Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LOOP OSTOMY SYSTEM 40209-34**

Facility

$93.00

Hospital Charge Code	1605930
Hospital Revenue Code	272
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$46.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.90
Rate for Payer: Oxford Commercial	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.95
Rate for Payer: UnitedHealthcare Commercial	$18.60
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

LOOP OSTOMY SYSTEM 40209-34**

Facility

$93.00

Hospital Charge Code	1605930
Hospital Revenue Code	272
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

LOOP, RD 20MMW X 12MMD

Facility

$75.00

Hospital Charge Code	270650788
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LOOP, RD 20MMW X 12MMD

Facility

$75.00

Hospital Charge Code	270650788
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

LOOP RECORD CONFIRM

Facility

$21,850.00

Hospital Charge Code	2709007371
Hospital Revenue Code	272
Min. Negotiated Rate	$3,277.50
Max. Negotiated Rate	$3,277.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,277.50

LOOP RECORD CONFIRM

Facility

$21,850.00

Hospital Charge Code	2709007371
Hospital Revenue Code	272
Min. Negotiated Rate	$526.59
Max. Negotiated Rate	$10,925.00
Rate for Payer: Aetna Commercial	$8,303.00
Rate for Payer: Aetna Medicare Advantage	$6,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,571.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,571.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,571.75
Rate for Payer: Cigna Commercial	$10,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,555.00
Rate for Payer: Oxford Commercial	$4,370.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,277.50
Rate for Payer: UnitedHealthcare Commercial	$4,370.00
Rate for Payer: UnitedHealthcare Community & State	$526.59
Rate for Payer: Wellpoint Medicaid Managed Care	$579.02

LOOP RECORDER ANALYSIS

Facility

$66.63

Service Code	HCPCS 93285
Hospital Charge Code	5100536
Hospital Revenue Code	480
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$9.99
Rate for Payer: Qualcare PPO/HMO/WC	$9.99

LOOP RECORDER ANALYSIS

Facility

$66.63

Service Code	HCPCS 93285
Hospital Charge Code	5100536
Hospital Revenue Code	480
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.99
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.99
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.77

LOOP RECORDER IMPLANTABLE

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

LOOP RECORDER IMPLANTABLE

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

LOOP VASCULAR BLU PK 01-1-012

Facility

$19.25

Hospital Charge Code	270061365
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

LOOP VASCULAR BLU PK 01-1-012

Facility

$19.25

Hospital Charge Code	270061365
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

LOOP VASCULAR BLU PK 01-1-032

Facility

$13.65

Hospital Charge Code	270608722
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

LOOP VASCULAR BLU PK 01-1-032

Facility

$13.65

Hospital Charge Code	270608722
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

LOOP VASCULAR MINI BLUE

Facility

$46.00

Hospital Charge Code	270666271
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

LOOP VASCULAR MINI BLUE

Facility

$46.00

Hospital Charge Code	270666271
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

LOOP VASCULAR RED PK 01-1-011

Facility

$19.25

Hospital Charge Code	270061360
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

LOOP VASCULAR RED PK 01-1-011

Facility

$19.25

Hospital Charge Code	270061360
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

LOOP VESSEL BLUE MAXI 30-723

Facility

$5.70

Hospital Charge Code	270644692
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.71
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

LOOP VESSEL BLUE MAXI 30-723

Facility

$5.70

Hospital Charge Code	270644692
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LOOP VESSEL MINI BLUE

Facility

$1.72

Hospital Charge Code	270650782
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

LOOP VESSEL MINI BLUE

Facility

$1.72

Hospital Charge Code	270650782
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna Commercial	$0.65
Rate for Payer: Aetna Medicare Advantage	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.44
Rate for Payer: Cigna Commercial	$0.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.34
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.34
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

LOOP VESSEL RED MAXI

Facility

$12.56

Hospital Charge Code	270651003
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.77
Rate for Payer: Oxford Commercial	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.51
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

LOOP VESSEL RED MAXI

Facility

$12.56

Hospital Charge Code	270651003
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

LOOP VESSEL RED MINI

Facility

$5.70

Hospital Charge Code	270647510
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

Know your out-of-pocket cost for care.

All Charges