Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PULSE GENERATOR KIT SPECTRA

Facility

$102,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270696217
Hospital Revenue Code	278
Min. Negotiated Rate	$15,375.00
Max. Negotiated Rate	$24,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,805.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22,550.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,375.00

PULSE OXIMERTY (CHILD)***

Facility

$103.20

Hospital Charge Code	9501172
Hospital Revenue Code	279
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.60
Rate for Payer: Aetna Commercial	$39.22
Rate for Payer: Aetna Medicare Advantage	$30.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.32
Rate for Payer: Cigna Commercial	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.96
Rate for Payer: Oxford Commercial	$20.64
Rate for Payer: Qualcare PPO/HMO/WC	$15.48
Rate for Payer: UnitedHealthcare Commercial	$20.64
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

PULSE OXIMERTY (CHILD)***

Facility

$103.20

Hospital Charge Code	9501172
Hospital Revenue Code	279
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$15.48
Rate for Payer: Qualcare PPO/HMO/WC	$15.48

PULSE OXIMETRY****

Facility

$36.00

Service Code	HCPCS 94760
Hospital Charge Code	5100128
Hospital Revenue Code	469
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

PULSE OXIMETRY****

Facility

$36.00

Service Code	HCPCS 94760
Hospital Charge Code	5100128
Hospital Revenue Code	469
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

PULSE OXIMETRY NON INV CONT MO

Facility

$1,066.25

Service Code	HCPCS 94762
Hospital Charge Code	9500614
Hospital Revenue Code	460
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$415.81
Rate for Payer: Aetna Medicare Advantage	$495.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$152.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.81
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: Cigna Medicare Advantage	$152.87
Rate for Payer: Clover Medicare Advantage	$145.23
Rate for Payer: EmblemHealth Commercial	$458.61
Rate for Payer: Humana Medicare Advantage	$157.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$152.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.88
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.94
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.87
Rate for Payer: Wellcare Medicare Advantage	$152.87
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

PULSE OXIMETRY NON INV CONT MO

Facility

$1,066.25

Service Code	HCPCS 94762
Hospital Charge Code	9500614
Hospital Revenue Code	460
Min. Negotiated Rate	$159.94
Max. Negotiated Rate	$159.94
Rate for Payer: Qualcare PPO/HMO/WC	$159.94

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83091022
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83092032
Hospital Revenue Code	460
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$191.14
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.90
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$12.12
Rate for Payer: Wellpoint Medicaid Managed Care	$13.33

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83091022
Hospital Revenue Code	460
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$191.14
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.90
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$12.12
Rate for Payer: Wellpoint Medicaid Managed Care	$13.33

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83092032
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

PULSE OXIMETRY SPOT CHECK

Facility

$10,110.97

Service Code	HCPCS 94760
Hospital Charge Code	9500612
Hospital Revenue Code	460
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$5,055.48
Rate for Payer: Aetna Commercial	$3,842.17
Rate for Payer: Aetna Medicare Advantage	$3,033.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,578.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,578.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,578.30
Rate for Payer: Cigna Commercial	$5,055.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,033.29
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.65
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$243.67
Rate for Payer: Wellpoint Medicaid Managed Care	$267.94

PULSE OXIMETRY SPOT CHECK

Facility

$10,110.97

Service Code	HCPCS 94760
Hospital Charge Code	9500612
Hospital Revenue Code	460
Min. Negotiated Rate	$1,516.65
Max. Negotiated Rate	$1,516.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.65

PULSE OX MULTI DETERMINATION

Facility

$10,222.71

Service Code	HCPCS 94761
Hospital Charge Code	9500615
Hospital Revenue Code	460
Min. Negotiated Rate	$1,533.41
Max. Negotiated Rate	$1,533.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.41

PULSE OX MULTI DETERMINATION

Facility

$10,222.71

Service Code	HCPCS 94761
Hospital Charge Code	9500615
Hospital Revenue Code	460
Min. Negotiated Rate	$54.21
Max. Negotiated Rate	$5,111.35
Rate for Payer: Aetna Commercial	$3,884.63
Rate for Payer: Aetna Medicare Advantage	$3,066.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.79
Rate for Payer: Cigna Commercial	$5,111.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,066.81
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.41
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$246.37
Rate for Payer: Wellpoint Medicaid Managed Care	$270.90

PULSE SPRAY INFUSION SYS 5FR 4

Facility

$2,260.00

Hospital Charge Code	270665488
Hospital Revenue Code	270
Min. Negotiated Rate	$54.47
Max. Negotiated Rate	$1,130.00
Rate for Payer: Aetna Commercial	$858.80
Rate for Payer: Aetna Medicare Advantage	$678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.30
Rate for Payer: Cigna Commercial	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.00
Rate for Payer: Oxford Commercial	$452.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00
Rate for Payer: UnitedHealthcare Commercial	$452.00
Rate for Payer: UnitedHealthcare Community & State	$54.47
Rate for Payer: Wellpoint Medicaid Managed Care	$59.89

PULSE SPRAY INFUSION SYS 5FR 4

Facility

$2,260.00

Hospital Charge Code	270665488
Hospital Revenue Code	270
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$339.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00

PULSE SPRAY INFUSION SYS 5FR 9

Facility

$2,260.00

Hospital Charge Code	270663789
Hospital Revenue Code	270
Min. Negotiated Rate	$54.47
Max. Negotiated Rate	$1,130.00
Rate for Payer: Aetna Commercial	$858.80
Rate for Payer: Aetna Medicare Advantage	$678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.30
Rate for Payer: Cigna Commercial	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.00
Rate for Payer: Oxford Commercial	$452.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00
Rate for Payer: UnitedHealthcare Commercial	$452.00
Rate for Payer: UnitedHealthcare Community & State	$54.47
Rate for Payer: Wellpoint Medicaid Managed Care	$59.89

PULSE SPRAY INFUSION SYS 5FR 9

Facility

$2,260.00

Hospital Charge Code	270663789
Hospital Revenue Code	270
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$339.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00

PULSEVAC FAN SPRAY TIP *****

Facility

$40.00

Hospital Charge Code	1606276
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

PULSEVAC FAN SPRAY TIP *****

Facility

$40.00

Hospital Charge Code	1606276
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

PUMP ABBOTT ADMIN SET***

Facility

$42.00

Hospital Charge Code	7000458
Hospital Revenue Code	279
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

PUMP ABBOTT ADMIN SET***

Facility

$42.00

Hospital Charge Code	7000458
Hospital Revenue Code	279
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

PUMP AMPRO SUMP AN-40

Facility

$508.00

Hospital Charge Code	270301380
Hospital Revenue Code	272
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$254.00
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna Medicare Advantage	$152.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.54
Rate for Payer: Cigna Commercial	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.40
Rate for Payer: Oxford Commercial	$101.60
Rate for Payer: Qualcare PPO/HMO/WC	$76.20
Rate for Payer: UnitedHealthcare Commercial	$101.60
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: Wellpoint Medicaid Managed Care	$13.46

PUMP AMPRO SUMP AN-40

Facility

$508.00

Hospital Charge Code	270301380
Hospital Revenue Code	272
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$76.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.20

Know your out-of-pocket cost for care.

All Charges