Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRAPE UNDER BUTTOCK W/POUCH

Facility

$20.26

Hospital Charge Code	270649150
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.13
Rate for Payer: Aetna Commercial	$7.70
Rate for Payer: Aetna Medicare Advantage	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.17
Rate for Payer: Cigna Commercial	$10.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.08
Rate for Payer: Oxford Commercial	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$4.05
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

DRAPE UNI VIDEO CAM/LAS ARM

Facility

$24.57

Hospital Charge Code	270654584
Hospital Revenue Code	272
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$3.69

DRAPE UNI VIDEO CAM/LAS ARM

Facility

$24.57

Hospital Charge Code	270654584
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.29
Rate for Payer: Aetna Commercial	$9.34
Rate for Payer: Aetna Medicare Advantage	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.27
Rate for Payer: Cigna Commercial	$12.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.37
Rate for Payer: Oxford Commercial	$4.91
Rate for Payer: Qualcare PPO/HMO/WC	$3.69
Rate for Payer: UnitedHealthcare Commercial	$4.91
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

DRAPE UROLOG STER ******

Facility

$28.00

Hospital Charge Code	1600626
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

DRAPE UROLOG STER ******

Facility

$28.00

Hospital Charge Code	1600626
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

DRAPE UTILITY 89731

Facility

$6.68

Hospital Charge Code	270649152
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.34
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna Medicare Advantage	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.70
Rate for Payer: Cigna Commercial	$3.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

DRAPE UTILITY 89731

Facility

$6.68

Hospital Charge Code	270649152
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

DRAPE VIDEO CAMERA

Facility

$64.20

Hospital Charge Code	270664199
Hospital Revenue Code	270
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$9.63
Rate for Payer: Qualcare PPO/HMO/WC	$9.63

DRAPE VIDEO CAMERA

Facility

$64.20

Hospital Charge Code	270664199
Hospital Revenue Code	270
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$32.10
Rate for Payer: Aetna Commercial	$24.40
Rate for Payer: Aetna Medicare Advantage	$19.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.37
Rate for Payer: Cigna Commercial	$32.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.26
Rate for Payer: Oxford Commercial	$12.84
Rate for Payer: Qualcare PPO/HMO/WC	$9.63
Rate for Payer: UnitedHealthcare Commercial	$12.84
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

DRAPE VIDEO CAMERA 4604

Facility

$77.65

Hospital Charge Code	270614584
Hospital Revenue Code	272
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

DRAPE VIDEO CAMERA 4604

Facility

$77.65

Hospital Charge Code	270614584
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$15.53
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

DRAPE WARMER 44x66 ORS-300

Facility

$196.88

Hospital Charge Code	270648307
Hospital Revenue Code	272
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$29.53
Rate for Payer: Qualcare PPO/HMO/WC	$29.53

DRAPE WARMER 44x66 ORS-300

Facility

$196.88

Hospital Charge Code	270648307
Hospital Revenue Code	272
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$98.44
Rate for Payer: Aetna Commercial	$74.81
Rate for Payer: Aetna Medicare Advantage	$59.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.20
Rate for Payer: Cigna Commercial	$98.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.06
Rate for Payer: Oxford Commercial	$39.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.53
Rate for Payer: UnitedHealthcare Commercial	$39.38
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$5.22

DRAPE XRAY CASSETTE *******

Facility

$17.00

Hospital Charge Code	1603042
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

DRAPE XRAY CASSETTE *******

Facility

$17.00

Hospital Charge Code	1603042
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

DRAPE XRAY CASSETTE Z-DRAPE

Facility

$47.25

Hospital Charge Code	270060845
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

DRAPE XRAY CASSETTE Z-DRAPE

Facility

$47.25

Hospital Charge Code	270060845
Hospital Revenue Code	272
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

DRAPE X-RAY CASSETT LARGE

Facility

$35.83

Hospital Charge Code	270650754
Hospital Revenue Code	270
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$5.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.37

DRAPE X-RAY CASSETT LARGE

Facility

$35.83

Hospital Charge Code	270650754
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$13.62
Rate for Payer: Aetna Medicare Advantage	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Oxford Commercial	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$5.37
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

DRAPE X-RAY MINI C-ARM/MOBILE

Facility

$172.75

Hospital Charge Code	270656039
Hospital Revenue Code	271
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$86.38
Rate for Payer: Aetna Commercial	$65.64
Rate for Payer: Aetna Medicare Advantage	$51.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.05
Rate for Payer: Cigna Commercial	$86.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.83
Rate for Payer: Oxford Commercial	$34.55
Rate for Payer: Qualcare PPO/HMO/WC	$25.91
Rate for Payer: UnitedHealthcare Commercial	$34.55
Rate for Payer: UnitedHealthcare Community & State	$4.16
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

DRAPE X-RAY MINI C-ARM/MOBILE

Facility

$172.75

Hospital Charge Code	270656039
Hospital Revenue Code	271
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$25.91
Rate for Payer: Qualcare PPO/HMO/WC	$25.91

DRAW BLOOD ESTABLISHED LINE

Facility

$623.55

Service Code	HCPCS 36592
Hospital Charge Code	3401165
Hospital Revenue Code	361
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.06
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.53
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$15.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.52

DRAW BLOOD ESTABLISHED LINE

Facility

$623.55

Service Code	HCPCS 36592
Hospital Charge Code	3401165
Hospital Revenue Code	361
Min. Negotiated Rate	$93.53
Max. Negotiated Rate	$93.53
Rate for Payer: Qualcare PPO/HMO/WC	$93.53

DREAMTOME 450CM

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696134
Hospital Revenue Code	272
Min. Negotiated Rate	$48.92
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$771.30
Rate for Payer: Aetna Medicare Advantage	$608.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.59
Rate for Payer: Cigna Commercial	$1,014.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$608.92
Rate for Payer: Oxford Commercial	$405.95
Rate for Payer: Qualcare PPO/HMO/WC	$304.46
Rate for Payer: UnitedHealthcare Commercial	$405.95
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$53.79

DREAMTOME 450CM

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696134
Hospital Revenue Code	272
Min. Negotiated Rate	$304.46
Max. Negotiated Rate	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$304.46

Know your out-of-pocket cost for care.

All Charges