Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AUTO SYRINGE (TUBING) ******

Facility

$8.00

Hospital Charge Code	1801067
Hospital Revenue Code	279
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

AUTOTOME 30MM STD

Facility

$1,072.45

Hospital Charge Code	270660086
Hospital Revenue Code	272
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$536.23
Rate for Payer: Aetna Commercial	$407.53
Rate for Payer: Aetna Medicare Advantage	$321.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.47
Rate for Payer: Cigna Commercial	$536.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.74
Rate for Payer: Oxford Commercial	$214.49
Rate for Payer: Qualcare PPO/HMO/WC	$160.87
Rate for Payer: UnitedHealthcare Commercial	$214.49
Rate for Payer: UnitedHealthcare Community & State	$25.85
Rate for Payer: Wellpoint Medicaid Managed Care	$28.42

AUTOTOME 30MM STD

Facility

$1,072.45

Hospital Charge Code	270660086
Hospital Revenue Code	272
Min. Negotiated Rate	$160.87
Max. Negotiated Rate	$160.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.87

AUTOTOME 39

Facility

$1,069.80

Hospital Charge Code	270676503
Hospital Revenue Code	272
Min. Negotiated Rate	$160.47
Max. Negotiated Rate	$160.47
Rate for Payer: Qualcare PPO/HMO/WC	$160.47

AUTOTOME 39

Facility

$1,069.80

Hospital Charge Code	270676503
Hospital Revenue Code	272
Min. Negotiated Rate	$25.78
Max. Negotiated Rate	$534.90
Rate for Payer: Aetna Commercial	$406.52
Rate for Payer: Aetna Medicare Advantage	$320.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.80
Rate for Payer: Cigna Commercial	$534.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.94
Rate for Payer: Oxford Commercial	$213.96
Rate for Payer: Qualcare PPO/HMO/WC	$160.47
Rate for Payer: UnitedHealthcare Commercial	$213.96
Rate for Payer: UnitedHealthcare Community & State	$25.78
Rate for Payer: Wellpoint Medicaid Managed Care	$28.35

AUTOTOME RX 39

Facility

$1,072.45

Hospital Charge Code	270683532
Hospital Revenue Code	272
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$536.23
Rate for Payer: Aetna Commercial	$407.53
Rate for Payer: Aetna Medicare Advantage	$321.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.47
Rate for Payer: Cigna Commercial	$536.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.74
Rate for Payer: Oxford Commercial	$214.49
Rate for Payer: Qualcare PPO/HMO/WC	$160.87
Rate for Payer: UnitedHealthcare Commercial	$214.49
Rate for Payer: UnitedHealthcare Community & State	$25.85
Rate for Payer: Wellpoint Medicaid Managed Care	$28.42

AUTOTOME RX 39

Facility

$1,072.45

Hospital Charge Code	270683532
Hospital Revenue Code	272
Min. Negotiated Rate	$160.87
Max. Negotiated Rate	$160.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.87

AUTOTRANSFUSION INF.PUMP

Facility

$174.00

Hospital Charge Code	270339073
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

AUTOTRANSFUSION INF.PUMP

Facility

$174.00

Hospital Charge Code	270339073
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

Auto Transfusion Procedure ( C

Facility

$2,640.00

Hospital Charge Code	270654319
Hospital Revenue Code	272
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$792.00
Rate for Payer: Oxford Commercial	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Commercial	$528.00
Rate for Payer: UnitedHealthcare Community & State	$63.62
Rate for Payer: Wellpoint Medicaid Managed Care	$69.96

Auto Transfusion Procedure ( C

Facility

$2,640.00

Hospital Charge Code	270654319
Hospital Revenue Code	272
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

AUTOTRANSFUSION SYSTEM ZIMMER

Facility

$186.00

Hospital Charge Code	1606375
Hospital Revenue Code	279
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

AUTOTRANSFUSION SYSTEM ZIMMER

Facility

$186.00

Hospital Charge Code	1606375
Hospital Revenue Code	279
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$37.20
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

AUTOTRANSFUSION TUBING KIT

Facility

$3,875.00

Hospital Charge Code	270697350
Hospital Revenue Code	272
Min. Negotiated Rate	$93.39
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,162.50
Rate for Payer: Oxford Commercial	$775.00
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Commercial	$775.00
Rate for Payer: UnitedHealthcare Community & State	$93.39
Rate for Payer: Wellpoint Medicaid Managed Care	$102.69

AUTOTRANSFUSION TUBING KIT

Facility

$3,875.00

Hospital Charge Code	270697350
Hospital Revenue Code	272
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$581.25
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

