Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIOTROPIUM 18 MCG CAP FOR INH

Facility

$42.28

Service Code	NDC 597007547
Hospital Charge Code	60629366
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.34

TIOTROPIUM 18 MCG CAP FOR INH

Facility

$42.28

Service Code	NDC 597007547
Hospital Charge Code	60629366
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.14
Rate for Payer: Aetna Commercial	$16.07
Rate for Payer: Aetna Medicare Advantage	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.78
Rate for Payer: Cigna Commercial	$21.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Oxford Commercial	$8.46
Rate for Payer: Qualcare PPO/HMO/WC	$6.34
Rate for Payer: UnitedHealthcare Commercial	$8.46
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

TIP CAUTERTY LAPSCPC FLAT 0017

Facility

$383.25

Hospital Charge Code	270617785
Hospital Revenue Code	272
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

TIP CAUTERTY LAPSCPC FLAT 0017

Facility

$383.25

Hospital Charge Code	270617785
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$145.63
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$76.65
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

TIP CONTROL FENESTRATED 3222

Facility

$332.50

Hospital Charge Code	270641065
Hospital Revenue Code	272
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$166.25
Rate for Payer: Aetna Commercial	$126.35
Rate for Payer: Aetna Medicare Advantage	$99.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.79
Rate for Payer: Cigna Commercial	$166.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.75
Rate for Payer: Oxford Commercial	$66.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.88
Rate for Payer: UnitedHealthcare Commercial	$66.50
Rate for Payer: UnitedHealthcare Community & State	$8.01
Rate for Payer: Wellpoint Medicaid Managed Care	$8.81

TIP CONTROL FENESTRATED 3222

Facility

$332.50

Hospital Charge Code	270641065
Hospital Revenue Code	272
Min. Negotiated Rate	$49.88
Max. Negotiated Rate	$49.88
Rate for Payer: Qualcare PPO/HMO/WC	$49.88

TIP COTTON APPLICATOR STERILE

Facility

$2.70

Hospital Charge Code	270300055
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.41

TIP COTTON APPLICATOR STERILE

Facility

$2.70

Hospital Charge Code	270300055
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna Commercial	$1.03
Rate for Payer: Aetna Medicare Advantage	$0.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.69
Rate for Payer: Cigna Commercial	$1.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.81
Rate for Payer: Oxford Commercial	$0.54
Rate for Payer: Qualcare PPO/HMO/WC	$0.41
Rate for Payer: UnitedHealthcare Commercial	$0.54
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

TIP DIFSUR FIBER IND LAS LF002

Facility

$4,955.10

Hospital Charge Code	270632947
Hospital Revenue Code	272
Min. Negotiated Rate	$743.26
Max. Negotiated Rate	$743.26
Rate for Payer: Qualcare PPO/HMO/WC	$743.26

TIP DIFSUR FIBER IND LAS LF002

Facility

$4,955.10

Hospital Charge Code	270632947
Hospital Revenue Code	272
Min. Negotiated Rate	$119.42
Max. Negotiated Rate	$2,477.55
Rate for Payer: Aetna Commercial	$1,882.94
Rate for Payer: Aetna Medicare Advantage	$1,486.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,263.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,263.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,263.55
Rate for Payer: Cigna Commercial	$2,477.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.53
Rate for Payer: Oxford Commercial	$991.02
Rate for Payer: Qualcare PPO/HMO/WC	$743.26
Rate for Payer: UnitedHealthcare Commercial	$991.02
Rate for Payer: UnitedHealthcare Community & State	$119.42
Rate for Payer: Wellpoint Medicaid Managed Care	$131.31

TIP DPY BAYONET K 2MM 14179-9

Facility

$113.65

Hospital Charge Code	270612491
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$43.19
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$22.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$22.73
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

TIP DPY BAYONET K 2MM 14179-9

Facility

$113.65

Hospital Charge Code	270612491
Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

TIP EXTENDERS

Facility

$1,805.00

Hospital Charge Code	270687912
Hospital Revenue Code	278
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$902.50
Rate for Payer: Aetna Commercial	$685.90
Rate for Payer: Aetna Medicare Advantage	$541.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$460.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$460.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$460.27
Rate for Payer: Cigna Commercial	$902.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.10
Rate for Payer: Qualcare PPO/HMO/WC	$270.75
Rate for Payer: UnitedHealthcare Community & State	$43.50
Rate for Payer: Wellpoint Medicaid Managed Care	$47.83

TIP EXTENDERS

Facility

$1,805.00

Hospital Charge Code	270687912
Hospital Revenue Code	278
Min. Negotiated Rate	$270.75
Max. Negotiated Rate	$436.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.10
Rate for Payer: Qualcare PPO/HMO/WC	$270.75

TIP FRAZIER SUCTION #10 MD097

Facility

$270.45

Hospital Charge Code	270606617
Hospital Revenue Code	272
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$135.22
Rate for Payer: Aetna Commercial	$102.77
Rate for Payer: Aetna Medicare Advantage	$81.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.96
Rate for Payer: Cigna Commercial	$135.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.14
Rate for Payer: Oxford Commercial	$54.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.57
Rate for Payer: UnitedHealthcare Commercial	$54.09
Rate for Payer: UnitedHealthcare Community & State	$6.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7.17

TIP FRAZIER SUCTION #10 MD097

Facility

$270.45

Hospital Charge Code	270606617
Hospital Revenue Code	272
Min. Negotiated Rate	$40.57
Max. Negotiated Rate	$40.57
Rate for Payer: Qualcare PPO/HMO/WC	$40.57

TIP GUARD

Facility

$9.75

Hospital Charge Code	270691527
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

TIP GUARD

Facility

$9.75

Hospital Charge Code	270691527
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.88
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$1.95
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

TIP HIGH FLOW

Facility

$57.51

Hospital Charge Code	270681089
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.75
Rate for Payer: Aetna Commercial	$21.85
Rate for Payer: Aetna Medicare Advantage	$17.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.67
Rate for Payer: Cigna Commercial	$28.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.25
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.63
Rate for Payer: UnitedHealthcare Commercial	$11.50
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

TIP HIGH FLOW

Facility

$57.51

Hospital Charge Code	270681089
Hospital Revenue Code	272
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$8.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.63

TIP MINI FLAREDTURBO SONICS

Facility

$375.00

Hospital Charge Code	270653349
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

TIP MINI FLAREDTURBO SONICS

Facility

$375.00

Hospital Charge Code	270653349
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

TIP NEEDLE DOUBLE DIAMOND

Facility

$695.00

Hospital Charge Code	270670712
Hospital Revenue Code	272
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$347.50
Rate for Payer: Aetna Commercial	$264.10
Rate for Payer: Aetna Medicare Advantage	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.22
Rate for Payer: Cigna Commercial	$347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.50
Rate for Payer: Oxford Commercial	$139.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.25
Rate for Payer: UnitedHealthcare Commercial	$139.00
Rate for Payer: UnitedHealthcare Community & State	$16.75
Rate for Payer: Wellpoint Medicaid Managed Care	$18.42

TIP NEEDLE DOUBLE DIAMOND

Facility

$695.00

Hospital Charge Code	270670712
Hospital Revenue Code	272
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$104.25
Rate for Payer: Qualcare PPO/HMO/WC	$104.25

TIP PHACO I/A TURBO 30KTS

Facility

$325.00

Hospital Charge Code	270600240
Hospital Revenue Code	270
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

Know your out-of-pocket cost for care.

All Charges