Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT REPAIR HICKM 10FR 0601750

Facility

$744.00

Hospital Charge Code	270603374
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

KIT REPAIR HICKM 10FR 0601750

Facility

$744.00

Hospital Charge Code	270603374
Hospital Revenue Code	272
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.20
Rate for Payer: Oxford Commercial	$148.80
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Commercial	$148.80
Rate for Payer: UnitedHealthcare Community & State	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.72

KIT REPAIR HICKM RD CP 0601690

Facility

$514.45

Hospital Charge Code	270603372
Hospital Revenue Code	272
Min. Negotiated Rate	$77.17
Max. Negotiated Rate	$77.17
Rate for Payer: Qualcare PPO/HMO/WC	$77.17

KIT REPAIR HICKM RD CP 0601690

Facility

$514.45

Hospital Charge Code	270603372
Hospital Revenue Code	272
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$257.23
Rate for Payer: Aetna Commercial	$195.49
Rate for Payer: Aetna Medicare Advantage	$154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.18
Rate for Payer: Cigna Commercial	$257.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.34
Rate for Payer: Oxford Commercial	$102.89
Rate for Payer: Qualcare PPO/HMO/WC	$77.17
Rate for Payer: UnitedHealthcare Commercial	$102.89
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

KIT REPAIR HICKM WT CP 0601680

Facility

$514.45

Hospital Charge Code	270603373
Hospital Revenue Code	272
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$257.23
Rate for Payer: Aetna Commercial	$195.49
Rate for Payer: Aetna Medicare Advantage	$154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.18
Rate for Payer: Cigna Commercial	$257.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.34
Rate for Payer: Oxford Commercial	$102.89
Rate for Payer: Qualcare PPO/HMO/WC	$77.17
Rate for Payer: UnitedHealthcare Commercial	$102.89
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

KIT REPAIR HICKM WT CP 0601680

Facility

$514.45

Hospital Charge Code	270603373
Hospital Revenue Code	272
Min. Negotiated Rate	$77.17
Max. Negotiated Rate	$77.17
Rate for Payer: Qualcare PPO/HMO/WC	$77.17

KIT REPAIR LIGAMENT 2.0

Facility

$7,475.00

Hospital Charge Code	270688256
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

KIT REPAIR LIGAMENT 2.0

Facility

$7,475.00

Hospital Charge Code	270688256
Hospital Revenue Code	272
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

KIT RESORABLE MIN BEAD

Facility

$3,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270645042
Hospital Revenue Code	278
Min. Negotiated Rate	$84.11
Max. Negotiated Rate	$1,745.00
Rate for Payer: Aetna Commercial	$1,326.20
Rate for Payer: Aetna Medicare Advantage	$1,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$889.95
Rate for Payer: Cigna Commercial	$1,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$767.80
Rate for Payer: Qualcare PPO/HMO/WC	$523.50
Rate for Payer: UnitedHealthcare Community & State	$84.11
Rate for Payer: Wellpoint Medicaid Managed Care	$92.48

KIT RESORABLE MIN BEAD

Facility

$3,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270645042
Hospital Revenue Code	278
Min. Negotiated Rate	$523.50
Max. Negotiated Rate	$844.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$767.80
Rate for Payer: Qualcare PPO/HMO/WC	$523.50

KIT RETRACTOR 3308L

Facility

$662.45

Hospital Charge Code	270600268
Hospital Revenue Code	272
Min. Negotiated Rate	$99.37
Max. Negotiated Rate	$99.37
Rate for Payer: Qualcare PPO/HMO/WC	$99.37

KIT RETRACTOR 3308L

Facility

$662.45

Hospital Charge Code	270600268
Hospital Revenue Code	272
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$331.23
Rate for Payer: Aetna Commercial	$251.73
Rate for Payer: Aetna Medicare Advantage	$198.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.92
Rate for Payer: Cigna Commercial	$331.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.74
Rate for Payer: Oxford Commercial	$132.49
Rate for Payer: Qualcare PPO/HMO/WC	$99.37
Rate for Payer: UnitedHealthcare Commercial	$132.49
Rate for Payer: UnitedHealthcare Community & State	$15.97
Rate for Payer: Wellpoint Medicaid Managed Care	$17.55

KIT RETRIEVAL SNARE

Facility

$2,500.00

Hospital Charge Code	270671363N
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363S
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363S
Hospital Revenue Code	272
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$450.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

KIT RETRIEVAL SNARE

Facility

$2,500.00

Hospital Charge Code	270671363N
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363C
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363C
Hospital Revenue Code	272
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$450.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

KIT REVISION STERILE 355010

Facility

$1,438.45

Hospital Charge Code	270632708
Hospital Revenue Code	272
Min. Negotiated Rate	$215.77
Max. Negotiated Rate	$215.77
Rate for Payer: Qualcare PPO/HMO/WC	$215.77

KIT REVISION STERILE 355010

Facility

$1,438.45

Hospital Charge Code	270632708
Hospital Revenue Code	272
Min. Negotiated Rate	$34.67
Max. Negotiated Rate	$719.23
Rate for Payer: Aetna Commercial	$546.61
Rate for Payer: Aetna Medicare Advantage	$431.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.80
Rate for Payer: Cigna Commercial	$719.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.54
Rate for Payer: Oxford Commercial	$287.69
Rate for Payer: Qualcare PPO/HMO/WC	$215.77
Rate for Payer: UnitedHealthcare Commercial	$287.69
Rate for Payer: UnitedHealthcare Community & State	$34.67
Rate for Payer: Wellpoint Medicaid Managed Care	$38.12

KIT RIGHT HEART

Facility

$750.00

Hospital Charge Code	270678577N
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

KIT RIGHT HEART

Facility

$75.00

Hospital Charge Code	270678577
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

KIT RIGHT HEART

Facility

$750.00

Hospital Charge Code	270678577N
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

KIT RIGHT HEART

Facility

$75.00

Hospital Charge Code	270678577
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

KIT RIGHT HEART (CUSTOM)

Facility

$112.50

Hospital Charge Code	2709002684
Hospital Revenue Code	272
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

Know your out-of-pocket cost for care.

All Charges