Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PUMPING SYST SGL ACTION*****

Facility

$190.00

Hospital Charge Code	1604727
Hospital Revenue Code	272
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PUMP INTRATHECAL AP03000H

Facility

$69,750.00

Service Code	HCPCS C1772
Hospital Charge Code	270699219
Hospital Revenue Code	278
Min. Negotiated Rate	$10,462.50
Max. Negotiated Rate	$16,879.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,879.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,462.50

PUMP INTRATHECAL AP03000H

Facility

$69,750.00

Service Code	HCPCS C1772
Hospital Charge Code	270699219
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.97
Max. Negotiated Rate	$34,875.00
Rate for Payer: Aetna Commercial	$26,505.00
Rate for Payer: Aetna Medicare Advantage	$20,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,786.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,786.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,786.25
Rate for Payer: Cigna Commercial	$34,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,879.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,462.50
Rate for Payer: UnitedHealthcare Community & State	$1,680.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1,848.38

PUMP IZ 700CX

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270688017
Hospital Revenue Code	278
Min. Negotiated Rate	$7,728.75
Max. Negotiated Rate	$12,469.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,335.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75

PUMP IZ 700CX

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270688017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.75
Max. Negotiated Rate	$25,762.50
Rate for Payer: Aetna Commercial	$19,579.50
Rate for Payer: Aetna Medicare Advantage	$15,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,138.88
Rate for Payer: Cigna Commercial	$25,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,335.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75
Rate for Payer: UnitedHealthcare Community & State	$1,241.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,365.41

PUMP MANUALECTRIC

Facility

$184.85

Hospital Charge Code	270600467
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$92.42
Rate for Payer: Aetna Commercial	$70.24
Rate for Payer: Aetna Medicare Advantage	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.14
Rate for Payer: Cigna Commercial	$92.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.45
Rate for Payer: Oxford Commercial	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$27.73
Rate for Payer: UnitedHealthcare Commercial	$36.97
Rate for Payer: UnitedHealthcare Community & State	$4.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

PUMP MANUALECTRIC

Facility

$184.85

Hospital Charge Code	270600467
Hospital Revenue Code	272
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$27.73
Rate for Payer: Qualcare PPO/HMO/WC	$27.73

PUMP MEDT INFUSION 861718

Facility

$33,405.65

Hospital Charge Code	270612538
Hospital Revenue Code	278
Min. Negotiated Rate	$5,010.85
Max. Negotiated Rate	$8,084.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,681.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,084.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,349.24
Rate for Payer: Qualcare PPO/HMO/WC	$5,010.85

PUMP MEDT INFUSION 861718

Facility

$33,405.65

Hospital Charge Code	270612538
Hospital Revenue Code	278
Min. Negotiated Rate	$805.08
Max. Negotiated Rate	$16,702.83
Rate for Payer: Aetna Commercial	$12,694.15
Rate for Payer: Aetna Medicare Advantage	$10,021.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,518.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,518.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,681.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,518.44
Rate for Payer: Cigna Commercial	$16,702.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,084.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,349.24
Rate for Payer: Qualcare PPO/HMO/WC	$5,010.85
Rate for Payer: UnitedHealthcare Community & State	$805.08
Rate for Payer: Wellpoint Medicaid Managed Care	$885.25

PUMP MITIVAC

Facility

$760.00

Hospital Charge Code	270600590
Hospital Revenue Code	272
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.00
Rate for Payer: Oxford Commercial	$152.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Commercial	$152.00
Rate for Payer: UnitedHealthcare Community & State	$18.32
Rate for Payer: Wellpoint Medicaid Managed Care	$20.14

PUMP MITIVAC

Facility

$760.00

Hospital Charge Code	270600590
Hospital Revenue Code	272
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

PUMP ON-Q 100ML x 2ML/HR

Facility

$500.00

Hospital Charge Code	270650273
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

