Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROBE INJECTION GOLD 6015

Facility

$1,075.00

Hospital Charge Code	270603932
Hospital Revenue Code	272
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.50
Rate for Payer: Oxford Commercial	$215.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Commercial	$215.00
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

PROBE INJECTION GOLD 6015

Facility

$1,075.00

Hospital Charge Code	270603932
Hospital Revenue Code	272
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

PROBE INJECTION GOLD 7 6017

Facility

$1,801.65

Hospital Charge Code	270603942
Hospital Revenue Code	272
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$684.63
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.50
Rate for Payer: Oxford Commercial	$360.33
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$360.33
Rate for Payer: UnitedHealthcare Community & State	$43.42
Rate for Payer: Wellpoint Medicaid Managed Care	$47.74

PROBE INJECTION GOLD 7 6017

Facility

$1,801.65

Hospital Charge Code	270603942
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

PROBE INJECTION GOLD 8

Facility

$1,801.65

Hospital Charge Code	270603943
Hospital Revenue Code	272
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$684.63
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.50
Rate for Payer: Oxford Commercial	$360.33
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$360.33
Rate for Payer: UnitedHealthcare Community & State	$43.42
Rate for Payer: Wellpoint Medicaid Managed Care	$47.74

PROBE INJECTION GOLD 8

Facility

$1,801.65

Hospital Charge Code	270603943
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

PROBE IRRIGATING OCUTOME *****

Facility

$620.00

Hospital Charge Code	1600881
Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

PROBE IRRIGATING OCUTOME *****

Facility

$620.00

Hospital Charge Code	1600881
Hospital Revenue Code	272
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$235.60
Rate for Payer: Aetna Medicare Advantage	$186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.10
Rate for Payer: Cigna Commercial	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.00
Rate for Payer: Oxford Commercial	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.94
Rate for Payer: Wellpoint Medicaid Managed Care	$16.43

PROBE KIT HIP SYSTEM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673016
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PROBE KIT HIP SYSTEM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673016
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PROBE KIT RF ABLATION

Facility

$21,075.00

Service Code	HCPCS C1886
Hospital Charge Code	270690464
Hospital Revenue Code	278
Min. Negotiated Rate	$3,161.25
Max. Negotiated Rate	$5,100.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,100.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,636.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,161.25

PROBE KIT RF ABLATION

Facility

$21,075.00

Service Code	HCPCS C1886
Hospital Charge Code	270690464
Hospital Revenue Code	278
Min. Negotiated Rate	$507.91
Max. Negotiated Rate	$10,537.50
Rate for Payer: Aetna Commercial	$8,008.50
Rate for Payer: Aetna Medicare Advantage	$6,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,374.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,374.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,374.12
Rate for Payer: Cigna Commercial	$10,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,100.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,636.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,161.25
Rate for Payer: UnitedHealthcare Community & State	$507.91
Rate for Payer: Wellpoint Medicaid Managed Care	$558.49

PROBE LAPARASOPIC 5MM

Facility

$618.00

Hospital Charge Code	270664983
Hospital Revenue Code	272
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

PROBE LAPARASOPIC 5MM

Facility

$618.00

Hospital Charge Code	270664983
Hospital Revenue Code	272
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$309.00
Rate for Payer: Aetna Commercial	$234.84
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.59
Rate for Payer: Cigna Commercial	$309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.40
Rate for Payer: Oxford Commercial	$123.60
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$123.60
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

PROBE LAVEEN 4.0 14/15 26213

Facility

$6,572.00

Hospital Charge Code	270631812
Hospital Revenue Code	272
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,971.60
Rate for Payer: Oxford Commercial	$1,314.40
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Commercial	$1,314.40
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

PROBE LAVEEN 4.0 14/15 26213

Facility

$6,045.00

Hospital Charge Code	270630812
Hospital Revenue Code	272
Min. Negotiated Rate	$145.68
Max. Negotiated Rate	$3,022.50
Rate for Payer: Aetna Commercial	$2,297.10
Rate for Payer: Aetna Medicare Advantage	$1,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,541.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,541.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,541.47
Rate for Payer: Cigna Commercial	$3,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.50
Rate for Payer: Oxford Commercial	$1,209.00
Rate for Payer: Qualcare PPO/HMO/WC	$906.75
Rate for Payer: UnitedHealthcare Commercial	$1,209.00
Rate for Payer: UnitedHealthcare Community & State	$145.68
Rate for Payer: Wellpoint Medicaid Managed Care	$160.19

PROBE LAVEEN 4.0 14/15 26213

Facility

$6,045.00

Hospital Charge Code	270630812
Hospital Revenue Code	272
Min. Negotiated Rate	$906.75
Max. Negotiated Rate	$906.75
Rate for Payer: Qualcare PPO/HMO/WC	$906.75

PROBE LAVEEN 4.0 14/15 26213

Facility

$6,572.00

Hospital Charge Code	270631812
Hospital Revenue Code	272
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$985.80
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

PROBE LITHOTRIPLE ELECTROHYDRA

Facility

$3,250.00

Hospital Charge Code	270658476
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PROBE LITHOTRIPLE ELECTROHYDRA

Facility

$3,250.00

Hospital Charge Code	270658476
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

PROBE MCV GOLD 7FR 6007

Facility

$231.25

Hospital Charge Code	270603908
Hospital Revenue Code	272
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

PROBE MCV GOLD 7FR 6007

Facility

$231.25

Hospital Charge Code	270603908
Hospital Revenue Code	272
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$115.62
Rate for Payer: Aetna Commercial	$87.88
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$46.25
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$46.25
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

PROBE MCV LITHOC .8 2.4 840202

Facility

$3,025.65

Hospital Charge Code	270624387
Hospital Revenue Code	272
Min. Negotiated Rate	$72.92
Max. Negotiated Rate	$1,512.83
Rate for Payer: Aetna Commercial	$1,149.75
Rate for Payer: Aetna Medicare Advantage	$907.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.54
Rate for Payer: Cigna Commercial	$1,512.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.70
Rate for Payer: Oxford Commercial	$605.13
Rate for Payer: Qualcare PPO/HMO/WC	$453.85
Rate for Payer: UnitedHealthcare Commercial	$605.13
Rate for Payer: UnitedHealthcare Community & State	$72.92
Rate for Payer: Wellpoint Medicaid Managed Care	$80.18

PROBE MCV LITHOC .8 2.4 840202

Facility

$3,025.65

Hospital Charge Code	270624387
Hospital Revenue Code	272
Min. Negotiated Rate	$453.85
Max. Negotiated Rate	$453.85
Rate for Payer: Qualcare PPO/HMO/WC	$453.85

PROBE MCV SWISS 1.6 423 840214

Facility

$3,050.00

Hospital Charge Code	270624051
Hospital Revenue Code	272
Min. Negotiated Rate	$457.50
Max. Negotiated Rate	$457.50
Rate for Payer: Qualcare PPO/HMO/WC	$457.50

Know your out-of-pocket cost for care.

All Charges