AUTO TRANS PROCEDURE SCHEDULED

Facility

$3,222.45

Hospital Charge Code	270605796
Hospital Revenue Code	272
Min. Negotiated Rate	$483.37
Max. Negotiated Rate	$483.37
Rate for Payer: Qualcare PPO/HMO/WC	$483.37

AUTO TRANS PROCEDURE SCHEDULED

Facility

$3,222.45

Hospital Charge Code	270605796
Hospital Revenue Code	272
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$1,611.22
Rate for Payer: Aetna Commercial	$1,224.53
Rate for Payer: Aetna Medicare Advantage	$966.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$821.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$821.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$821.72
Rate for Payer: Cigna Commercial	$1,611.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.74
Rate for Payer: Oxford Commercial	$644.49
Rate for Payer: Qualcare PPO/HMO/WC	$483.37
Rate for Payer: UnitedHealthcare Commercial	$644.49
Rate for Payer: UnitedHealthcare Community & State	$77.66
Rate for Payer: Wellpoint Medicaid Managed Care	$85.39

AVALON ELITE 19FR

Facility

$13,969.00

Hospital Charge Code	2703110M
Hospital Revenue Code	272
Min. Negotiated Rate	$2,095.35
Max. Negotiated Rate	$2,095.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35

AVALON ELITE 19FR

Facility

$13,969.00

Hospital Charge Code	2703110M
Hospital Revenue Code	272
Min. Negotiated Rate	$336.65
Max. Negotiated Rate	$6,984.50
Rate for Payer: Aetna Commercial	$5,308.22
Rate for Payer: Aetna Medicare Advantage	$4,190.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,562.09
Rate for Payer: Cigna Commercial	$6,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,190.70
Rate for Payer: Oxford Commercial	$2,793.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35
Rate for Payer: UnitedHealthcare Commercial	$2,793.80
Rate for Payer: UnitedHealthcare Community & State	$336.65
Rate for Payer: Wellpoint Medicaid Managed Care	$370.18

AVALON ELITE 23FR

Facility

$13,969.00

Hospital Charge Code	2703110N
Hospital Revenue Code	272
Min. Negotiated Rate	$2,095.35
Max. Negotiated Rate	$2,095.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35

AVALON ELITE 23FR

Facility

$13,969.00

Hospital Charge Code	2703110N
Hospital Revenue Code	272
Min. Negotiated Rate	$336.65
Max. Negotiated Rate	$6,984.50
Rate for Payer: Aetna Commercial	$5,308.22
Rate for Payer: Aetna Medicare Advantage	$4,190.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,562.09
Rate for Payer: Cigna Commercial	$6,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,190.70
Rate for Payer: Oxford Commercial	$2,793.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35
Rate for Payer: UnitedHealthcare Commercial	$2,793.80
Rate for Payer: UnitedHealthcare Community & State	$336.65
Rate for Payer: Wellpoint Medicaid Managed Care	$370.18

AVALON ELITE 27FR

Facility

$13,969.00

Hospital Charge Code	2703110O
Hospital Revenue Code	272
Min. Negotiated Rate	$2,095.35
Max. Negotiated Rate	$2,095.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35

AVALON ELITE 27FR

Facility

$13,969.00

Hospital Charge Code	2703110O
Hospital Revenue Code	272
Min. Negotiated Rate	$336.65
Max. Negotiated Rate	$6,984.50
Rate for Payer: Aetna Commercial	$5,308.22
Rate for Payer: Aetna Medicare Advantage	$4,190.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,562.09
Rate for Payer: Cigna Commercial	$6,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,190.70
Rate for Payer: Oxford Commercial	$2,793.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35
Rate for Payer: UnitedHealthcare Commercial	$2,793.80
Rate for Payer: UnitedHealthcare Community & State	$336.65
Rate for Payer: Wellpoint Medicaid Managed Care	$370.18

AVALON ELITE 31FR

Facility

$13,969.00

Hospital Charge Code	2703110P
Hospital Revenue Code	272
Min. Negotiated Rate	$336.65
Max. Negotiated Rate	$6,984.50
Rate for Payer: Aetna Commercial	$5,308.22
Rate for Payer: Aetna Medicare Advantage	$4,190.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,562.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,562.09
Rate for Payer: Cigna Commercial	$6,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,190.70
Rate for Payer: Oxford Commercial	$2,793.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35
Rate for Payer: UnitedHealthcare Commercial	$2,793.80
Rate for Payer: UnitedHealthcare Community & State	$336.65
Rate for Payer: Wellpoint Medicaid Managed Care	$370.18

AVALON ELITE 31FR

Facility

$13,969.00

Hospital Charge Code	2703110P
Hospital Revenue Code	272
Min. Negotiated Rate	$2,095.35
Max. Negotiated Rate	$2,095.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,095.35

Know your out-of-pocket cost for care.

All Charges