Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYRINGE EMBO RED 500-700 2.0ML

Facility

$1,265.00

Hospital Charge Code	2709003375
Hospital Revenue Code	272
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$632.50
Rate for Payer: Aetna Commercial	$480.70
Rate for Payer: Aetna Medicare Advantage	$379.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.57
Rate for Payer: Cigna Commercial	$632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.50
Rate for Payer: Oxford Commercial	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.75
Rate for Payer: UnitedHealthcare Commercial	$253.00
Rate for Payer: UnitedHealthcare Community & State	$30.49
Rate for Payer: Wellpoint Medicaid Managed Care	$33.52

SYRINGE EMBO RED 500-700 2.0ML

Facility

$1,265.00

Hospital Charge Code	2709003375
Hospital Revenue Code	272
Min. Negotiated Rate	$189.75
Max. Negotiated Rate	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$189.75

SYRINGE EMBOSPHERE 2ml GREEN

Facility

$1,535.00

Hospital Charge Code	2706931481
Hospital Revenue Code	272
Min. Negotiated Rate	$230.25
Max. Negotiated Rate	$230.25
Rate for Payer: Qualcare PPO/HMO/WC	$230.25

SYRINGE EMBOSPHERE 2ml GREEN

Facility

$1,535.00

Hospital Charge Code	2706931481
Hospital Revenue Code	272
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$767.50
Rate for Payer: Aetna Commercial	$583.30
Rate for Payer: Aetna Medicare Advantage	$460.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.43
Rate for Payer: Cigna Commercial	$767.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$460.50
Rate for Payer: Oxford Commercial	$307.00
Rate for Payer: Qualcare PPO/HMO/WC	$230.25
Rate for Payer: UnitedHealthcare Commercial	$307.00
Rate for Payer: UnitedHealthcare Community & State	$36.99
Rate for Payer: Wellpoint Medicaid Managed Care	$40.68

SYRINGE EMBOSPHERE 2ML S420GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270658213
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPHERE 2ML S420GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270658213
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

SYRINGE EMBOSPHERE 2ML S420GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270658213S
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

SYRINGE EMBOSPHERE 2ML S420GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270658213S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPHERE 2ML S420GHC

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270687184
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPHERE 2ML S420GHC

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270687184
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

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$253.00

Hospital Charge Code	270631462N
Hospital Revenue Code	270
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Oxford Commercial	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$50.60
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631462S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631462S
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

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631462
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

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$253.00

Hospital Charge Code	270631462N
Hospital Revenue Code	270
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

SYRINGE EMBOSPHERE 2ML S620GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631462
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631481S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
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
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$992.00

Hospital Charge Code	270631481N
Hospital Revenue Code	272
Min. Negotiated Rate	$148.80
Max. Negotiated Rate	$148.80
Rate for Payer: Qualcare PPO/HMO/WC	$148.80

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$6,200.00

Hospital Charge Code	270631481
Hospital Revenue Code	279
Min. Negotiated Rate	$149.42
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.00
Rate for Payer: Oxford Commercial	$1,240.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00
Rate for Payer: UnitedHealthcare Community & State	$149.42
Rate for Payer: Wellpoint Medicaid Managed Care	$164.30

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$992.00

Hospital Charge Code	270631481N
Hospital Revenue Code	272
Min. Negotiated Rate	$23.91
Max. Negotiated Rate	$496.00
Rate for Payer: Aetna Commercial	$376.96
Rate for Payer: Aetna Medicare Advantage	$297.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.96
Rate for Payer: Cigna Commercial	$496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.60
Rate for Payer: Oxford Commercial	$198.40
Rate for Payer: Qualcare PPO/HMO/WC	$148.80
Rate for Payer: UnitedHealthcare Commercial	$198.40
Rate for Payer: UnitedHealthcare Community & State	$23.91
Rate for Payer: Wellpoint Medicaid Managed Care	$26.29

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$6,200.00

Hospital Charge Code	270631481
Hospital Revenue Code	279
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$930.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

SYRINGE EMBOSPRE 2ML GR S820GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270631481S
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

SYRINGEEMBOYELLOW100-300 2.0M

Facility

$1,265.00

Hospital Charge Code	2709004169
Hospital Revenue Code	272
Min. Negotiated Rate	$189.75
Max. Negotiated Rate	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$189.75

SYRINGEEMBOYELLOW100-300 2.0M

Facility

$1,265.00

Hospital Charge Code	2709004169
Hospital Revenue Code	272
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$632.50
Rate for Payer: Aetna Commercial	$480.70
Rate for Payer: Aetna Medicare Advantage	$379.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.57
Rate for Payer: Cigna Commercial	$632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.50
Rate for Payer: Oxford Commercial	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.75
Rate for Payer: UnitedHealthcare Commercial	$253.00
Rate for Payer: UnitedHealthcare Community & State	$30.49
Rate for Payer: Wellpoint Medicaid Managed Care	$33.52

SYRINGE EPI PULSATOR PLASTIC

Facility

$731.05

Hospital Charge Code	270665061
Hospital Revenue Code	270
Min. Negotiated Rate	$109.66
Max. Negotiated Rate	$109.66
Rate for Payer: Qualcare PPO/HMO/WC	$109.66

Know your out-of-pocket cost for care.

All Charges