Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT SPRAY ACCESSORY 934500

Facility

$208.00

Hospital Charge Code	270635992
Hospital Revenue Code	272
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$41.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$41.60
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

KIT STAPLE FUSEFORSE 15X15MM

Facility

$6,425.00

Hospital Charge Code	270678362
Hospital Revenue Code	272
Min. Negotiated Rate	$963.75
Max. Negotiated Rate	$963.75
Rate for Payer: Qualcare PPO/HMO/WC	$963.75

KIT STAPLE FUSEFORSE 15X15MM

Facility

$6,425.00

Hospital Charge Code	270678362
Hospital Revenue Code	272
Min. Negotiated Rate	$154.84
Max. Negotiated Rate	$3,212.50
Rate for Payer: Aetna Commercial	$2,441.50
Rate for Payer: Aetna Medicare Advantage	$1,927.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.38
Rate for Payer: Cigna Commercial	$3,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.50
Rate for Payer: Oxford Commercial	$1,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.75
Rate for Payer: UnitedHealthcare Commercial	$1,285.00
Rate for Payer: UnitedHealthcare Community & State	$154.84
Rate for Payer: Wellpoint Medicaid Managed Care	$170.26

KIT STAPLE FUSEFORSE 20X20MM

Facility

$6,425.00

Hospital Charge Code	270678360
Hospital Revenue Code	272
Min. Negotiated Rate	$154.84
Max. Negotiated Rate	$3,212.50
Rate for Payer: Aetna Commercial	$2,441.50
Rate for Payer: Aetna Medicare Advantage	$1,927.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.38
Rate for Payer: Cigna Commercial	$3,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.50
Rate for Payer: Oxford Commercial	$1,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.75
Rate for Payer: UnitedHealthcare Commercial	$1,285.00
Rate for Payer: UnitedHealthcare Community & State	$154.84
Rate for Payer: Wellpoint Medicaid Managed Care	$170.26

KIT STAPLE FUSEFORSE 20X20MM

Facility

$6,425.00

Hospital Charge Code	270678360
Hospital Revenue Code	272
Min. Negotiated Rate	$963.75
Max. Negotiated Rate	$963.75
Rate for Payer: Qualcare PPO/HMO/WC	$963.75

KIT STAPLE FUSEFORSE 25X22MM

Facility

$6,425.00

Hospital Charge Code	270678358
Hospital Revenue Code	272
Min. Negotiated Rate	$154.84
Max. Negotiated Rate	$3,212.50
Rate for Payer: Aetna Commercial	$2,441.50
Rate for Payer: Aetna Medicare Advantage	$1,927.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.38
Rate for Payer: Cigna Commercial	$3,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.50
Rate for Payer: Oxford Commercial	$1,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.75
Rate for Payer: UnitedHealthcare Commercial	$1,285.00
Rate for Payer: UnitedHealthcare Community & State	$154.84
Rate for Payer: Wellpoint Medicaid Managed Care	$170.26

KIT STAPLE FUSEFORSE 25X22MM

Facility

$6,425.00

Hospital Charge Code	270678358
Hospital Revenue Code	272
Min. Negotiated Rate	$963.75
Max. Negotiated Rate	$963.75
Rate for Payer: Qualcare PPO/HMO/WC	$963.75

KIT STAPLER HEMORRHOID PPH03

Facility

$1,987.65

Hospital Charge Code	270632860
Hospital Revenue Code	272
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$993.83
Rate for Payer: Aetna Commercial	$755.31
Rate for Payer: Aetna Medicare Advantage	$596.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.85
Rate for Payer: Cigna Commercial	$993.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.29
Rate for Payer: Oxford Commercial	$397.53
Rate for Payer: Qualcare PPO/HMO/WC	$298.15
Rate for Payer: UnitedHealthcare Commercial	$397.53
Rate for Payer: UnitedHealthcare Community & State	$47.90
Rate for Payer: Wellpoint Medicaid Managed Care	$52.67

