Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET THORACIC DUAL DRAIN 571505

Facility

$116.85

Hospital Charge Code	270606360
Hospital Revenue Code	270
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$23.37
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$23.37
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

SET THORACIC DUAL DRAIN 571505

Facility

$116.85

Hospital Charge Code	270606360
Hospital Revenue Code	270
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

SET THROMBECTOMY DVX ULTRA

Facility

$9,025.00

Hospital Charge Code	270645567C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

SET THROMBECTOMY DVX ULTRA

Facility

$9,025.00

Hospital Charge Code	270645567C
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$4,512.50
Rate for Payer: Aetna Commercial	$3,429.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$4,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75
Rate for Payer: UnitedHealthcare Community & State	$217.50
Rate for Payer: Wellpoint Medicaid Managed Care	$239.16

SET THROMBECTOMY XPEEDIOR

Facility

$7,975.00

Hospital Charge Code	270645566C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

SET THROMBECTOMY XPEEDIOR

Facility

$7,975.00

Hospital Charge Code	270645566C
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$2,474.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
Hospital Revenue Code	278
Min. Negotiated Rate	$246.42
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,885.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,249.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75
Rate for Payer: UnitedHealthcare Community & State	$246.42
Rate for Payer: Wellpoint Medicaid Managed Care	$270.96

SET TRACHEOESOPHAGEAL PUNCTURE

Facility

$1,179.00

Hospital Charge Code	270645551
Hospital Revenue Code	272
Min. Negotiated Rate	$176.85
Max. Negotiated Rate	$176.85
Rate for Payer: Qualcare PPO/HMO/WC	$176.85

SET TRACHEOESOPHAGEAL PUNCTURE

Facility

$1,179.00

Hospital Charge Code	270645551
Hospital Revenue Code	272
Min. Negotiated Rate	$28.41
Max. Negotiated Rate	$589.50
Rate for Payer: Aetna Commercial	$448.02
Rate for Payer: Aetna Medicare Advantage	$353.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.64
Rate for Payer: Cigna Commercial	$589.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.70
Rate for Payer: Oxford Commercial	$235.80
Rate for Payer: Qualcare PPO/HMO/WC	$176.85
Rate for Payer: UnitedHealthcare Commercial	$235.80
Rate for Payer: UnitedHealthcare Community & State	$28.41
Rate for Payer: Wellpoint Medicaid Managed Care	$31.24

SET TROCAR FTBAL RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270614364
Hospital Revenue Code	272
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$40.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.33

SET TROCAR FTBAL RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270614364
Hospital Revenue Code	272
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$134.43
Rate for Payer: Aetna Commercial	$102.16
Rate for Payer: Aetna Medicare Advantage	$80.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.56
Rate for Payer: Cigna Commercial	$134.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.66
Rate for Payer: Oxford Commercial	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$40.33
Rate for Payer: UnitedHealthcare Commercial	$53.77
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.12

SET TROCAR RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270613419
Hospital Revenue Code	272
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$134.43
Rate for Payer: Aetna Commercial	$102.16
Rate for Payer: Aetna Medicare Advantage	$80.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.56
Rate for Payer: Cigna Commercial	$134.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.66
Rate for Payer: Oxford Commercial	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$40.33
Rate for Payer: UnitedHealthcare Commercial	$53.77
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.12

SET TROCAR RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270613419
Hospital Revenue Code	272
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$40.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.33

SET TUBE INTERMEDULLARY 281103

Facility

$83.50

Hospital Charge Code	270638602
Hospital Revenue Code	272
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$41.75
Rate for Payer: Aetna Commercial	$31.73
Rate for Payer: Aetna Medicare Advantage	$25.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.29
Rate for Payer: Cigna Commercial	$41.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Oxford Commercial	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$12.53
Rate for Payer: UnitedHealthcare Commercial	$16.70
Rate for Payer: UnitedHealthcare Community & State	$2.01
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

SET TUBE INTERMEDULLARY 281103

Facility

$83.50

Hospital Charge Code	270638602
Hospital Revenue Code	272
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$12.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.53

SET TUBING IRRIGATION 284504

Facility

$231.25

Hospital Charge Code	270638603
Hospital Revenue Code	272
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$115.62
Rate for Payer: Aetna Commercial	$87.88
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$46.25
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$46.25
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

SET TUBING IRRIGATION 284504

Facility

$231.25

Hospital Charge Code	270638603
Hospital Revenue Code	272
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

SET TUBING PUMP INFUSION

Facility

$1,196.00

Hospital Charge Code	270651983
Hospital Revenue Code	271
Min. Negotiated Rate	$28.82
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$454.48
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.80
Rate for Payer: Oxford Commercial	$239.20
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$239.20
Rate for Payer: UnitedHealthcare Community & State	$28.82
Rate for Payer: Wellpoint Medicaid Managed Care	$31.69

SET TUBING PUMP INFUSION

Facility

$1,196.00

Hospital Charge Code	270651983
Hospital Revenue Code	271
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

SETUP SUTURE

Facility

$289.65

Hospital Charge Code	8500027
Hospital Revenue Code	272
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.89
Rate for Payer: Oxford Commercial	$57.93
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Commercial	$57.93
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

SETUP SUTURE

Facility

$289.65

Hospital Charge Code	8500027
Hospital Revenue Code	272
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$43.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

SETUP TPA*****

Facility

$220.00

Hospital Charge Code	8003600
Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

Know your out-of-pocket cost for care.

All Charges