Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HOLDER INSTRUMENT LAPKIT LK700

Facility

$12.35

Hospital Charge Code	270635070
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.85

HOLDER INSTRUMENT LAPKIT LK700

Facility

$12.35

Hospital Charge Code	270635070
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.17
Rate for Payer: Aetna Commercial	$4.69
Rate for Payer: Aetna Medicare Advantage	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.15
Rate for Payer: Cigna Commercial	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.71
Rate for Payer: Oxford Commercial	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.85
Rate for Payer: UnitedHealthcare Commercial	$2.47
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

HOLDER LIMB DISP*****

Facility

$7.00

Hospital Charge Code	8003378
Hospital Revenue Code	279
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

HOLDER LIMB DISP*****

Facility

$7.00

Hospital Charge Code	8003378
Hospital Revenue Code	279
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

HOLDER LIMB DISPOSABLE

Facility

$13.98

Hospital Charge Code	270649967
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

HOLDER LIMB DISPOSABLE

Facility

$13.98

Hospital Charge Code	270649967
Hospital Revenue Code	270
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.99
Rate for Payer: Aetna Commercial	$5.31
Rate for Payer: Aetna Medicare Advantage	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.56
Rate for Payer: Cigna Commercial	$6.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.19
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

HOLDER NASAL DRESSING

Facility

$23.80

Hospital Charge Code	270600308
Hospital Revenue Code	272
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$3.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.57

HOLDER NASAL DRESSING

Facility

$23.80

Hospital Charge Code	270600308
Hospital Revenue Code	272
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$11.90
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: Aetna Medicare Advantage	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.07
Rate for Payer: Cigna Commercial	$11.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.14
Rate for Payer: Oxford Commercial	$4.76
Rate for Payer: Qualcare PPO/HMO/WC	$3.57
Rate for Payer: UnitedHealthcare Commercial	$4.76
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

HOLDER PIN

Facility

$1,475.00

Hospital Charge Code	270677967
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

HOLDER PIN

Facility

$1,475.00

Hospital Charge Code	270677967
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

HOLDER TRACH TUBE

Facility

$162.43

Hospital Charge Code	270655464
Hospital Revenue Code	270
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna Commercial	$61.72
Rate for Payer: Aetna Medicare Advantage	$48.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.42
Rate for Payer: Cigna Commercial	$81.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.73
Rate for Payer: Oxford Commercial	$32.49
Rate for Payer: Qualcare PPO/HMO/WC	$24.36
Rate for Payer: UnitedHealthcare Commercial	$32.49
Rate for Payer: UnitedHealthcare Community & State	$3.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.30

HOLDER TRACH TUBE

Facility

$4.46

Hospital Charge Code	270649129
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

HOLDER TRACH TUBE

Facility

$4.46

Hospital Charge Code	270649129
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare Advantage	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$0.89
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

HOLDER TRACH TUBE

Facility

$162.43

Hospital Charge Code	270655464
Hospital Revenue Code	270
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$24.36
Rate for Payer: Qualcare PPO/HMO/WC	$24.36

HOLDER TRACH TUBE 1

Facility

$14.44

Hospital Charge Code	270302216
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.22
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Aetna Medicare Advantage	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.68
Rate for Payer: Cigna Commercial	$7.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

HOLDER TRACH TUBE 1

Facility

$14.44

Hospital Charge Code	270302216
Hospital Revenue Code	270
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

HOLDER TRACH TUBE ADHESIVE 270

Facility

$35.15

Hospital Charge Code	270642091
Hospital Revenue Code	419
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$13.36
Rate for Payer: Aetna Medicare Advantage	$10.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.96
Rate for Payer: Cigna Commercial	$17.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.54
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

HOLDER TRACH TUBE ADHESIVE 270

Facility

$35.15

Hospital Charge Code	270642091
Hospital Revenue Code	419
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

HOLDER TRUCLIP 8X2.7X2.5 IN

Facility

$600.00

Hospital Charge Code	270683526
Hospital Revenue Code	272
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

HOLDER TRUCLIP 8X2.7X2.5 IN

Facility

$600.00

Hospital Charge Code	270683526
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

HOLDING PINS MINI HEAD 3.2mm

Facility

$1,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270674366
Hospital Revenue Code	278
Min. Negotiated Rate	$251.25
Max. Negotiated Rate	$405.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$368.50
Rate for Payer: Qualcare PPO/HMO/WC	$251.25

HOLDING PINS MINI HEAD 3.2mm

Facility

$1,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270674366
Hospital Revenue Code	278
Min. Negotiated Rate	$40.37
Max. Negotiated Rate	$837.50
Rate for Payer: Aetna Commercial	$636.50
Rate for Payer: Aetna Medicare Advantage	$502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$427.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$427.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$427.12
Rate for Payer: Cigna Commercial	$837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$368.50
Rate for Payer: Qualcare PPO/HMO/WC	$251.25
Rate for Payer: UnitedHealthcare Community & State	$40.37
Rate for Payer: Wellpoint Medicaid Managed Care	$44.39

HOLDING SLEEVE

Facility

$1,590.00

Hospital Charge Code	270654605
Hospital Revenue Code	272
Min. Negotiated Rate	$238.50
Max. Negotiated Rate	$238.50
Rate for Payer: Qualcare PPO/HMO/WC	$238.50

HOLDING SLEEVE

Facility

$1,590.00

Hospital Charge Code	270654605
Hospital Revenue Code	272
Min. Negotiated Rate	$38.32
Max. Negotiated Rate	$795.00
Rate for Payer: Aetna Commercial	$604.20
Rate for Payer: Aetna Medicare Advantage	$477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$405.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$405.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$405.45
Rate for Payer: Cigna Commercial	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.00
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$238.50
Rate for Payer: UnitedHealthcare Commercial	$318.00
Rate for Payer: UnitedHealthcare Community & State	$38.32
Rate for Payer: Wellpoint Medicaid Managed Care	$42.13

HOLDING SLEEVE FOR STARDRIVE

Facility

$3,344.05

Hospital Charge Code	270688592
Hospital Revenue Code	272
Min. Negotiated Rate	$501.61
Max. Negotiated Rate	$501.61
Rate for Payer: Qualcare PPO/HMO/WC	$501.61

Know your out-of-pocket cost for care.

All Charges