Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETRIEVAL BALLON

Facility

$172.00

Hospital Charge Code	270325610
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

RETRIEVAL BASKET SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684734
Hospital Revenue Code	272
Min. Negotiated Rate	$51.69
Max. Negotiated Rate	$1,072.50
Rate for Payer: Aetna Commercial	$815.10
Rate for Payer: Aetna Medicare Advantage	$643.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$546.98
Rate for Payer: Cigna Commercial	$1,072.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.50
Rate for Payer: Oxford Commercial	$429.00
Rate for Payer: Qualcare PPO/HMO/WC	$321.75
Rate for Payer: UnitedHealthcare Commercial	$429.00
Rate for Payer: UnitedHealthcare Community & State	$51.69
Rate for Payer: Wellpoint Medicaid Managed Care	$56.84

RETRIEVAL BASKET SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684734
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$321.75
Rate for Payer: Qualcare PPO/HMO/WC	$321.75

RETRIEVER FIBERTAPE

Facility

$7,475.00

Hospital Charge Code	270675963
Hospital Revenue Code	272
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

RETRIEVER FIBERTAPE

Facility

$7,475.00

Hospital Charge Code	270675963
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

RETRIEVER LVT SUTUER LG 9894

Facility

$165.95

Hospital Charge Code	270611100
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$82.97
Rate for Payer: Aetna Commercial	$63.06
Rate for Payer: Aetna Medicare Advantage	$49.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.32
Rate for Payer: Cigna Commercial	$82.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.78
Rate for Payer: Oxford Commercial	$33.19
Rate for Payer: Qualcare PPO/HMO/WC	$24.89
Rate for Payer: UnitedHealthcare Commercial	$33.19
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

RETRIEVER LVT SUTUER LG 9894

Facility

$165.95

Hospital Charge Code	270611100
Hospital Revenue Code	272
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$24.89
Rate for Payer: Qualcare PPO/HMO/WC	$24.89

RETRIEVER LVT SUTUER SM 9892

Facility

$165.95

Hospital Charge Code	270611101
Hospital Revenue Code	272
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$24.89
Rate for Payer: Qualcare PPO/HMO/WC	$24.89

RETRIEVER LVT SUTUER SM 9892

Facility

$165.95

Hospital Charge Code	270611101
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$82.97
Rate for Payer: Aetna Commercial	$63.06
Rate for Payer: Aetna Medicare Advantage	$49.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.32
Rate for Payer: Cigna Commercial	$82.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.78
Rate for Payer: Oxford Commercial	$33.19
Rate for Payer: Qualcare PPO/HMO/WC	$24.89
Rate for Payer: UnitedHealthcare Commercial	$33.19
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

RETRIEVER MCV BALLN 11.5 4545

Facility

$739.25

Hospital Charge Code	270627943
Hospital Revenue Code	272
Min. Negotiated Rate	$110.89
Max. Negotiated Rate	$110.89
Rate for Payer: Qualcare PPO/HMO/WC	$110.89

RETRIEVER MCV BALLN 11.5 4545

Facility

$739.25

Hospital Charge Code	270627943
Hospital Revenue Code	272
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$369.62
Rate for Payer: Aetna Commercial	$280.92
Rate for Payer: Aetna Medicare Advantage	$221.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.51
Rate for Payer: Cigna Commercial	$369.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.78
Rate for Payer: Oxford Commercial	$147.85
Rate for Payer: Qualcare PPO/HMO/WC	$110.89
Rate for Payer: UnitedHealthcare Commercial	$147.85
Rate for Payer: UnitedHealthcare Community & State	$17.82
Rate for Payer: Wellpoint Medicaid Managed Care	$19.59

RETRIEVER MCV BALLN 8.5 4544

Facility

$739.10

Hospital Charge Code	270627944
Hospital Revenue Code	272
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$110.86
Rate for Payer: Qualcare PPO/HMO/WC	$110.86

RETRIEVER MCV BALLN 8.5 4544

Facility

$739.10

Hospital Charge Code	270627944
Hospital Revenue Code	272
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$369.55
Rate for Payer: Aetna Commercial	$280.86
Rate for Payer: Aetna Medicare Advantage	$221.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.47
Rate for Payer: Cigna Commercial	$369.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.73
Rate for Payer: Oxford Commercial	$147.82
Rate for Payer: Qualcare PPO/HMO/WC	$110.86
Rate for Payer: UnitedHealthcare Commercial	$147.82
Rate for Payer: UnitedHealthcare Community & State	$17.81
Rate for Payer: Wellpoint Medicaid Managed Care	$19.59

RETRIEVER NET ROTH 2.5mm 230cm

Facility

$500.00

Hospital Charge Code	270684082
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

RETRIEVER NET ROTH 2.5mm 230cm

Facility

$500.00

Hospital Charge Code	270684082
Hospital Revenue Code	272
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) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

RETRIEVER SUTURE HEWSON 10.1L

Facility

$324.00

Hospital Charge Code	270644147
Hospital Revenue Code	272
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$64.80
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

RETRIEVER SUTURE HEWSON 10.1L

Facility

$324.00

Hospital Charge Code	270644147
Hospital Revenue Code	272
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

RETRIEV POSITRAP BASKET

Facility

$456.00

Hospital Charge Code	270606230
Hospital Revenue Code	270
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$68.40
Rate for Payer: Qualcare PPO/HMO/WC	$68.40

RETRIEV POSITRAP BASKET

Facility

$456.00

Hospital Charge Code	270606230
Hospital Revenue Code	270
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$173.28
Rate for Payer: Aetna Medicare Advantage	$136.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.28
Rate for Payer: Cigna Commercial	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.80
Rate for Payer: Oxford Commercial	$91.20
Rate for Payer: Qualcare PPO/HMO/WC	$68.40
Rate for Payer: UnitedHealthcare Commercial	$91.20
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: Wellpoint Medicaid Managed Care	$12.08

RETRIVAL SNARE SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684733
Hospital Revenue Code	272
Min. Negotiated Rate	$51.69
Max. Negotiated Rate	$1,072.50
Rate for Payer: Aetna Commercial	$815.10
Rate for Payer: Aetna Medicare Advantage	$643.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$546.98
Rate for Payer: Cigna Commercial	$1,072.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.50
Rate for Payer: Oxford Commercial	$429.00
Rate for Payer: Qualcare PPO/HMO/WC	$321.75
Rate for Payer: UnitedHealthcare Commercial	$429.00
Rate for Payer: UnitedHealthcare Community & State	$51.69
Rate for Payer: Wellpoint Medicaid Managed Care	$56.84

RETRIVAL SNARE SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684733
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$321.75
Rate for Payer: Qualcare PPO/HMO/WC	$321.75

RETROBULBAR NEEDLE 25G.

Facility

$48.00

Hospital Charge Code	270331702
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

RETROBULBAR NEEDLE 25G.

Facility

$48.00

Hospital Charge Code	270331702
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

RETROGRADE PYELOGRAM

Facility

$2,469.00

Service Code	HCPCS 74420
Hospital Charge Code	1600000439
Hospital Revenue Code	360
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$414.47
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$740.70
Rate for Payer: Qualcare PPO/HMO/WC	$370.35
Rate for Payer: UnitedHealthcare Community & State	$59.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$65.43

RETROGRADE PYELOGRAM

Facility

$2,469.00

Service Code	HCPCS 74420
Hospital Charge Code	1600000439
Hospital Revenue Code	360
Min. Negotiated Rate	$370.35
Max. Negotiated Rate	$370.35
Rate for Payer: Qualcare PPO/HMO/WC	$370.35

Know your out-of-pocket cost for care.

All Charges