Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACTOR STONE CAPTURA 2.5FR

Facility

$883.05

Hospital Charge Code	270658544
Hospital Revenue Code	272
Min. Negotiated Rate	$132.46
Max. Negotiated Rate	$132.46
Rate for Payer: Qualcare PPO/HMO/WC	$132.46

EXTRACTOR STONE CAPTURA 2.5FR

Facility

$883.05

Hospital Charge Code	270658544
Hospital Revenue Code	272
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$441.52
Rate for Payer: Aetna Commercial	$335.56
Rate for Payer: Aetna Medicare Advantage	$264.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.18
Rate for Payer: Cigna Commercial	$441.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.92
Rate for Payer: Oxford Commercial	$176.61
Rate for Payer: Qualcare PPO/HMO/WC	$132.46
Rate for Payer: UnitedHealthcare Commercial	$176.61
Rate for Payer: UnitedHealthcare Community & State	$21.28
Rate for Payer: Wellpoint Medicaid Managed Care	$23.40

EXTRACTOR STONE HEL S 4.5

Facility

$864.85

Hospital Charge Code	270605391
Hospital Revenue Code	272
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$432.43
Rate for Payer: Aetna Commercial	$328.64
Rate for Payer: Aetna Medicare Advantage	$259.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.54
Rate for Payer: Cigna Commercial	$432.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.45
Rate for Payer: Oxford Commercial	$172.97
Rate for Payer: Qualcare PPO/HMO/WC	$129.73
Rate for Payer: UnitedHealthcare Commercial	$172.97
Rate for Payer: UnitedHealthcare Community & State	$20.84
Rate for Payer: Wellpoint Medicaid Managed Care	$22.92

EXTRACTOR STONE HEL S 4.5

Facility

$864.85

Hospital Charge Code	270605391
Hospital Revenue Code	272
Min. Negotiated Rate	$129.73
Max. Negotiated Rate	$129.73
Rate for Payer: Qualcare PPO/HMO/WC	$129.73

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.70
Rate for Payer: Oxford Commercial	$205.80
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Commercial	$205.80
Rate for Payer: UnitedHealthcare Community & State	$24.80
Rate for Payer: Wellpoint Medicaid Managed Care	$27.27

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$154.35
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$156.61
Max. Negotiated Rate	$156.61
Rate for Payer: Qualcare PPO/HMO/WC	$156.61

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$25.16
Max. Negotiated Rate	$522.02
Rate for Payer: Aetna Commercial	$396.74
Rate for Payer: Aetna Medicare Advantage	$313.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.23
Rate for Payer: Cigna Commercial	$522.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.21
Rate for Payer: Oxford Commercial	$208.81
Rate for Payer: Qualcare PPO/HMO/WC	$156.61
Rate for Payer: UnitedHealthcare Commercial	$208.81
Rate for Payer: UnitedHealthcare Community & State	$25.16
Rate for Payer: Wellpoint Medicaid Managed Care	$27.67

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$70.88
Rate for Payer: Qualcare PPO/HMO/WC	$70.88

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Commercial	$179.55
Rate for Payer: Aetna Medicare Advantage	$141.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.49
Rate for Payer: Cigna Commercial	$236.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.75
Rate for Payer: Oxford Commercial	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.88
Rate for Payer: UnitedHealthcare Commercial	$94.50
Rate for Payer: UnitedHealthcare Community & State	$11.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.52

EXTRACTOR STONE RETR XL 5

Facility

$1,024.85

Hospital Charge Code	270604771
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.42
Rate for Payer: Aetna Commercial	$389.44
Rate for Payer: Aetna Medicare Advantage	$307.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.34
Rate for Payer: Cigna Commercial	$512.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.45
Rate for Payer: Oxford Commercial	$204.97
Rate for Payer: Qualcare PPO/HMO/WC	$153.73
Rate for Payer: UnitedHealthcare Commercial	$204.97
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

