Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAY EPIDURAL SNGL SHOT SSET01

Facility

$113.65

Hospital Charge Code	270605412
Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

TRAY EPIDURAL SNGL SHOT SSET01

Facility

$113.65

Hospital Charge Code	270605412
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

TRAY EPIDURAL/SPINAL

Facility

$188.00

Hospital Charge Code	270666517
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$71.44
Rate for Payer: Aetna Medicare Advantage	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$94.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.40
Rate for Payer: Oxford Commercial	$37.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.20
Rate for Payer: UnitedHealthcare Commercial	$37.60
Rate for Payer: UnitedHealthcare Community & State	$4.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

TRAY EPIDURAL/SPINAL

Facility

$188.00

Hospital Charge Code	270666517
Hospital Revenue Code	270
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

TRAY EPIDURAL W/TUOHY

Facility

$141.70

Hospital Charge Code	270677807
Hospital Revenue Code	272
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

TRAY EPIDURAL W/TUOHY

Facility

$141.70

Hospital Charge Code	270677807
Hospital Revenue Code	272
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$70.85
Rate for Payer: Aetna Commercial	$53.85
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.13
Rate for Payer: Cigna Commercial	$70.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Oxford Commercial	$28.34
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$28.34
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

TRAY EPIDUR SNG SHOT A2532-20

Facility

$70.79

Hospital Charge Code	270626734
Hospital Revenue Code	272
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.40
Rate for Payer: Aetna Commercial	$26.90
Rate for Payer: Aetna Medicare Advantage	$21.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.05
Rate for Payer: Cigna Commercial	$35.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.24
Rate for Payer: Oxford Commercial	$14.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.62
Rate for Payer: UnitedHealthcare Commercial	$14.16
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

TRAY EPIDUR SNG SHOT A2532-20

Facility

$70.79

Hospital Charge Code	270626734
Hospital Revenue Code	272
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$10.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.62

TRAY EPIDUR SNG SHOT CUS002-02

Facility

$72.00

Hospital Charge Code	270615564
Hospital Revenue Code	279
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

TRAY EPIDUR SNG SHOT CUS002-02

Facility

$72.00

Hospital Charge Code	270615564
Hospital Revenue Code	279
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

TRAY ERASE ADD-A-CATH

Facility

$52.49

Service Code	HCPCS C1729
Hospital Charge Code	270649649
Hospital Revenue Code	278
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$7.87

TRAY ERASE ADD-A-CATH

Facility

$52.49

Service Code	HCPCS C1729
Hospital Charge Code	270649649
Hospital Revenue Code	278
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.38
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$7.87
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

TRAY ERASE CAUTI 14FR

Facility

$73.37

Hospital Charge Code	270649651
Hospital Revenue Code	278
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$36.69
Rate for Payer: Aetna Commercial	$27.88
Rate for Payer: Aetna Medicare Advantage	$22.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.71
Rate for Payer: Cigna Commercial	$36.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.14
Rate for Payer: Qualcare PPO/HMO/WC	$11.01
Rate for Payer: UnitedHealthcare Community & State	$1.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.94

TRAY ERASE CAUTI 14FR

Facility

$73.37

Hospital Charge Code	270649651
Hospital Revenue Code	278
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$17.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.14
Rate for Payer: Qualcare PPO/HMO/WC	$11.01

TRAY ERASE CAUTI 16FR

Facility

$77.30

Hospital Charge Code	270649652
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$38.65
Rate for Payer: Aetna Commercial	$29.37
Rate for Payer: Aetna Medicare Advantage	$23.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.71
Rate for Payer: Cigna Commercial	$38.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.19
Rate for Payer: Oxford Commercial	$15.46
Rate for Payer: Qualcare PPO/HMO/WC	$11.60
Rate for Payer: UnitedHealthcare Commercial	$15.46
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

TRAY ERASE CAUTI 16FR

Facility

$77.30

Hospital Charge Code	270649652
Hospital Revenue Code	270
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.60

TRAY EXCHANGE TRANSFUSION

Facility

$617.65

Hospital Charge Code	270600473
Hospital Revenue Code	272
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$308.82
Rate for Payer: Aetna Commercial	$234.71
Rate for Payer: Aetna Medicare Advantage	$185.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.50
Rate for Payer: Cigna Commercial	$308.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.29
Rate for Payer: Oxford Commercial	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$92.65
Rate for Payer: UnitedHealthcare Commercial	$123.53
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: Wellpoint Medicaid Managed Care	$16.37

TRAY EXCHANGE TRANSFUSION

Facility

$617.65

Hospital Charge Code	270600473
Hospital Revenue Code	272
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$92.65
Rate for Payer: Qualcare PPO/HMO/WC	$92.65

TRAY FIRST FRACTURE EXPRESS II

Facility

$14,962.50

Hospital Charge Code	270691562
Hospital Revenue Code	272
Min. Negotiated Rate	$360.60
Max. Negotiated Rate	$7,481.25
Rate for Payer: Aetna Commercial	$5,685.75
Rate for Payer: Aetna Medicare Advantage	$4,488.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,815.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,815.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,815.44
Rate for Payer: Cigna Commercial	$7,481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,488.75
Rate for Payer: Oxford Commercial	$2,992.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,244.38
Rate for Payer: UnitedHealthcare Commercial	$2,992.50
Rate for Payer: UnitedHealthcare Community & State	$360.60
Rate for Payer: Wellpoint Medicaid Managed Care	$396.51

TRAY FIRST FRACTURE EXPRESS II

Facility

$14,962.50

Hospital Charge Code	270691562
Hospital Revenue Code	272
Min. Negotiated Rate	$2,244.38
Max. Negotiated Rate	$2,244.38
Rate for Payer: Qualcare PPO/HMO/WC	$2,244.38

TRAY FIXED SAIPH KNEE C

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680033
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TRAY FIXED SAIPH KNEE C

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680033
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

TRAY FOLEY 16FR CATH LTX FREE

Facility

$136.85

Hospital Charge Code	270612396
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.42
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare Advantage	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.90
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.05
Rate for Payer: Oxford Commercial	$27.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$27.37
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

TRAY FOLEY 16FR CATH LTX FREE

Facility

$136.85

Hospital Charge Code	270612396
Hospital Revenue Code	272
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

TRAY FOLEY CATH 16FR

Facility

$81.82

Hospital Charge Code	270649268S
Hospital Revenue Code	272
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$12.27
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

Know your out-of-pocket cost for care.

All Charges