Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.30
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$65.35
Rate for Payer: Aetna Commercial	$49.67
Rate for Payer: Aetna Medicare Advantage	$39.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.33
Rate for Payer: Cigna Commercial	$65.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.21
Rate for Payer: Oxford Commercial	$26.14
Rate for Payer: Qualcare PPO/HMO/WC	$19.61
Rate for Payer: UnitedHealthcare Commercial	$26.14
Rate for Payer: UnitedHealthcare Community & State	$3.15
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.61

SYRINGE 10cc W/LUER LOCK

Facility

$0.35

Hospital Charge Code	27020080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.13
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.07
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE 10cc W/LUER LOCK

Facility

$0.35

Hospital Charge Code	27020080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 10CC W/LUER LOK 309604

Facility

$0.35

Hospital Charge Code	270309604C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.13
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.07
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE 10CC W/LUER LOK 309604

Facility

$0.35

Hospital Charge Code	270309604C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$32.09
Max. Negotiated Rate	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$32.09

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$106.95
Rate for Payer: Aetna Commercial	$81.28
Rate for Payer: Aetna Medicare Advantage	$64.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.54
Rate for Payer: Cigna Commercial	$106.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.17
Rate for Payer: Oxford Commercial	$42.78
Rate for Payer: Qualcare PPO/HMO/WC	$32.09
Rate for Payer: UnitedHealthcare Commercial	$42.78
Rate for Payer: UnitedHealthcare Community & State	$5.15
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

SYRINGE 1ml DURASPE EXP 890215

Facility

$982.15

Hospital Charge Code	270632488
Hospital Revenue Code	272
Min. Negotiated Rate	$23.67
Max. Negotiated Rate	$491.07
Rate for Payer: Aetna Commercial	$373.22
Rate for Payer: Aetna Medicare Advantage	$294.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.45
Rate for Payer: Cigna Commercial	$491.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.64
Rate for Payer: Oxford Commercial	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$147.32
Rate for Payer: UnitedHealthcare Commercial	$196.43
Rate for Payer: UnitedHealthcare Community & State	$23.67
Rate for Payer: Wellpoint Medicaid Managed Care	$26.03

SYRINGE 1ml DURASPE EXP 890215

Facility

$982.15

Hospital Charge Code	270632488
Hospital Revenue Code	272
Min. Negotiated Rate	$147.32
Max. Negotiated Rate	$147.32
Rate for Payer: Qualcare PPO/HMO/WC	$147.32

SYRINGE 20CC BF301625

Facility

$80.00

Hospital Charge Code	270606347
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

SYRINGE 20CC BF301625

Facility

$80.00

Hospital Charge Code	270606347
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

SYRINGE 20cc W/LUER LOK

Facility

$0.93

Hospital Charge Code	27020090
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna Commercial	$0.35
Rate for Payer: Aetna Medicare Advantage	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.24
Rate for Payer: Cigna Commercial	$0.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.28
Rate for Payer: Oxford Commercial	$0.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.14
Rate for Payer: UnitedHealthcare Commercial	$0.19
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

SYRINGE 20cc W/LUER LOK

Facility

$0.93

Hospital Charge Code	27020090
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.14

SYRINGE 20CC W/LUER LOK 309661

Facility

$0.35

Hospital Charge Code	270309661C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 20CC W/LUER LOK 309661

Facility

$0.35

Hospital Charge Code	270309661C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.13
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.07
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE 30CC W/LUER LOCK

Facility

$1.05

Hospital Charge Code	270020095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.40
Rate for Payer: Aetna Medicare Advantage	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.27
Rate for Payer: Cigna Commercial	$0.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$0.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.21
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

SYRINGE 30CC W/LUER LOCK

Facility

$1.05

Hospital Charge Code	270020095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.16

SYRINGE 30CC W/LUER LOK

Facility

$1.40

Hospital Charge Code	270309650C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna Commercial	$0.53
Rate for Payer: Aetna Medicare Advantage	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.36
Rate for Payer: Cigna Commercial	$0.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$0.28
Rate for Payer: Qualcare PPO/HMO/WC	$0.21
Rate for Payer: UnitedHealthcare Commercial	$0.28
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

SYRINGE 30CC W/LUER LOK

Facility

$1.40

Hospital Charge Code	270309650C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.21

SYRINGE 3cc W/ LUER LOCK

Facility

$0.20

Hospital Charge Code	270020070
Hospital Revenue Code	272
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna Commercial	$0.08
Rate for Payer: Aetna Medicare Advantage	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.05
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.06
Rate for Payer: Oxford Commercial	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.03
Rate for Payer: UnitedHealthcare Commercial	$0.04
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE 3cc W/ LUER LOCK

Facility

$0.20

Hospital Charge Code	270020070
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.03

SYRINGE 3CC W/LUER LOK 309585

Facility

$1.00

Hospital Charge Code	270309585C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SYRINGE 3CC W/LUER LOK 309585

Facility

$1.00

Hospital Charge Code	270309585C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

Know your out-of-pocket cost for care.

All Charges