KIT STAPLER HEMORRHOID PPH03

Facility

$1,987.65

Hospital Charge Code	270632860
Hospital Revenue Code	272
Min. Negotiated Rate	$298.15
Max. Negotiated Rate	$298.15
Rate for Payer: Qualcare PPO/HMO/WC	$298.15

KIT STAPLE STRAIGHT 8X 8 MM

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270700260
Hospital Revenue Code	278
Min. Negotiated Rate	$987.75
Max. Negotiated Rate	$1,593.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,448.70
Rate for Payer: Qualcare PPO/HMO/WC	$987.75

KIT STAPLE STRAIGHT 8X 8 MM

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270700260
Hospital Revenue Code	278
Min. Negotiated Rate	$158.70
Max. Negotiated Rate	$3,292.50
Rate for Payer: Aetna Commercial	$2,502.30
Rate for Payer: Aetna Medicare Advantage	$1,975.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,679.17
Rate for Payer: Cigna Commercial	$3,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,448.70
Rate for Payer: Qualcare PPO/HMO/WC	$987.75
Rate for Payer: UnitedHealthcare Community & State	$158.70
Rate for Payer: Wellpoint Medicaid Managed Care	$174.50

KIT STERILE WATER 1000ml

Facility

$14.58

Hospital Charge Code	270645085
Hospital Revenue Code	270
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

KIT STERILE WATER 1000ml

Facility

$14.58

Hospital Charge Code	270645085
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.29
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.72
Rate for Payer: Cigna Commercial	$7.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.37
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

KIT STYLET

Facility

$564.85

Hospital Charge Code	270606342
Hospital Revenue Code	272
Min. Negotiated Rate	$84.73
Max. Negotiated Rate	$84.73
Rate for Payer: Qualcare PPO/HMO/WC	$84.73

KIT STYLET

Facility

$564.85

Hospital Charge Code	270606342
Hospital Revenue Code	272
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$282.43
Rate for Payer: Aetna Commercial	$214.64
Rate for Payer: Aetna Medicare Advantage	$169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.04
Rate for Payer: Cigna Commercial	$282.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.46
Rate for Payer: Oxford Commercial	$112.97
Rate for Payer: Qualcare PPO/HMO/WC	$84.73
Rate for Payer: UnitedHealthcare Commercial	$112.97
Rate for Payer: UnitedHealthcare Community & State	$13.61
Rate for Payer: Wellpoint Medicaid Managed Care	$14.97

KIT STYLET 6057-58

Facility

$198.45

Hospital Charge Code	270615018
Hospital Revenue Code	272
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$75.41
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.53
Rate for Payer: Oxford Commercial	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$39.69
Rate for Payer: UnitedHealthcare Community & State	$4.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.26

KIT STYLET 6057-58

Facility

$198.45

Hospital Charge Code	270615018
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

KIT SUCTION W/CUP 14FR

Facility

$2.06

Hospital Charge Code	270649681
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna Commercial	$0.78
Rate for Payer: Aetna Medicare Advantage	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.53
Rate for Payer: Cigna Commercial	$1.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.62
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.31
Rate for Payer: UnitedHealthcare Commercial	$0.41
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

KIT SUCTION W/CUP 14FR

Facility

$2.06

Hospital Charge Code	270649681
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.31

KIT SUPERION IDS 102-9800

Facility

$1,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270698877
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

KIT SUPERION IDS 102-9800

Facility

$1,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270698877
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

KIT SURFIT LOOP OSTOMY ******

Facility

$32.00

Hospital Charge Code	8002669
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

KIT SURFIT LOOP OSTOMY ******

Facility

$32.00

Hospital Charge Code	8002669
Hospital Revenue Code	279
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.72
Rate for Payer: Oxford Commercial	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

Know your out-of-pocket cost for care.

All Charges