Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR BLADE SHARP 45MM

Facility

$362.50

Hospital Charge Code	270653457
Hospital Revenue Code	272
Min. Negotiated Rate	$54.38
Max. Negotiated Rate	$54.38
Rate for Payer: Qualcare PPO/HMO/WC	$54.38

RETRACTOR BLADE SHARP 45MM

Facility

$362.50

Hospital Charge Code	270653457
Hospital Revenue Code	272
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$181.25
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare Advantage	$108.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.44
Rate for Payer: Cigna Commercial	$181.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.75
Rate for Payer: Oxford Commercial	$72.50
Rate for Payer: Qualcare PPO/HMO/WC	$54.38
Rate for Payer: UnitedHealthcare Commercial	$72.50
Rate for Payer: UnitedHealthcare Community & State	$8.74
Rate for Payer: Wellpoint Medicaid Managed Care	$9.61

RETRACTOR BLUNT 12 MM

Facility

$47.43

Hospital Charge Code	270691054
Hospital Revenue Code	272
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$7.11
Rate for Payer: Qualcare PPO/HMO/WC	$7.11

RETRACTOR BLUNT 12 MM

Facility

$47.43

Hospital Charge Code	270691054
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.71
Rate for Payer: Aetna Commercial	$18.02
Rate for Payer: Aetna Medicare Advantage	$14.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.09
Rate for Payer: Cigna Commercial	$23.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$7.11
Rate for Payer: UnitedHealthcare Commercial	$9.49
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

RETRACTOR CAPSULE

Facility

$3,600.00

Hospital Charge Code	270698355
Hospital Revenue Code	272
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,368.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.00
Rate for Payer: Oxford Commercial	$720.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00
Rate for Payer: UnitedHealthcare Commercial	$720.00
Rate for Payer: UnitedHealthcare Community & State	$86.76
Rate for Payer: Wellpoint Medicaid Managed Care	$95.40

RETRACTOR CAPSULE

Facility

$3,600.00

Hospital Charge Code	270698355
Hospital Revenue Code	272
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

RETRACTOR EDS ENDO EK441601

Facility

$2,806.45

Hospital Charge Code	270628755
Hospital Revenue Code	272
Min. Negotiated Rate	$67.64
Max. Negotiated Rate	$1,403.22
Rate for Payer: Aetna Commercial	$1,066.45
Rate for Payer: Aetna Medicare Advantage	$841.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$715.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$715.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$715.64
Rate for Payer: Cigna Commercial	$1,403.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$841.93
Rate for Payer: Oxford Commercial	$561.29
Rate for Payer: Qualcare PPO/HMO/WC	$420.97
Rate for Payer: UnitedHealthcare Commercial	$561.29
Rate for Payer: UnitedHealthcare Community & State	$67.64
Rate for Payer: Wellpoint Medicaid Managed Care	$74.37

RETRACTOR EDS ENDO EK441601

Facility

$2,806.45

Hospital Charge Code	270628755
Hospital Revenue Code	272
Min. Negotiated Rate	$420.97
Max. Negotiated Rate	$420.97
Rate for Payer: Qualcare PPO/HMO/WC	$420.97

RETRACTOR ENDO 10MM STD LGTH

Facility

$364.34

Hospital Charge Code	270667606
Hospital Revenue Code	272
Min. Negotiated Rate	$54.65
Max. Negotiated Rate	$54.65
Rate for Payer: Qualcare PPO/HMO/WC	$54.65

RETRACTOR ENDO 10MM STD LGTH

Facility

$364.34

Hospital Charge Code	270667606
Hospital Revenue Code	272
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$182.17
Rate for Payer: Aetna Commercial	$138.45
Rate for Payer: Aetna Medicare Advantage	$109.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.91
Rate for Payer: Cigna Commercial	$182.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.30
Rate for Payer: Oxford Commercial	$72.87
Rate for Payer: Qualcare PPO/HMO/WC	$54.65
Rate for Payer: UnitedHealthcare Commercial	$72.87
Rate for Payer: UnitedHealthcare Community & State	$8.78
Rate for Payer: Wellpoint Medicaid Managed Care	$9.66

RETRACTOR ENDO 12MM LOR12

Facility

$1,228.85

Hospital Charge Code	270608761
Hospital Revenue Code	272
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$614.42
Rate for Payer: Aetna Commercial	$466.96
Rate for Payer: Aetna Medicare Advantage	$368.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$313.36
Rate for Payer: Cigna Commercial	$614.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.65
Rate for Payer: Oxford Commercial	$245.77
Rate for Payer: Qualcare PPO/HMO/WC	$184.33
Rate for Payer: UnitedHealthcare Commercial	$245.77
Rate for Payer: UnitedHealthcare Community & State	$29.62
Rate for Payer: Wellpoint Medicaid Managed Care	$32.56

