Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRAIN ROUND SILICONE 14 19FR

Facility

$29.81

Hospital Charge Code	270649143
Hospital Revenue Code	270
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$4.47

DRAIN ROUND SILICONE 14 19FR

Facility

$29.81

Hospital Charge Code	270649143
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.90
Rate for Payer: Aetna Commercial	$11.33
Rate for Payer: Aetna Medicare Advantage	$8.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.60
Rate for Payer: Cigna Commercial	$14.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.94
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.47
Rate for Payer: UnitedHealthcare Commercial	$5.96
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DRAIN SHIRLEY WOUND

Facility

$44.03

Hospital Charge Code	270649920
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.02
Rate for Payer: Aetna Commercial	$16.73
Rate for Payer: Aetna Medicare Advantage	$13.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.23
Rate for Payer: Cigna Commercial	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.21
Rate for Payer: Oxford Commercial	$8.81
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.81
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

DRAIN SHIRLEY WOUND

Facility

$44.03

Hospital Charge Code	270649920
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

DRAIN SILICONE TRIPLE

Facility

$332.00

Hospital Charge Code	270060730
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$166.00
Rate for Payer: Aetna Commercial	$126.16
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.60
Rate for Payer: Oxford Commercial	$66.40
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$66.40
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

DRAIN SILICONE TRIPLE

Facility

$332.00

Hospital Charge Code	270060730
Hospital Revenue Code	272
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

DRAIN (TAUT) *******

Facility

$55.00

Hospital Charge Code	8000564
Hospital Revenue Code	279
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

DRAIN (TAUT) *******

Facility

$55.00

Hospital Charge Code	8000564
Hospital Revenue Code	279
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

DRAIN TO PERITONEAL CAVITY

Facility

$3,005.56

Service Code	HCPCS 49062
Hospital Charge Code	1600000343
Hospital Revenue Code	360
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$1,142.11
Rate for Payer: Aetna Medicare Advantage	$901.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.42
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	$766.42
Rate for Payer: Cigna Commercial	$1,502.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$901.67
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.83
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$72.43
Rate for Payer: Wellpoint Medicaid Managed Care	$79.65

DRAIN TO PERITONEAL CAVITY

Facility

$3,005.56

Service Code	HCPCS 49062
Hospital Charge Code	1600000343
Hospital Revenue Code	360
Min. Negotiated Rate	$450.83
Max. Negotiated Rate	$450.83
Rate for Payer: Qualcare PPO/HMO/WC	$450.83

DRAIN T-TUBE CATTELL 16 FR

Facility

$37.73

Hospital Charge Code	270659384
Hospital Revenue Code	270
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$14.34
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.62
Rate for Payer: Cigna Commercial	$18.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Oxford Commercial	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Commercial	$7.55
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

DRAIN T-TUBE CATTELL 16 FR

Facility

$37.73

Hospital Charge Code	270659384
Hospital Revenue Code	270
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$5.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

DRAIN URET,SYSTEM STRL

Facility

$103.00

Hospital Charge Code	270331591
Hospital Revenue Code	278
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAIN URET,SYSTEM STRL

Facility

$103.00

Hospital Charge Code	270331591
Hospital Revenue Code	278
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

DRAIN WICK MEROCAL EYE 400108

Facility

$3.25

Hospital Charge Code	270614580
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Commercial	$0.65
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

DRAIN WICK MEROCAL EYE 400108

Facility

$3.25

Hospital Charge Code	270614580
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

DRAIN WOUND EVAC MED 1/8

Facility

$53.35

Hospital Charge Code	270601098
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$26.68
Rate for Payer: Aetna Commercial	$20.27
Rate for Payer: Aetna Medicare Advantage	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.60
Rate for Payer: Cigna Commercial	$26.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.00
Rate for Payer: Oxford Commercial	$10.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.00
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

DRAIN WOUND EVAC MED 1/8

Facility

$53.35

Hospital Charge Code	270601098
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.00

DRAIN WOUND SHIRLEY AN-30

Facility

$51.45

Hospital Charge Code	270649145
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.73
Rate for Payer: Aetna Commercial	$19.55
Rate for Payer: Aetna Medicare Advantage	$15.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$25.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.44
Rate for Payer: Oxford Commercial	$10.29
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$10.29
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

DRAIN WOUND SHIRLEY AN-30

Facility

$51.45

Hospital Charge Code	270649145
Hospital Revenue Code	270
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

DRAPE 3M STER *******

Facility

$15.00

Hospital Charge Code	1600857
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

DRAPE 3M STER *******

Facility

$15.00

Hospital Charge Code	1600857
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DRAPE ANGIOGRAPHY

Facility

$30.57

Hospital Charge Code	270628155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.29
Rate for Payer: Aetna Commercial	$11.62
Rate for Payer: Aetna Medicare Advantage	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.80
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.17
Rate for Payer: Oxford Commercial	$6.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.11
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

DRAPE ANGIOGRAPHY

Facility

$30.57

Hospital Charge Code	270628155
Hospital Revenue Code	270
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

DRAPE BAG VI ISOLATION

Facility

$93.65

Hospital Charge Code	270060795
Hospital Revenue Code	272
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$46.83
Rate for Payer: Aetna Commercial	$35.59
Rate for Payer: Aetna Medicare Advantage	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.88
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$18.73
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

Know your out-of-pocket cost for care.

All Charges