Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IRRIGATION NOZZLE F/ 05.001.05

Facility

$833.00

Hospital Charge Code	270674165
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRRIGATION NOZZLE F/ 05.001.05

Facility

$833.00

Hospital Charge Code	270674165
Hospital Revenue Code	272
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.90
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$20.08
Rate for Payer: Wellpoint Medicaid Managed Care	$22.07

IRRIGATION NOZZLE F/05.001.183

Facility

$833.00

Hospital Charge Code	270674707
Hospital Revenue Code	272
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.90
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$20.08
Rate for Payer: Wellpoint Medicaid Managed Care	$22.07

IRRIGATION NOZZLE F/05.001.183

Facility

$833.00

Hospital Charge Code	270674707
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270690850
Hospital Revenue Code	272
Min. Negotiated Rate	$90.19
Max. Negotiated Rate	$90.19
Rate for Payer: Qualcare PPO/HMO/WC	$90.19

IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270690850
Hospital Revenue Code	272
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$300.62
Rate for Payer: Aetna Commercial	$228.47
Rate for Payer: Aetna Medicare Advantage	$180.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.32
Rate for Payer: Cigna Commercial	$300.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.38
Rate for Payer: Oxford Commercial	$120.25
Rate for Payer: Qualcare PPO/HMO/WC	$90.19
Rate for Payer: UnitedHealthcare Commercial	$120.25
Rate for Payer: UnitedHealthcare Community & State	$14.49
Rate for Payer: Wellpoint Medicaid Managed Care	$15.93

IRRIGATION TUBE SET

Facility

$250.00

Hospital Charge Code	270669366
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

IRRIGATION TUBE SET

Facility

$250.00

Hospital Charge Code	270669366
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

IRRIGATION TUBE SET SINGLE PK

Facility

$231.00

Hospital Charge Code	270674704
Hospital Revenue Code	272
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$115.50
Rate for Payer: Aetna Commercial	$87.78
Rate for Payer: Aetna Medicare Advantage	$69.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.91
Rate for Payer: Cigna Commercial	$115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.30
Rate for Payer: Oxford Commercial	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$34.65
Rate for Payer: UnitedHealthcare Commercial	$46.20
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.12

IRRIGATION TUBE SET SINGLE PK

Facility

$231.00

Hospital Charge Code	270674704
Hospital Revenue Code	272
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$34.65
Rate for Payer: Qualcare PPO/HMO/WC	$34.65

IRRIGATOR ARTHRO FLO

Facility

$120.00

Hospital Charge Code	270654349
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

IRRIGATOR ARTHRO FLO

Facility

$120.00

Hospital Charge Code	270654349
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$24.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

IRRIGATOR IGLOO WOUND

Facility

$5.34

Hospital Charge Code	270644301
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.03
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

IRRIGATOR IGLOO WOUND

Facility

$5.34

Hospital Charge Code	270644301
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

IRRIGATOR SHOWEHEAD SET TIP

Facility

$628.45

Hospital Charge Code	270657856
Hospital Revenue Code	270
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$314.23
Rate for Payer: Aetna Commercial	$238.81
Rate for Payer: Aetna Medicare Advantage	$188.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.25
Rate for Payer: Cigna Commercial	$314.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.53
Rate for Payer: Oxford Commercial	$125.69
Rate for Payer: Qualcare PPO/HMO/WC	$94.27
Rate for Payer: UnitedHealthcare Commercial	$125.69
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.65

IRRIGATOR SHOWEHEAD SET TIP

Facility

$628.45

Hospital Charge Code	270657856
Hospital Revenue Code	270
Min. Negotiated Rate	$94.27
Max. Negotiated Rate	$94.27
Rate for Payer: Qualcare PPO/HMO/WC	$94.27

IRRIGATOR SIMPULSE

Facility

$475.00

Hospital Charge Code	270335141
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

IRRIGATOR SIMPULSE

Facility

$475.00

Hospital Charge Code	270335141
Hospital Revenue Code	272
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

IRRIGATOR SUCTION

Facility

$453.65

Hospital Charge Code	270600334
Hospital Revenue Code	270
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$226.82
Rate for Payer: Aetna Commercial	$172.39
Rate for Payer: Aetna Medicare Advantage	$136.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.68
Rate for Payer: Cigna Commercial	$226.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.09
Rate for Payer: Oxford Commercial	$90.73
Rate for Payer: Qualcare PPO/HMO/WC	$68.05
Rate for Payer: UnitedHealthcare Commercial	$90.73
Rate for Payer: UnitedHealthcare Community & State	$10.93
Rate for Payer: Wellpoint Medicaid Managed Care	$12.02

IRRIGATOR SUCTION

Facility

$453.65

Hospital Charge Code	270600334
Hospital Revenue Code	270
Min. Negotiated Rate	$68.05
Max. Negotiated Rate	$68.05
Rate for Payer: Qualcare PPO/HMO/WC	$68.05

IRRIG CORPOR CAVERN F PRIAPISM

Facility

$833.00

Service Code	HCPCS 54220
Hospital Charge Code	5770001
Hospital Revenue Code	450
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$1,071.47
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.47
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$22.07

IRRIG CORPOR CAVERN F PRIAPISM

Facility

$833.00

Service Code	HCPCS 54220
Hospital Charge Code	5770001
Hospital Revenue Code	450
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRRIG. CYSTOTOME 25G FORMED

Facility

$36.00

Hospital Charge Code	270331571
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

IRRIG. CYSTOTOME 25G FORMED

Facility

$36.00

Hospital Charge Code	270331571
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

IRRIG G.U. 3000 ML *****

Facility

$20.00

Hospital Charge Code	7000888
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

Know your out-of-pocket cost for care.

All Charges