Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGIPATCH 10.5MM PREM 172035

Facility

$67.25

Hospital Charge Code	270600092
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$13.45
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

SURGIPATCH 11.5MM PREM 172037

Facility

$67.25

Hospital Charge Code	270600093
Hospital Revenue Code	272
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SURGIPATCH 11.5MM PREM 172037

Facility

$67.25

Hospital Charge Code	270600093
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$13.45
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

SURGIPHOR IRRIGATION SYSTEM

Facility

$7,459.35

Hospital Charge Code	270705877
Hospital Revenue Code	272
Min. Negotiated Rate	$179.77
Max. Negotiated Rate	$3,729.68
Rate for Payer: Aetna Commercial	$2,834.55
Rate for Payer: Aetna Medicare Advantage	$2,237.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,902.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,902.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,902.13
Rate for Payer: Cigna Commercial	$3,729.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,237.80
Rate for Payer: Oxford Commercial	$1,491.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,118.90
Rate for Payer: UnitedHealthcare Commercial	$1,491.87
Rate for Payer: UnitedHealthcare Community & State	$179.77
Rate for Payer: Wellpoint Medicaid Managed Care	$197.67

SURGIPHOR IRRIGATION SYSTEM

Facility

$7,459.35

Hospital Charge Code	270705877
Hospital Revenue Code	272
Min. Negotiated Rate	$1,118.90
Max. Negotiated Rate	$1,118.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,118.90

SURGIPORT 11MM *****

Facility

$382.00

Hospital Charge Code	1603240
Hospital Revenue Code	272
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$57.30
Rate for Payer: Qualcare PPO/HMO/WC	$57.30

SURGIPORT 11MM *****

Facility

$382.00

Hospital Charge Code	1603240
Hospital Revenue Code	272
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$145.16
Rate for Payer: Aetna Medicare Advantage	$114.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.41
Rate for Payer: Cigna Commercial	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.60
Rate for Payer: Oxford Commercial	$76.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.30
Rate for Payer: UnitedHealthcare Commercial	$76.40
Rate for Payer: UnitedHealthcare Community & State	$9.21
Rate for Payer: Wellpoint Medicaid Managed Care	$10.12

SURGIPORT 12MM *****

Facility

$421.00

Hospital Charge Code	1606011
Hospital Revenue Code	272
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SURGIPORT 12MM *****

Facility

$421.00

Hospital Charge Code	1606011
Hospital Revenue Code	272
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$159.98
Rate for Payer: Aetna Medicare Advantage	$126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.36
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.30
Rate for Payer: Oxford Commercial	$84.20
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$84.20
Rate for Payer: UnitedHealthcare Community & State	$10.15
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

SURGIPORT 12MM *****

Facility

$398.00

Hospital Charge Code	1603265
Hospital Revenue Code	272
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$59.70
Rate for Payer: Qualcare PPO/HMO/WC	$59.70

SURGIPORT 12MM *****

Facility

$398.00

Hospital Charge Code	1603265
Hospital Revenue Code	272
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$199.00
Rate for Payer: Aetna Commercial	$151.24
Rate for Payer: Aetna Medicare Advantage	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.49
Rate for Payer: Cigna Commercial	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.40
Rate for Payer: Oxford Commercial	$79.60
Rate for Payer: Qualcare PPO/HMO/WC	$59.70
Rate for Payer: UnitedHealthcare Commercial	$79.60
Rate for Payer: UnitedHealthcare Community & State	$9.59
Rate for Payer: Wellpoint Medicaid Managed Care	$10.55

SURGIPORT 15MM *****

Facility

$414.00

Hospital Charge Code	1603257
Hospital Revenue Code	272
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

SURGIPORT 15MM *****

Facility

$414.00

Hospital Charge Code	1603257
Hospital Revenue Code	272
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

SURGIPORT CONVERTOR 5.5/15MM**

Facility

$29.00

Hospital Charge Code	1603356
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.39
Rate for Payer: Cigna Commercial	$14.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.70
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$5.80
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SURGIPORT CONVERTOR 5.5/15MM**

Facility

$29.00

Hospital Charge Code	1603356
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

SURGIPORT CONVERTR 10.5/15MM**

Facility

$27.00

Hospital Charge Code	1603349
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

SURGIPORT CONVERTR 10.5/15MM**

Facility

$27.00

Hospital Charge Code	1603349
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

SURGIPRO* 3-0 BLUE 30 SC-2

Facility

$7.45

Hospital Charge Code	270657584
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SURGIPRO* 3-0 BLUE 30 SC-2

Facility

$7.45

Hospital Charge Code	270657584
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$40.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$36.74
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$36.74
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

SURGIPRO II 6/0 24 IN BLUE CV

Facility

$37.54

Hospital Charge Code	270651240
Hospital Revenue Code	270
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$5.63

SURGIPRO II 6/0 24 IN BLUE CV

Facility

$37.54

Hospital Charge Code	270651240
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.77
Rate for Payer: Aetna Commercial	$14.27
Rate for Payer: Aetna Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.57
Rate for Payer: Cigna Commercial	$18.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.26
Rate for Payer: Oxford Commercial	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$5.63
Rate for Payer: UnitedHealthcare Commercial	$7.51
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

Know your out-of-pocket cost for care.

All Charges