Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR KIT *********

Facility

$259.00

Hospital Charge Code	1608512
Hospital Revenue Code	272
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$279.95
Rate for Payer: Aetna Commercial	$212.76
Rate for Payer: Aetna Medicare Advantage	$167.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.77
Rate for Payer: Cigna Commercial	$279.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.97
Rate for Payer: Oxford Commercial	$111.98
Rate for Payer: Qualcare PPO/HMO/WC	$83.98
Rate for Payer: UnitedHealthcare Commercial	$111.98
Rate for Payer: UnitedHealthcare Community & State	$13.49
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$83.98

RETRACTOR LARGE HASSANS

Facility

$442.80

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$66.42
Rate for Payer: Qualcare PPO/HMO/WC	$66.42

RETRACTOR LARGE HASSANS

Facility

$442.80

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna Commercial	$168.26
Rate for Payer: Aetna Medicare Advantage	$132.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.91
Rate for Payer: Cigna Commercial	$221.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.84
Rate for Payer: Oxford Commercial	$88.56
Rate for Payer: Qualcare PPO/HMO/WC	$66.42
Rate for Payer: UnitedHealthcare Commercial	$88.56
Rate for Payer: UnitedHealthcare Community & State	$10.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.73

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$164.54
Max. Negotiated Rate	$164.54
Rate for Payer: Qualcare PPO/HMO/WC	$164.54

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$548.48
Rate for Payer: Aetna Commercial	$416.84
Rate for Payer: Aetna Medicare Advantage	$329.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.72
Rate for Payer: Cigna Commercial	$548.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.08
Rate for Payer: Oxford Commercial	$219.39
Rate for Payer: Qualcare PPO/HMO/WC	$164.54
Rate for Payer: UnitedHealthcare Commercial	$219.39
Rate for Payer: UnitedHealthcare Community & State	$26.44
Rate for Payer: Wellpoint Medicaid Managed Care	$29.07

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$57.91
Rate for Payer: Qualcare PPO/HMO/WC	$57.91

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$193.05
Rate for Payer: Aetna Commercial	$146.72
Rate for Payer: Aetna Medicare Advantage	$115.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.46
Rate for Payer: Cigna Commercial	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.83
Rate for Payer: Oxford Commercial	$77.22
Rate for Payer: Qualcare PPO/HMO/WC	$57.91
Rate for Payer: UnitedHealthcare Commercial	$77.22
Rate for Payer: UnitedHealthcare Community & State	$9.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.23

RETRACTOR LONEST COLORECT DISP

Facility

$817.08

Hospital Charge Code	270695673
Hospital Revenue Code	272
Min. Negotiated Rate	$122.56
Max. Negotiated Rate	$122.56
Rate for Payer: Qualcare PPO/HMO/WC	$122.56

RETRACTOR LONEST COLORECT DISP

Facility

$817.08

Hospital Charge Code	270695673
Hospital Revenue Code	272
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$408.54
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna Medicare Advantage	$245.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.36
Rate for Payer: Cigna Commercial	$408.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.12
Rate for Payer: Oxford Commercial	$163.42
Rate for Payer: Qualcare PPO/HMO/WC	$122.56
Rate for Payer: UnitedHealthcare Commercial	$163.42
Rate for Payer: UnitedHealthcare Community & State	$19.69
Rate for Payer: Wellpoint Medicaid Managed Care	$21.65

RETRACTOR MEDT 22 9 9560709

Facility

$1,440.00

Hospital Charge Code	270629192
Hospital Revenue Code	272
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna Commercial	$547.20
Rate for Payer: Aetna Medicare Advantage	$432.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$367.20
Rate for Payer: Cigna Commercial	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.00
Rate for Payer: Oxford Commercial	$288.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.00
Rate for Payer: UnitedHealthcare Commercial	$288.00
Rate for Payer: UnitedHealthcare Community & State	$34.70
Rate for Payer: Wellpoint Medicaid Managed Care	$38.16

RETRACTOR MEDT 22 9 9560709

Facility

$1,440.00

Hospital Charge Code	270629192
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.00

RETRACTOR MEDT 22 9 9560709**

Facility

$1,800.00

Hospital Charge Code	270629198
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

RETRACTOR MEDT 22 9 9560709**

Facility

$1,800.00

Hospital Charge Code	270629198
Hospital Revenue Code	272
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

RETRACTOR MICRO TEK 711 *****

Facility

$33.00

Hospital Charge Code	1606227
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

RETRACTOR MICRO TEK 711 *****

Facility

$33.00

Hospital Charge Code	1606227
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

RETRACTOR MOB ELAST MED 900515

Facility

$325.00

Hospital Charge Code	270633016
Hospital Revenue Code	272
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$65.00
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

RETRACTOR MOB ELAST MED 900515

Facility

$325.00

Hospital Charge Code	270633016
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

RETRACTOR MOBIUS 900-520

Facility

$620.00

Hospital Charge Code	270633148
Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

RETRACTOR MOBIUS 900-520

Facility

$620.00

Hospital Charge Code	270633148
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

RETRACTOR RIGHT ANGLED 18MM

Facility

$1,005.00

Hospital Charge Code	270692073
Hospital Revenue Code	272
Min. Negotiated Rate	$24.22
Max. Negotiated Rate	$502.50
Rate for Payer: Aetna Commercial	$381.90
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.50
Rate for Payer: Oxford Commercial	$201.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.75
Rate for Payer: UnitedHealthcare Commercial	$201.00
Rate for Payer: UnitedHealthcare Community & State	$24.22
Rate for Payer: Wellpoint Medicaid Managed Care	$26.63

RETRACTOR RIGHT ANGLED 18MM

Facility

$1,005.00

Hospital Charge Code	270692073
Hospital Revenue Code	272
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$150.75
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

RETRACTOR RIGHT ANGLED 43MM

Facility

$1,105.00

Hospital Charge Code	270692074
Hospital Revenue Code	272
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.50
Rate for Payer: Aetna Commercial	$419.90
Rate for Payer: Aetna Medicare Advantage	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.77
Rate for Payer: Cigna Commercial	$552.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.50
Rate for Payer: Oxford Commercial	$221.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.75
Rate for Payer: UnitedHealthcare Commercial	$221.00
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

RETRACTOR RIGHT ANGLED 43MM

Facility

$1,105.00

Hospital Charge Code	270692074
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$165.75
Rate for Payer: Qualcare PPO/HMO/WC	$165.75

Know your out-of-pocket cost for care.

All Charges