EXTRACTOR STONE RETR XL 5

Facility

$1,024.85

Hospital Charge Code	270604771
Hospital Revenue Code	272
Min. Negotiated Rate	$153.73
Max. Negotiated Rate	$153.73
Rate for Payer: Qualcare PPO/HMO/WC	$153.73

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

EXTRACTOR STONE RETR XL 7 5047

Facility

$1,024.85

Hospital Charge Code	270604773
Hospital Revenue Code	272
Min. Negotiated Rate	$153.73
Max. Negotiated Rate	$153.73
Rate for Payer: Qualcare PPO/HMO/WC	$153.73

EXTRACTOR STONE RETR XL 7 5047

Facility

$1,024.85

Hospital Charge Code	270604773
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.42
Rate for Payer: Aetna Commercial	$389.44
Rate for Payer: Aetna Medicare Advantage	$307.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.34
Rate for Payer: Cigna Commercial	$512.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.45
Rate for Payer: Oxford Commercial	$204.97
Rate for Payer: Qualcare PPO/HMO/WC	$153.73
Rate for Payer: UnitedHealthcare Commercial	$204.97
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

EXTRACTOR WC STONE 12MM TXR12A

Facility

$591.85

Hospital Charge Code	270623616
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$295.93
Rate for Payer: Aetna Commercial	$224.90
Rate for Payer: Aetna Medicare Advantage	$177.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.92
Rate for Payer: Cigna Commercial	$295.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.56
Rate for Payer: Oxford Commercial	$118.37
Rate for Payer: Qualcare PPO/HMO/WC	$88.78
Rate for Payer: UnitedHealthcare Commercial	$118.37
Rate for Payer: UnitedHealthcare Community & State	$14.26
Rate for Payer: Wellpoint Medicaid Managed Care	$15.68

EXTRACTOR WC STONE 12MM TXR12A

Facility

$591.85

Hospital Charge Code	270623616
Hospital Revenue Code	272
Min. Negotiated Rate	$88.78
Max. Negotiated Rate	$88.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.78

EXTRACTOR WC STONE 15MM TXR15A

Facility

$591.85

Hospital Charge Code	270623617
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$295.93
Rate for Payer: Aetna Commercial	$224.90
Rate for Payer: Aetna Medicare Advantage	$177.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.92
Rate for Payer: Cigna Commercial	$295.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.56
Rate for Payer: Oxford Commercial	$118.37
Rate for Payer: Qualcare PPO/HMO/WC	$88.78
Rate for Payer: UnitedHealthcare Commercial	$118.37
Rate for Payer: UnitedHealthcare Community & State	$14.26
Rate for Payer: Wellpoint Medicaid Managed Care	$15.68

EXTRACTOR WC STONE 15MM TXR15A

Facility

$591.85

Hospital Charge Code	270623617
Hospital Revenue Code	272
Min. Negotiated Rate	$88.78
Max. Negotiated Rate	$88.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.78

EXTRACTOR WC STONE 3F 013300

Facility

$1,015.25

Hospital Charge Code	270601101
Hospital Revenue Code	272
Min. Negotiated Rate	$152.29
Max. Negotiated Rate	$152.29
Rate for Payer: Qualcare PPO/HMO/WC	$152.29

EXTRACTOR WC STONE 3F 013300

Facility

$1,015.25

Hospital Charge Code	270601101
Hospital Revenue Code	272
Min. Negotiated Rate	$24.47
Max. Negotiated Rate	$507.62
Rate for Payer: Aetna Commercial	$385.80
Rate for Payer: Aetna Medicare Advantage	$304.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.89
Rate for Payer: Cigna Commercial	$507.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.57
Rate for Payer: Oxford Commercial	$203.05
Rate for Payer: Qualcare PPO/HMO/WC	$152.29
Rate for Payer: UnitedHealthcare Commercial	$203.05
Rate for Payer: UnitedHealthcare Community & State	$24.47
Rate for Payer: Wellpoint Medicaid Managed Care	$26.90

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
Hospital Revenue Code	272
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTRSTRIPSCREW4MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695332
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

Know your out-of-pocket cost for care.

All Charges