RETRACTOR ENDO 12MM LOR12

Facility

$1,228.85

Hospital Charge Code	270608761
Hospital Revenue Code	272
Min. Negotiated Rate	$184.33
Max. Negotiated Rate	$184.33
Rate for Payer: Qualcare PPO/HMO/WC	$184.33

RETRACTOR ENDO PADDLE 12MM

Facility

$2,006.25

Hospital Charge Code	270641076
Hospital Revenue Code	272
Min. Negotiated Rate	$300.94
Max. Negotiated Rate	$300.94
Rate for Payer: Qualcare PPO/HMO/WC	$300.94

RETRACTOR ENDO PADDLE 12MM

Facility

$2,006.25

Hospital Charge Code	270641076
Hospital Revenue Code	272
Min. Negotiated Rate	$48.35
Max. Negotiated Rate	$1,003.12
Rate for Payer: Aetna Commercial	$762.38
Rate for Payer: Aetna Medicare Advantage	$601.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.59
Rate for Payer: Cigna Commercial	$1,003.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$601.88
Rate for Payer: Oxford Commercial	$401.25
Rate for Payer: Qualcare PPO/HMO/WC	$300.94
Rate for Payer: UnitedHealthcare Commercial	$401.25
Rate for Payer: UnitedHealthcare Community & State	$48.35
Rate for Payer: Wellpoint Medicaid Managed Care	$53.17

RETRACTOR HOHMANN 15MMx160MM

Facility

$1,117.15

Hospital Charge Code	270608594
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$424.52
Rate for Payer: Aetna Medicare Advantage	$335.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.87
Rate for Payer: Cigna Commercial	$558.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.14
Rate for Payer: Oxford Commercial	$223.43
Rate for Payer: Qualcare PPO/HMO/WC	$167.57
Rate for Payer: UnitedHealthcare Commercial	$223.43
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

RETRACTOR HOHMANN 15MMx160MM

Facility

$1,117.15

Hospital Charge Code	270608594
Hospital Revenue Code	272
Min. Negotiated Rate	$167.57
Max. Negotiated Rate	$167.57
Rate for Payer: Qualcare PPO/HMO/WC	$167.57

RETRACTOR HOHMANN 24 MM BLADE

Facility

$396.85

Hospital Charge Code	270681333
Hospital Revenue Code	272
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$198.43
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna Medicare Advantage	$119.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.20
Rate for Payer: Cigna Commercial	$198.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.06
Rate for Payer: Oxford Commercial	$79.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.53
Rate for Payer: UnitedHealthcare Commercial	$79.37
Rate for Payer: UnitedHealthcare Community & State	$9.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10.52

RETRACTOR HOHMANN 24 MM BLADE

Facility

$396.85

Hospital Charge Code	270681333
Hospital Revenue Code	272
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

RETRACTOR HOHMANN 6mmX160mm

Facility

$903.90

Hospital Charge Code	270638980
Hospital Revenue Code	272
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$451.95
Rate for Payer: Aetna Commercial	$343.48
Rate for Payer: Aetna Medicare Advantage	$271.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.49
Rate for Payer: Cigna Commercial	$451.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.17
Rate for Payer: Oxford Commercial	$180.78
Rate for Payer: Qualcare PPO/HMO/WC	$135.59
Rate for Payer: UnitedHealthcare Commercial	$180.78
Rate for Payer: UnitedHealthcare Community & State	$21.78
Rate for Payer: Wellpoint Medicaid Managed Care	$23.95

RETRACTOR HOHMANN 6mmX160mm

Facility

$903.90

Hospital Charge Code	270638980
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$451.95
Rate for Payer: Aetna Commercial	$343.48
Rate for Payer: Aetna Medicare Advantage	$271.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.49
Rate for Payer: Cigna Commercial	$451.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.17
Rate for Payer: Oxford Commercial	$180.78
Rate for Payer: Qualcare PPO/HMO/WC	$135.59
Rate for Payer: UnitedHealthcare Commercial	$180.78
Rate for Payer: UnitedHealthcare Community & State	$21.78
Rate for Payer: Wellpoint Medicaid Managed Care	$23.95

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$3,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$614.55
Max. Negotiated Rate	$12,750.00
Rate for Payer: Aetna Commercial	$9,690.00
Rate for Payer: Aetna Medicare Advantage	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,502.50
Rate for Payer: Cigna Commercial	$12,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,650.00
Rate for Payer: Oxford Commercial	$5,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00
Rate for Payer: UnitedHealthcare Commercial	$5,100.00
Rate for Payer: UnitedHealthcare Community & State	$614.55
Rate for Payer: Wellpoint Medicaid Managed Care	$675.75

RETRACTOR KIT *********

Facility

$259.00

Hospital Charge Code	1608512
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$129.50
Rate for Payer: Aetna Commercial	$98.42
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.70
Rate for Payer: Oxford Commercial	$51.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$51.80
Rate for Payer: UnitedHealthcare Community & State	$6.24
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

Know your out-of-pocket cost for care.

All Charges