Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BASKET RETRIEVAL FB 00711152

Facility

$525.00

Hospital Charge Code	270637475
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

BASKET RETRIEVAL ZERO 1.9FX90

Facility

$1,878.95

Hospital Charge Code	270698287
Hospital Revenue Code	272
Min. Negotiated Rate	$45.28
Max. Negotiated Rate	$939.48
Rate for Payer: Aetna Commercial	$714.00
Rate for Payer: Aetna Medicare Advantage	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.13
Rate for Payer: Cigna Commercial	$939.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.68
Rate for Payer: Oxford Commercial	$375.79
Rate for Payer: Qualcare PPO/HMO/WC	$281.84
Rate for Payer: UnitedHealthcare Commercial	$375.79
Rate for Payer: UnitedHealthcare Community & State	$45.28
Rate for Payer: Wellpoint Medicaid Managed Care	$49.79

BASKET RETRIEVAL ZERO 1.9FX90

Facility

$1,878.95

Hospital Charge Code	270698287
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$281.84
Rate for Payer: Qualcare PPO/HMO/WC	$281.84

BASKET ROTATABLE RETRIEVAL

Facility

$575.00

Hospital Charge Code	270664340
Hospital Revenue Code	270
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BASKET ROTATABLE RETRIEVAL

Facility

$575.00

Hospital Charge Code	270664340
Hospital Revenue Code	270
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Oxford Commercial	$115.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$115.00
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

BASKET RX 3x1.5 LITHOTRIP 1086

Facility

$1,433.50

Hospital Charge Code	270627947
Hospital Revenue Code	272
Min. Negotiated Rate	$215.03
Max. Negotiated Rate	$215.03
Rate for Payer: Qualcare PPO/HMO/WC	$215.03

BASKET RX 3x1.5 LITHOTRIP 1086

Facility

$1,433.50

Hospital Charge Code	270627947
Hospital Revenue Code	272
Min. Negotiated Rate	$34.55
Max. Negotiated Rate	$716.75
Rate for Payer: Aetna Commercial	$544.73
Rate for Payer: Aetna Medicare Advantage	$430.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.54
Rate for Payer: Cigna Commercial	$716.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.05
Rate for Payer: Oxford Commercial	$286.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.03
Rate for Payer: UnitedHealthcare Commercial	$286.70
Rate for Payer: UnitedHealthcare Community & State	$34.55
Rate for Payer: Wellpoint Medicaid Managed Care	$37.99

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$33.05
Max. Negotiated Rate	$685.77
Rate for Payer: Aetna Commercial	$521.19
Rate for Payer: Aetna Medicare Advantage	$411.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.75
Rate for Payer: Cigna Commercial	$685.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$301.74
Rate for Payer: Qualcare PPO/HMO/WC	$205.73
Rate for Payer: UnitedHealthcare Community & State	$33.05
Rate for Payer: Wellpoint Medicaid Managed Care	$36.35

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$205.73
Max. Negotiated Rate	$331.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$301.74
Rate for Payer: Qualcare PPO/HMO/WC	$205.73

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$33.52
Max. Negotiated Rate	$695.50
Rate for Payer: Aetna Commercial	$528.58
Rate for Payer: Aetna Medicare Advantage	$417.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.70
Rate for Payer: Cigna Commercial	$695.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.02
Rate for Payer: Qualcare PPO/HMO/WC	$208.65
Rate for Payer: UnitedHealthcare Community & State	$33.52
Rate for Payer: Wellpoint Medicaid Managed Care	$36.86

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$336.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.02
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$348.82
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Community & State	$38.21
Rate for Payer: Wellpoint Medicaid Managed Care	$42.02

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$383.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$348.82
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET SEGURA 4.5FR

Facility

$765.00

Hospital Charge Code	270655486
Hospital Revenue Code	272
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.50
Rate for Payer: Oxford Commercial	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$153.00
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

BASKET SEGURA 4.5FR

Facility

$765.00

Hospital Charge Code	270655486
Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

BASKET SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
Hospital Revenue Code	272
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$475.67
Rate for Payer: Oxford Commercial	$317.11
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$317.11
Rate for Payer: UnitedHealthcare Community & State	$38.21
Rate for Payer: Wellpoint Medicaid Managed Care	$42.02

BASKET SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$137.76
Rate for Payer: Qualcare PPO/HMO/WC	$137.76

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
Hospital Revenue Code	272
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$348.99
Rate for Payer: Aetna Medicare Advantage	$275.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.19
Rate for Payer: Cigna Commercial	$459.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.52
Rate for Payer: Oxford Commercial	$183.68
Rate for Payer: Qualcare PPO/HMO/WC	$137.76
Rate for Payer: UnitedHealthcare Commercial	$183.68
Rate for Payer: UnitedHealthcare Community & State	$22.13
Rate for Payer: Wellpoint Medicaid Managed Care	$24.34

BASKET STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$160.88
Max. Negotiated Rate	$160.88
Rate for Payer: Qualcare PPO/HMO/WC	$160.88

BASKET STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$536.25
Rate for Payer: Aetna Commercial	$407.55
Rate for Payer: Aetna Medicare Advantage	$321.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.49
Rate for Payer: Cigna Commercial	$536.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.75
Rate for Payer: Oxford Commercial	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.88
Rate for Payer: UnitedHealthcare Commercial	$214.50
Rate for Payer: UnitedHealthcare Community & State	$25.85
Rate for Payer: Wellpoint Medicaid Managed Care	$28.42

BASKET STZ STN FX 3FR 11276NB

Facility

$1,328.85

Hospital Charge Code	270601037
Hospital Revenue Code	272
Min. Negotiated Rate	$199.33
Max. Negotiated Rate	$199.33
Rate for Payer: Qualcare PPO/HMO/WC	$199.33

BASKET STZ STN FX 3FR 11276NB

Facility

$1,328.85

Hospital Charge Code	270601037
Hospital Revenue Code	272
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$664.42
Rate for Payer: Aetna Commercial	$504.96
Rate for Payer: Aetna Medicare Advantage	$398.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.86
Rate for Payer: Cigna Commercial	$664.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.65
Rate for Payer: Oxford Commercial	$265.77
Rate for Payer: Qualcare PPO/HMO/WC	$199.33
Rate for Payer: UnitedHealthcare Commercial	$265.77
Rate for Payer: UnitedHealthcare Community & State	$32.03
Rate for Payer: Wellpoint Medicaid Managed Care	$35.21

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$546.75
Rate for Payer: Aetna Commercial	$415.53
Rate for Payer: Aetna Medicare Advantage	$328.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.84
Rate for Payer: Cigna Commercial	$546.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.05
Rate for Payer: Oxford Commercial	$218.70
Rate for Payer: Qualcare PPO/HMO/WC	$164.03
Rate for Payer: UnitedHealthcare Commercial	$218.70
Rate for Payer: UnitedHealthcare Community & State	$26.35
Rate for Payer: Wellpoint Medicaid Managed Care	$28.98

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$164.03
Max. Negotiated Rate	$164.03
Rate for Payer: Qualcare PPO/HMO/WC	$164.03

Know your out-of-pocket cost for care.

All Charges