 SL 4X2MM

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697114S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,371.25
Max. Negotiated Rate	$19,958.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25

DEVICE WEB17 SL 4X2MM

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697114S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.65
Max. Negotiated Rate	$41,237.50
Rate for Payer: Aetna Commercial	$31,340.50
Rate for Payer: Aetna Medicare Advantage	$24,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,031.12
Rate for Payer: Cigna Commercial	$41,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25
Rate for Payer: UnitedHealthcare Community & State	$1,987.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2,185.59

DEVICE WEB17SL EMBOL COIL 4X2

Facility

$82,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697714S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.65
Max. Negotiated Rate	$41,237.50
Rate for Payer: Aetna Commercial	$31,340.50
Rate for Payer: Aetna Medicare Advantage	$24,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,031.12
Rate for Payer: Cigna Commercial	$41,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25
Rate for Payer: UnitedHealthcare Community & State	$1,987.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2,185.59

DEVICE WEB17SL EMBOL COIL 4X2

Facility

$82,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697714S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,371.25
Max. Negotiated Rate	$19,958.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25

DEVICE WEB17 SL EMBOLIZ COIL

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270696907S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.65
Max. Negotiated Rate	$41,237.50
Rate for Payer: Aetna Commercial	$31,340.50
Rate for Payer: Aetna Medicare Advantage	$24,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,031.12
Rate for Payer: Cigna Commercial	$41,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25
Rate for Payer: UnitedHealthcare Community & State	$1,987.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2,185.59

DEVICE WEB17 SL EMBOLIZ COIL

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270696907S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,371.25
Max. Negotiated Rate	$19,958.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,144.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25

DEVICE ZIM STATAK 2.5 2344-50

Facility

$3,132.00

Hospital Charge Code	270611218
Hospital Revenue Code	278
Min. Negotiated Rate	$75.48
Max. Negotiated Rate	$1,566.00
Rate for Payer: Aetna Commercial	$1,190.16
Rate for Payer: Aetna Medicare Advantage	$939.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$798.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$798.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$626.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$798.66
Rate for Payer: Cigna Commercial	$1,566.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$689.04
Rate for Payer: Qualcare PPO/HMO/WC	$469.80
Rate for Payer: UnitedHealthcare Community & State	$75.48
Rate for Payer: Wellpoint Medicaid Managed Care	$83.00

DEVICE ZIM STATAK 2.5 2344-50

Facility

$3,132.00

Hospital Charge Code	270611218
Hospital Revenue Code	278
Min. Negotiated Rate	$469.80
Max. Negotiated Rate	$757.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$626.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$689.04
Rate for Payer: Qualcare PPO/HMO/WC	$469.80

DEX 4 GEL

Facility

$10.00

Hospital Charge Code	60630069WG
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

DEX 4 GEL

Facility

$10.00

Hospital Charge Code	60630069WG
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEX 5%.3% SOD CHL500ml 7925-03

Facility

$17.50

Hospital Charge Code	270649408
Hospital Revenue Code	258
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

Know your out-of-pocket cost for care.

All Charges