Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACK ICE KWIK KOLD PAK

Facility

$24.20

Hospital Charge Code	270651596
Hospital Revenue Code	270
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$3.63

PACK ICE SMALL

Facility

$16.85

Hospital Charge Code	270301284
Hospital Revenue Code	270
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

PACK ICE SMALL

Facility

$16.85

Hospital Charge Code	270301284
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

PACKING COIL

Facility

$4,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270686142
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

PACKING COIL

Facility

$4,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270686142
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

Packing Coils 45cm

Facility

$6,450.00

Hospital Charge Code	270687057
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

Packing Coils 45cm

Facility

$6,450.00

Hospital Charge Code	270687057
Hospital Revenue Code	278
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$2,451.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50
Rate for Payer: UnitedHealthcare Community & State	$155.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.93

Packing Coils 60cm

Facility

$6,450.00

Hospital Charge Code	270687056
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

Packing Coils 60cm

Facility

$6,450.00

Hospital Charge Code	270687056
Hospital Revenue Code	278
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$2,451.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50
Rate for Payer: UnitedHealthcare Community & State	$155.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.93

PACKING EPISTAXIS 4.5 PEDS

Facility

$142.50

Hospital Charge Code	270628871
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

PACKING EPISTAXIS 4.5 PEDS

Facility

$142.50

Hospital Charge Code	270628871
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.75
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

PACKING EPISTAXIS 5.5 ANTERIOR

Facility

$150.00

Hospital Charge Code	270628873
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PACKING EPISTAXIS 5.5 ANTERIOR

Facility

$150.00

Hospital Charge Code	270628873
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

PACKING EPISTAXIS 7.5 ANT/POST

Facility

$157.50

Hospital Charge Code	270628874
Hospital Revenue Code	272
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

PACKING EPISTAXIS 7.5 ANT/POST

Facility

$157.50

Hospital Charge Code	270628874
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$59.85
Rate for Payer: Aetna Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.16
Rate for Payer: Cigna Commercial	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.25
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$31.50
Rate for Payer: UnitedHealthcare Community & State	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

PACKING NASAL DOYLE

Facility

$143.00

Hospital Charge Code	270600306
Hospital Revenue Code	272
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

PACKING NASAL DOYLE

Facility

$143.00

Hospital Charge Code	270600306
Hospital Revenue Code	272
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$71.50
Rate for Payer: Aetna Commercial	$54.34
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.47
Rate for Payer: Cigna Commercial	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$28.60
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

PACKING NASAL DOYLE **********

Facility

$52.00

Hospital Charge Code	8003956
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

PACKING NASAL DOYLE **********

Facility

$52.00

Hospital Charge Code	8003956
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

PACKING NASAL POPE EPISTAXIS

Facility

$140.00

Hospital Charge Code	270600029
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

PACKING NASAL POPE EPISTAXIS

Facility

$140.00

Hospital Charge Code	270600029
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

PACKING NASAL POPE EPISTAXIS**

Facility

$55.00

Hospital Charge Code	8003964
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

PACKING NASAL POPE EPISTAXIS**

Facility

$44.00

Hospital Charge Code	2706000029
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

PACKING NASAL POPE EPISTAXIS**

Facility

$55.00

Hospital Charge Code	8003964
Hospital Revenue Code	272
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

PACKING NASAL POPE EPISTAXIS**

Facility

$44.00

Hospital Charge Code	2706000029
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

Know your out-of-pocket cost for care.

All Charges