Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR WC COL BALLN QDC16X5.5

Facility

$396.85

Hospital Charge Code	270623618
Hospital Revenue Code	272
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

DILATOR WC COL BALLN QDC18X5.5

Facility

$396.85

Hospital Charge Code	270623619
Hospital Revenue Code	272
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

DILATOR WC COL BALLN QDC18X5.5

Facility

$396.85

Hospital Charge Code	270623619
Hospital Revenue Code	272
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$198.43
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna Medicare Advantage	$119.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.20
Rate for Payer: Cigna Commercial	$198.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.06
Rate for Payer: Oxford Commercial	$79.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.53
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Community & State	$9.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10.52

DILATOR WC VESSEL 10 JCD103820

Facility

$23.25

Hospital Charge Code	270601478
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.49

DILATOR WC VESSEL 10 JCD103820

Facility

$23.25

Hospital Charge Code	270601478
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.62
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare Advantage	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.93
Rate for Payer: Cigna Commercial	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.49
Rate for Payer: UnitedHealthcare Commercial	$4.65
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

DILATOR WC VESSEL 12 JCD123820

Facility

$30.45

Hospital Charge Code	270601475
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$11.57
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$6.09
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

DILATOR WC VESSEL 12 JCD123820

Facility

$30.45

Hospital Charge Code	270601475
Hospital Revenue Code	272
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.57

DILATOR WC VESSEL 16 JCD163820

Facility

$6.76

Hospital Charge Code	270601466
Hospital Revenue Code	278
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.01

DILATOR WC VESSEL 16 JCD163820

Facility

$6.76

Hospital Charge Code	270601466
Hospital Revenue Code	278
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.72
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

DILATOR WC VESSEL 4F JCD402520

Facility

$22.35

Hospital Charge Code	270601465
Hospital Revenue Code	272
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$3.35

DILATOR WC VESSEL 4F JCD402520

Facility

$22.35

Hospital Charge Code	270601465
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.18
Rate for Payer: Aetna Commercial	$8.49
Rate for Payer: Aetna Medicare Advantage	$6.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.70
Rate for Payer: Cigna Commercial	$11.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.71
Rate for Payer: Oxford Commercial	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.35
Rate for Payer: UnitedHealthcare Commercial	$4.47
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

DILATOR WC VESSEL 5F JCD503820

Facility

$22.70

Hospital Charge Code	270601467
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.35
Rate for Payer: Aetna Commercial	$8.63
Rate for Payer: Aetna Medicare Advantage	$6.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.79
Rate for Payer: Cigna Commercial	$11.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.81
Rate for Payer: Oxford Commercial	$4.54
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$4.54
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DILATOR WC VESSEL 5F JCD503820

Facility

$22.70

Hospital Charge Code	270601467
Hospital Revenue Code	272
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

DILATOR WC VESSEL 6F JCD603820

Facility

$22.70

Hospital Charge Code	270601480
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.35
Rate for Payer: Aetna Commercial	$8.63
Rate for Payer: Aetna Medicare Advantage	$6.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.79
Rate for Payer: Cigna Commercial	$11.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.81
Rate for Payer: Oxford Commercial	$4.54
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$4.54
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DILATOR WC VESSEL 6F JCD603820

Facility

$22.70

Hospital Charge Code	270601480
Hospital Revenue Code	272
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

DILATOR WC VESSEL 8 JCD083820

Facility

$23.25

Hospital Charge Code	270601477
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.49

DILATOR WC VESSEL 8 JCD083820

Facility

$23.25

Hospital Charge Code	270601477
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.62
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare Advantage	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.93
Rate for Payer: Cigna Commercial	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.49
Rate for Payer: UnitedHealthcare Commercial	$4.65
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

DILAT XST TRC NDURLGC PX

Facility

$18,928.50

Service Code	HCPCS 50436
Hospital Charge Code	411050436
Hospital Revenue Code	361
Min. Negotiated Rate	$2,839.28
Max. Negotiated Rate	$2,839.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28

DILAT XST TRC NDURLGC PX

Facility

$18,928.50

Service Code	HCPCS 50436
Hospital Charge Code	411050436
Hospital Revenue Code	361
Min. Negotiated Rate	$456.18
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,678.55
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$456.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$501.61

DILAT XST TRC NEW ACCESS RCS

Facility

$18,928.50

Service Code	HCPCS 50437
Hospital Charge Code	411050437
Hospital Revenue Code	361
Min. Negotiated Rate	$2,839.28
Max. Negotiated Rate	$2,839.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28

DILAT XST TRC NEW ACCESS RCS

Facility

$18,928.50

Service Code	HCPCS 50437
Hospital Charge Code	411050437
Hospital Revenue Code	361
Min. Negotiated Rate	$456.18
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,678.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$456.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$501.61

DILAUDID/2MG/TAB

Facility

$4.00

Hospital Charge Code	60632847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DILAUDID/2MG/TAB

Facility

$4.00

Hospital Charge Code	60632847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DILAUDID/3MG/TAB

Facility

$3.00

Hospital Charge Code	60632849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DILAUDID/3MG/TAB

Facility

$3.00

Hospital Charge Code	60632849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

Know your out-of-pocket cost for care.

All Charges