Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT TIGHTROPE 8.5 MM FLIPCUT I

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270682535
Hospital Revenue Code	278
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

KIT TIGHTROPE DUAL

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683592
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

KIT TIGHTROPE DUAL

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683592
Hospital Revenue Code	278
Min. Negotiated Rate	$283.18
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$283.18
Rate for Payer: Wellpoint Medicaid Managed Care	$311.38

KIT TITAN ASSEMBLY 91-9480SC

Facility

$2,250.00

Hospital Charge Code	270640425
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT TITAN ASSEMBLY 91-9480SC

Facility

$2,250.00

Hospital Charge Code	270640425
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 TOGGLELOC 909846

Facility

$3,825.00

Hospital Charge Code	270647899
Hospital Revenue Code	272
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.50
Rate for Payer: Oxford Commercial	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Commercial	$765.00
Rate for Payer: UnitedHealthcare Community & State	$92.18
Rate for Payer: Wellpoint Medicaid Managed Care	$101.36

KIT TOGGLELOC 909846

Facility

$3,825.00

Hospital Charge Code	270647899
Hospital Revenue Code	272
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$573.75
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

KIT TOOTHETTE PLUS W/PEROXIDE

Facility

$409.00

Hospital Charge Code	270649848
Hospital Revenue Code	270
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

KIT TOOTHETTE PLUS W/PEROXIDE

Facility

$409.00

Hospital Charge Code	270649848
Hospital Revenue Code	270
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Oxford Commercial	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$81.80
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

KIT TOOTHETTE W/CHLORHEXIDINE

Facility

$111.56

Hospital Charge Code	270649817
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.78
Rate for Payer: Aetna Commercial	$42.39
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.45
Rate for Payer: Cigna Commercial	$55.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.47
Rate for Payer: Oxford Commercial	$22.31
Rate for Payer: Qualcare PPO/HMO/WC	$16.73
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

KIT TOOTHETTE W/CHLORHEXIDINE

Facility

$111.56

Hospital Charge Code	270649817
Hospital Revenue Code	272
Min. Negotiated Rate	$16.73
Max. Negotiated Rate	$16.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.73

KIT TRACH CARE 14F EB TIP 2219

Facility

$96.85

Hospital Charge Code	270611888
Hospital Revenue Code	272
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$14.53
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

KIT TRACH CARE 14F EB TIP 2219

Facility

$96.85

Hospital Charge Code	270611888
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$48.42
Rate for Payer: Aetna Commercial	$36.80
Rate for Payer: Aetna Medicare Advantage	$29.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.70
Rate for Payer: Cigna Commercial	$48.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.05
Rate for Payer: Oxford Commercial	$19.37
Rate for Payer: Qualcare PPO/HMO/WC	$14.53
Rate for Payer: UnitedHealthcare Commercial	$19.37
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

KIT TRACH CARE 14FR W/WET PACK

Facility

$124.85

Hospital Charge Code	270606991
Hospital Revenue Code	272
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

KIT TRACH CARE 14FR W/WET PACK

Facility

$124.85

Hospital Charge Code	270606991
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$47.44
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.45
Rate for Payer: Oxford Commercial	$24.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$24.97
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

KIT TRACH CARE W/NACL BULLETS

Facility

$43.89

Hospital Charge Code	270608338
Hospital Revenue Code	272
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$6.58
Rate for Payer: Qualcare PPO/HMO/WC	$6.58

KIT TRACH CARE W/NACL BULLETS

Facility

$43.89

Hospital Charge Code	270608338
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$21.95
Rate for Payer: Aetna Commercial	$16.68
Rate for Payer: Aetna Medicare Advantage	$13.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.19
Rate for Payer: Cigna Commercial	$21.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.17
Rate for Payer: Oxford Commercial	$8.78
Rate for Payer: Qualcare PPO/HMO/WC	$6.58
Rate for Payer: UnitedHealthcare Commercial	$8.78
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

KIT TRANSPAC II MONITORING****

Facility

$204.00

Hospital Charge Code	8003139
Hospital Revenue Code	279
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$40.80
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

KIT TRANSPAC II MONITORING****

Facility

$204.00

Hospital Charge Code	8003139
Hospital Revenue Code	279
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

KIT TRANSPAC MONITORING

Facility

$54.90

Hospital Charge Code	270110096
Hospital Revenue Code	270
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.45
Rate for Payer: Aetna Commercial	$20.86
Rate for Payer: Aetna Medicare Advantage	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.00
Rate for Payer: Cigna Commercial	$27.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.47
Rate for Payer: Oxford Commercial	$10.98
Rate for Payer: Qualcare PPO/HMO/WC	$8.23
Rate for Payer: UnitedHealthcare Commercial	$10.98
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

KIT TRANSPAC MONITORING

Facility

$54.90

Hospital Charge Code	270110096
Hospital Revenue Code	270
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

KIT TRANSPAC MONITORING******

Facility

$166.00

Hospital Charge Code	1603182
Hospital Revenue Code	279
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.80
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

KIT TRANSPAC MONITORING******

Facility

$166.00

Hospital Charge Code	1603182
Hospital Revenue Code	279
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

KIT TRANSVENOUS PACING

Facility

$686.20

Hospital Charge Code	270616215
Hospital Revenue Code	272
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$343.10
Rate for Payer: Aetna Commercial	$260.76
Rate for Payer: Aetna Medicare Advantage	$205.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.98
Rate for Payer: Cigna Commercial	$343.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.86
Rate for Payer: Oxford Commercial	$137.24
Rate for Payer: Qualcare PPO/HMO/WC	$102.93
Rate for Payer: UnitedHealthcare Commercial	$137.24
Rate for Payer: UnitedHealthcare Community & State	$16.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.18

KIT TRANSVENOUS PACING

Facility

$686.20

Hospital Charge Code	270616215
Hospital Revenue Code	272
Min. Negotiated Rate	$102.93
Max. Negotiated Rate	$102.93
Rate for Payer: Qualcare PPO/HMO/WC	$102.93

Know your out-of-pocket cost for care.

All Charges