Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$20.00

Hospital Charge Code	7000888
Hospital Revenue Code	279
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

IRRIG OF DRUG DELIVERY SYSTEM

Facility

$323.35

Service Code	HCPCS 96523
Hospital Charge Code	3401160
Hospital Revenue Code	335
Min. Negotiated Rate	$48.50
Max. Negotiated Rate	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.50

IRRIG OF DRUG DELIVERY SYSTEM

Facility

$323.35

Service Code	HCPCS 96523
Hospital Charge Code	3401160
Hospital Revenue Code	335
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$49.06
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$8.57

IRRIG STERILE WATER 1000ML****

Facility

$10.00

Hospital Charge Code	7000110
Hospital Revenue Code	258
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

IRRIG STERILE WATER 1000ML****

Facility

$10.00

Hospital Charge Code	7000110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

IRRISEPT CLEANSNG & DEBRID SYS

Facility

$316.50

Hospital Charge Code	270680866
Hospital Revenue Code	272
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$158.25
Rate for Payer: Aetna Commercial	$120.27
Rate for Payer: Aetna Medicare Advantage	$94.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.71
Rate for Payer: Cigna Commercial	$158.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.95
Rate for Payer: Oxford Commercial	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$47.48
Rate for Payer: UnitedHealthcare Commercial	$63.30
Rate for Payer: UnitedHealthcare Community & State	$7.63
Rate for Payer: Wellpoint Medicaid Managed Care	$8.39

IRRISEPT CLEANSNG & DEBRID SYS

Facility

$316.50

Hospital Charge Code	270680866
Hospital Revenue Code	272
Min. Negotiated Rate	$47.48
Max. Negotiated Rate	$47.48
Rate for Payer: Qualcare PPO/HMO/WC	$47.48

IR RNAL CYST STDY TRNSLMBR LFT

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600110
Hospital Revenue Code	320
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

IR RNAL CYST STDY TRNSLMBR LFT

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600110
Hospital Revenue Code	320
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Qualcare PPO/HMO/WC	$99.73

IR RNAL CYST STDY TRNSLMBR RGH

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600111
Hospital Revenue Code	320
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

IR RNAL CYST STDY TRNSLMBR RGH

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600111
Hospital Revenue Code	320
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Qualcare PPO/HMO/WC	$99.73

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
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

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$392.00
Rate for Payer: Aetna Commercial	$297.92
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.20
Rate for Payer: Oxford Commercial	$156.80
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$156.80
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.78

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
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

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
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

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
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

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
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

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
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

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

Know your out-of-pocket cost for care.

All Charges