Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.09
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

PLEDGET TEFLON 6 4.5 1MM

Facility

$9.65

Hospital Charge Code	270601210
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

PLEDGET TEFLON 6 4.5 1MM

Facility

$9.65

Hospital Charge Code	270601210
Hospital Revenue Code	278
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PLEDGET TEFLON 6 4.5 1MM *****

Facility

$55.00

Hospital Charge Code	1604321
Hospital Revenue Code	278
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$13.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

PLEDGET TEFLON 6 4.5 1MM *****

Facility

$55.00

Hospital Charge Code	1604321
Hospital Revenue Code	278
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) NJ Health	$11.00
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	$13.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.62
Rate for Payer: Aetna Commercial	$5.03
Rate for Payer: Aetna Medicare Advantage	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.97
Rate for Payer: Oxford Commercial	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.65
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

PLETAL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635518
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PLETAL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635518
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PLEURAL BIOPSY/ABRAHAMS

Facility

$803.25

Hospital Charge Code	2708001497
Hospital Revenue Code	270
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$120.49
Rate for Payer: Qualcare PPO/HMO/WC	$120.49

PLEURAL BIOPSY/ABRAHAMS

Facility

$803.25

Hospital Charge Code	2708001497
Hospital Revenue Code	270
Min. Negotiated Rate	$19.36
Max. Negotiated Rate	$401.62
Rate for Payer: Aetna Commercial	$305.24
Rate for Payer: Aetna Medicare Advantage	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.83
Rate for Payer: Cigna Commercial	$401.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.97
Rate for Payer: Oxford Commercial	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$120.49
Rate for Payer: UnitedHealthcare Commercial	$160.65
Rate for Payer: UnitedHealthcare Community & State	$19.36
Rate for Payer: Wellpoint Medicaid Managed Care	$21.29

PLEURAL DR ESSENTL KIT 4992505

Facility

$1,150.00

Hospital Charge Code	270661650
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

PLEURAL DR ESSENTL KIT 4992505

Facility

$1,150.00

Hospital Charge Code	270661650
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

PLEURAL EFFUSION WITH CC

Facility

$34,103.47

Service Code	MSDRG 187
Min. Negotiated Rate	$10,384.07
Max. Negotiated Rate	$34,103.47
Rate for Payer: Aetna Commercial	$23,690.29
Rate for Payer: Aetna Medicare Advantage	$34,103.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,930.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,261.00
Rate for Payer: Cigna Commercial	$18,510.02
Rate for Payer: Cigna Medicare Advantage	$10,930.60
Rate for Payer: Clover Medicare Advantage	$10,384.07
Rate for Payer: EmblemHealth Commercial	$32,791.80
Rate for Payer: Humana Medicare Advantage	$11,258.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,930.60
Rate for Payer: Oxford Commercial	$13,303.40
Rate for Payer: UnitedHealthcare Commercial	$23,327.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,930.60
Rate for Payer: Wellcare Medicare Advantage	$10,930.60

PLEURAL EFFUSION WITH MCC

Facility

$52,507.35

Service Code	MSDRG 186
Min. Negotiated Rate	$15,987.82
Max. Negotiated Rate	$52,507.35
Rate for Payer: Aetna Commercial	$36,335.85
Rate for Payer: Aetna Medicare Advantage	$52,507.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,054.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,054.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,829.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,054.55
Rate for Payer: Cigna Commercial	$29,165.77
Rate for Payer: Cigna Medicare Advantage	$16,829.28
Rate for Payer: Clover Medicare Advantage	$15,987.82
Rate for Payer: EmblemHealth Commercial	$50,487.84
Rate for Payer: Humana Medicare Advantage	$17,334.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,829.28
Rate for Payer: Oxford Commercial	$20,961.83
Rate for Payer: UnitedHealthcare Commercial	$36,757.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,829.28
Rate for Payer: Wellcare Medicare Advantage	$16,829.28

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$25,315.18

Service Code	MSDRG 188
Min. Negotiated Rate	$7,708.15
Max. Negotiated Rate	$25,315.18
Rate for Payer: Aetna Commercial	$17,651.74
Rate for Payer: Aetna Medicare Advantage	$25,315.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,445.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,445.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,445.75
Rate for Payer: Cigna Commercial	$13,421.68
Rate for Payer: Cigna Medicare Advantage	$8,113.84
Rate for Payer: Clover Medicare Advantage	$7,708.15
Rate for Payer: EmblemHealth Commercial	$24,341.52
Rate for Payer: Humana Medicare Advantage	$8,357.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,113.84
Rate for Payer: Oxford Commercial	$9,646.34
Rate for Payer: UnitedHealthcare Commercial	$16,915.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,113.84
Rate for Payer: Wellcare Medicare Advantage	$8,113.84

PLEURAL FLUID CYTOLOGY

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005351
Hospital Revenue Code	311
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

PLEURAL FLUID CYTOLOGY

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005351
Hospital Revenue Code	311
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

PLEUR-A-VAC *******

Facility

$1,670.00

Hospital Charge Code	1603125
Hospital Revenue Code	272
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$835.00
Rate for Payer: Aetna Commercial	$634.60
Rate for Payer: Aetna Medicare Advantage	$501.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$425.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$425.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$425.85
Rate for Payer: Cigna Commercial	$835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.00
Rate for Payer: Oxford Commercial	$334.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.50
Rate for Payer: UnitedHealthcare Commercial	$334.00
Rate for Payer: UnitedHealthcare Community & State	$40.25
Rate for Payer: Wellpoint Medicaid Managed Care	$44.26

PLEUR-A-VAC *******

Facility

$1,670.00

Hospital Charge Code	1603125
Hospital Revenue Code	272
Min. Negotiated Rate	$250.50
Max. Negotiated Rate	$250.50
Rate for Payer: Qualcare PPO/HMO/WC	$250.50

PLEUR EVAC W/ FLOOR STAND

Facility

$99.73

Hospital Charge Code	270652701
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$49.87
Rate for Payer: Aetna Commercial	$37.90
Rate for Payer: Aetna Medicare Advantage	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.43
Rate for Payer: Cigna Commercial	$49.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.92
Rate for Payer: Oxford Commercial	$19.95
Rate for Payer: Qualcare PPO/HMO/WC	$14.96
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Community & State	$2.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.64

PLEUR EVAC W/ FLOOR STAND

Facility

$99.73

Hospital Charge Code	270652701
Hospital Revenue Code	270
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$14.96
Rate for Payer: Qualcare PPO/HMO/WC	$14.96

PLEUR-EVAC W/FLOOR STAND

Facility

$850.00

Hospital Charge Code	270331014
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

PLEUR-EVAC W/FLOOR STAND

Facility

$850.00

Hospital Charge Code	270331014
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

Know your out-of-pocket cost for care.

All Charges