Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BAG DRAINAGE ANTIFLUX 4000ml

Facility

$16.53

Service Code	HCPCS A4357
Hospital Charge Code	270649662
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

BAG DRAINAGE ANTIREFLUX 2000ml

Facility

$11.26

Service Code	HCPCS A4357
Hospital Charge Code	270649660
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

BAG DRAINAGE ANTIREFLUX 2000ml

Facility

$11.26

Service Code	HCPCS A4357
Hospital Charge Code	270649660
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.63
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482S
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482S
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

BAG DRAINAGE DEPORT 600ml

Facility

$46.50

Hospital Charge Code	270651482N
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

BAG DRAINAGE SYS UROL U2-033

Facility

$105.65

Hospital Charge Code	270601247
Hospital Revenue Code	272
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

BAG DRAINAGE SYS UROL U2-033

Facility

$105.65

Hospital Charge Code	270601247
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$52.83
Rate for Payer: Aetna Commercial	$40.15
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$21.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$21.13
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

BAG DRAINAGE URINARY

Facility

$19.37

Hospital Charge Code	270651484
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.69
Rate for Payer: Aetna Commercial	$7.36
Rate for Payer: Aetna Medicare Advantage	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.94
Rate for Payer: Cigna Commercial	$9.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Oxford Commercial	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.91
Rate for Payer: UnitedHealthcare Commercial	$3.87
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BAG DRAINAGE URINARY

Facility

$19.37

Hospital Charge Code	270651484
Hospital Revenue Code	270
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.91

BAG DRAIN FOLEY CLODES

Facility

$18.20

Hospital Charge Code	270650242S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

BAG DRAIN FOLEY CLODES

Facility

$18.20

Hospital Charge Code	270650242S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.10
Rate for Payer: Aetna Commercial	$6.92
Rate for Payer: Aetna Medicare Advantage	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.64
Rate for Payer: Cigna Commercial	$9.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$3.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$3.64
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

BAG DRAIN FOLEY CLOSED

Facility

$18.73

Hospital Charge Code	270650242
Hospital Revenue Code	272
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.81

BAG DRAIN FOLEY CLOSED

Facility

$18.73

Hospital Charge Code	270650242
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.37
Rate for Payer: Aetna Commercial	$7.12
Rate for Payer: Aetna Medicare Advantage	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$3.75
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

BAG DRAIN URO FLOW

Facility

$390.00

Hospital Charge Code	270660057A
Hospital Revenue Code	270
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$78.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BAG DRAIN URO FLOW

Facility

$390.00

Hospital Charge Code	270660057A
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BAG DS ALVEOLAR SAMPLE

Facility

$124.85

Hospital Charge Code	270600615
Hospital Revenue Code	270
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

BAG DS ALVEOLAR SAMPLE

Facility

$124.85

Hospital Charge Code	270600615
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

BAG EMESIS PLASTIC

Facility

$506.50

Hospital Charge Code	270651485
Hospital Revenue Code	272
Min. Negotiated Rate	$75.97
Max. Negotiated Rate	$75.97
Rate for Payer: Qualcare PPO/HMO/WC	$75.97

BAG EMESIS PLASTIC

Facility

$506.50

Hospital Charge Code	270651485
Hospital Revenue Code	272
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$253.25
Rate for Payer: Aetna Commercial	$192.47
Rate for Payer: Aetna Medicare Advantage	$151.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.16
Rate for Payer: Cigna Commercial	$253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.95
Rate for Payer: Oxford Commercial	$101.30
Rate for Payer: Qualcare PPO/HMO/WC	$75.97
Rate for Payer: UnitedHealthcare Commercial	$101.30
Rate for Payer: UnitedHealthcare Community & State	$12.21
Rate for Payer: Wellpoint Medicaid Managed Care	$13.42

BAG ENDOCATCH 5MM

Facility

$350.00

Hospital Charge Code	270678678
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BAG ENDOCATCH 5MM

Facility

$350.00

Hospital Charge Code	270678678
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

Know your out-of-pocket cost for care.

All Charges