PUMP ON-Q 100ML x 2ML/HR

Facility

$500.00

Hospital Charge Code	270650273
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PUMP ON-Q 100MLX2ML/HR W/2.5

Facility

$525.00

Service Code	HCPCS C1772
Hospital Charge Code	270650396
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

PUMP ON-Q 100MLX2ML/HR W/2.5

Facility

$525.00

Service Code	HCPCS C1772
Hospital Charge Code	270650396
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

PUMP ON-Q DUAL 600ML 1-7ML/HR

Facility

$2,850.00

Hospital Charge Code	270676702
Hospital Revenue Code	272
Min. Negotiated Rate	$68.69
Max. Negotiated Rate	$1,425.00
Rate for Payer: Aetna Commercial	$1,083.00
Rate for Payer: Aetna Medicare Advantage	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$726.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$726.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$726.75
Rate for Payer: Cigna Commercial	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$855.00
Rate for Payer: Oxford Commercial	$570.00
Rate for Payer: Qualcare PPO/HMO/WC	$427.50
Rate for Payer: UnitedHealthcare Commercial	$570.00
Rate for Payer: UnitedHealthcare Community & State	$68.69
Rate for Payer: Wellpoint Medicaid Managed Care	$75.53

PUMP ON-Q DUAL 600ML 1-7ML/HR

Facility

$2,850.00

Hospital Charge Code	270676702
Hospital Revenue Code	272
Min. Negotiated Rate	$427.50
Max. Negotiated Rate	$427.50
Rate for Payer: Qualcare PPO/HMO/WC	$427.50

PUMP ON-Q DUAL 600ML 2-14ML/HR

Facility

$2,350.00

Hospital Charge Code	270678112
Hospital Revenue Code	272
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.00
Rate for Payer: Oxford Commercial	$470.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$470.00
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

PUMP ON-Q DUAL 600ML 2-14ML/HR

Facility

$2,350.00

Hospital Charge Code	270678112
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

PUMP ON-Q W/DUAL SAF 400ML

Facility

$1,658.00

Hospital Charge Code	270650397
Hospital Revenue Code	272
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$829.00
Rate for Payer: Aetna Commercial	$630.04
Rate for Payer: Aetna Medicare Advantage	$497.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.79
Rate for Payer: Cigna Commercial	$829.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.40
Rate for Payer: Oxford Commercial	$331.60
Rate for Payer: Qualcare PPO/HMO/WC	$248.70
Rate for Payer: UnitedHealthcare Commercial	$331.60
Rate for Payer: UnitedHealthcare Community & State	$39.96
Rate for Payer: Wellpoint Medicaid Managed Care	$43.94

PUMP ON-Q W/DUAL SAF 400ML

Facility

$1,658.00

Hospital Charge Code	270650397
Hospital Revenue Code	272
Min. Negotiated Rate	$248.70
Max. Negotiated Rate	$248.70
Rate for Payer: Qualcare PPO/HMO/WC	$248.70

PUMP PAIN CONTROL ADMINISTRATI

Facility

$3,375.00

Hospital Charge Code	270656210
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PUMP PAIN CONTROL ADMINISTRATI

Facility

$3,375.00

Hospital Charge Code	270656210
Hospital Revenue Code	278
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

PUMP SET IMPELLA 2.5 AIC

Facility

$125,000.00

Hospital Charge Code	270681567
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.50
Max. Negotiated Rate	$62,500.00
Rate for Payer: Aetna Commercial	$47,500.00
Rate for Payer: Aetna Medicare Advantage	$37,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,875.00
Rate for Payer: Cigna Commercial	$62,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30,250.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,750.00
Rate for Payer: UnitedHealthcare Community & State	$3,012.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3,312.50

PUMP SET IMPELLA 2.5 AIC

Facility

$125,000.00

Hospital Charge Code	270681567
Hospital Revenue Code	278
Min. Negotiated Rate	$18,750.00
Max. Negotiated Rate	$30,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30,250.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,750.00

Know your out-of-pocket cost for care.

All Charges