Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERC INSERTION KIT FOR 2.9 PUS

Facility

$1,100.00

Hospital Charge Code	270672023
Hospital Revenue Code	272
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.00
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$220.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

PERCLOSE DEVICE 6FR.

Facility

$1,295.00

Hospital Charge Code	2706000682
Hospital Revenue Code	272
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

PERCLOSE DEVICE 6FR.

Facility

$1,295.00

Hospital Charge Code	2706000682
Hospital Revenue Code	272
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$194.25
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

PERCLOSE DEVICE 6FR.

Facility

$1,295.00

Hospital Charge Code	270651808
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

PERCLOSE DEVICE 6FR.

Facility

$1,295.00

Hospital Charge Code	270651808
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

PERCLOSE PROG CLOS SYS 1267303

Facility

$1,175.00

Hospital Charge Code	270637327
Hospital Revenue Code	272
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.50
Rate for Payer: Oxford Commercial	$235.00
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Commercial	$235.00
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

PERCLOSE PROG CLOS SYS 1267303

Facility

$1,175.00

Hospital Charge Code	270637327
Hospital Revenue Code	272
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$176.25
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

PERCLOSE PROSTYLE 12773-03

Facility

$1,200.00

Service Code	HCPCS C1760
Hospital Charge Code	270694951S
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

PERCLOSE PROSTYLE 12773-03

Facility

$1,200.00

Service Code	HCPCS C1760
Hospital Charge Code	270694951S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PERC N BX ABD /RETROPERITNL M

Facility

$8,404.60

Service Code	HCPCS 49180
Hospital Charge Code	160000198
Hospital Revenue Code	360
Min. Negotiated Rate	$202.55
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,521.38
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.69
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$202.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$222.72

PERC N BX ABD /RETROPERITNL M

Facility

$8,404.60

Service Code	HCPCS 49180
Hospital Charge Code	160000198
Hospital Revenue Code	360
Min. Negotiated Rate	$1,260.69
Max. Negotiated Rate	$1,260.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.69

PERC NDL CORE BRST BX WO GUID

Facility

$4,884.50

Service Code	HCPCS 19100
Hospital Charge Code	16000788
Hospital Revenue Code	360
Min. Negotiated Rate	$732.67
Max. Negotiated Rate	$732.67
Rate for Payer: Qualcare PPO/HMO/WC	$732.67

PERC NDL CORE BRST BX WO GUID

Facility

$4,884.50

Service Code	HCPCS 19100
Hospital Charge Code	16000788
Hospital Revenue Code	360
Min. Negotiated Rate	$117.72
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.35
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.67
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$117.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$129.44

PERC NEPHROSTOLITHOTOMY,TO 2CM

Facility

$39,246.40

Service Code	HCPCS 50080
Hospital Charge Code	1600000679
Hospital Revenue Code	360
Min. Negotiated Rate	$945.84
Max. Negotiated Rate	$40,596.17
Rate for Payer: Aetna Commercial	$30,590.24
Rate for Payer: Aetna Medicare Advantage	$36,438.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,596.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,596.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,246.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,596.17
Rate for Payer: Cigna Commercial	$22,543.37
Rate for Payer: Cigna Medicare Advantage	$11,246.41
Rate for Payer: Clover Medicare Advantage	$10,684.09
Rate for Payer: EmblemHealth Commercial	$33,739.23
Rate for Payer: Humana Medicare Advantage	$11,583.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,246.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,773.92
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,886.96
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$945.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,246.41
Rate for Payer: Wellcare Medicare Advantage	$11,246.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1,040.03

PERC NEPHROSTOLITHOTOMY,TO 2CM

Facility

$39,246.40

Service Code	HCPCS 50080
Hospital Charge Code	1600000679
Hospital Revenue Code	360
Min. Negotiated Rate	$5,886.96
Max. Negotiated Rate	$5,886.96
Rate for Payer: Qualcare PPO/HMO/WC	$5,886.96

PERCOCET/TAB

Facility

$4.00

Hospital Charge Code	60633627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERCOCET/TAB

Facility

$3.00

Hospital Charge Code	60633628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERCOCET/TAB

Facility

$4.00

Hospital Charge Code	60633627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PERCOCET/TAB

Facility

$3.00

Hospital Charge Code	60633628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERCODAN/TAB

Facility

$3.00

Hospital Charge Code	60633629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERCODAN/TAB

Facility

$3.00

Hospital Charge Code	60633629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERC PLACE IVC FILTER

Facility

$8,658.00

Hospital Charge Code	2009015
Hospital Revenue Code	320
Min. Negotiated Rate	$1,298.70
Max. Negotiated Rate	$1,298.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,298.70

PERC PLACE IVC FILTER

Facility

$8,658.00

Hospital Charge Code	2009015
Hospital Revenue Code	320
Min. Negotiated Rate	$208.66
Max. Negotiated Rate	$4,329.00
Rate for Payer: Aetna Commercial	$3,290.04
Rate for Payer: Aetna Medicare Advantage	$2,597.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,207.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,207.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,207.79
Rate for Payer: Cigna Commercial	$4,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,597.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,298.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.66
Rate for Payer: Wellpoint Medicaid Managed Care	$229.44

PERC PLACMNT OF ENTEROCLYSIS T

Facility

$766.60

Service Code	HCPCS 44015
Hospital Charge Code	1600000345
Hospital Revenue Code	360
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$291.31
Rate for Payer: Aetna Medicare Advantage	$229.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.48
Rate for Payer: Cigna Commercial	$383.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.98
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.99
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$18.48
Rate for Payer: Wellpoint Medicaid Managed Care	$20.31

PERC PLACMNT OF ENTEROCLYSIS T

Facility

$766.60

Service Code	HCPCS 44015
Hospital Charge Code	1600000345
Hospital Revenue Code	360
Min. Negotiated Rate	$114.99
Max. Negotiated Rate	$114.99
Rate for Payer: Qualcare PPO/HMO/WC	$114.99

Know your out-of-pocket cost for care.

All Charges