Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAY SPINAL PENCAN 24GAX4IN

Facility

$91.77

Service Code	HCPCS A4649
Hospital Charge Code	270698870
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$13.77
Rate for Payer: Qualcare PPO/HMO/WC	$13.77

TRAY SPINAL W/BUPIVCINE 333851

Facility

$94.66

Hospital Charge Code	270645719
Hospital Revenue Code	272
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$47.33
Rate for Payer: Aetna Commercial	$35.97
Rate for Payer: Aetna Medicare Advantage	$28.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.14
Rate for Payer: Cigna Commercial	$47.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.40
Rate for Payer: Oxford Commercial	$18.93
Rate for Payer: Qualcare PPO/HMO/WC	$14.20
Rate for Payer: UnitedHealthcare Commercial	$18.93
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.51

TRAY SPINAL W/BUPIVCINE 333851

Facility

$94.66

Hospital Charge Code	270645719
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.20

TRAY SPINAL WHITACRE 22G

Facility

$49.08

Hospital Charge Code	270649898
Hospital Revenue Code	272
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Qualcare PPO/HMO/WC	$7.36

TRAY SPINAL WHITACRE 22G

Facility

$49.08

Hospital Charge Code	270649898
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.54
Rate for Payer: Aetna Commercial	$18.65
Rate for Payer: Aetna Medicare Advantage	$14.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.52
Rate for Payer: Cigna Commercial	$24.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.72
Rate for Payer: Oxford Commercial	$9.82
Rate for Payer: Qualcare PPO/HMO/WC	$7.36
Rate for Payer: UnitedHealthcare Commercial	$9.82
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

TRAY SPINAL W/TETRACAIE 333743

Facility

$114.70

Hospital Charge Code	270333743
Hospital Revenue Code	272
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.20

TRAY SPINAL W/TETRACAIE 333743

Facility

$114.70

Hospital Charge Code	270333743
Hospital Revenue Code	272
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$57.35
Rate for Payer: Aetna Commercial	$43.59
Rate for Payer: Aetna Medicare Advantage	$34.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.25
Rate for Payer: Cigna Commercial	$57.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.41
Rate for Payer: Oxford Commercial	$22.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.20
Rate for Payer: UnitedHealthcare Commercial	$22.94
Rate for Payer: UnitedHealthcare Community & State	$2.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

TRAY SPINAL W/TETRACAIN 333743

Facility

$91.85

Hospital Charge Code	270621752
Hospital Revenue Code	272
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$13.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.78

TRAY SPINAL W/TETRACAIN 333743

Facility

$91.85

Hospital Charge Code	270621752
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.92
Rate for Payer: Aetna Commercial	$34.90
Rate for Payer: Aetna Medicare Advantage	$27.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.42
Rate for Payer: Cigna Commercial	$45.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.55
Rate for Payer: Oxford Commercial	$18.37
Rate for Payer: Qualcare PPO/HMO/WC	$13.78
Rate for Payer: UnitedHealthcare Commercial	$18.37
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

TRAY SPNL ANESTH SPROT B000110

Facility

$95.29

Hospital Charge Code	270644554
Hospital Revenue Code	272
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$47.65
Rate for Payer: Aetna Commercial	$36.21
Rate for Payer: Aetna Medicare Advantage	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.30
Rate for Payer: Cigna Commercial	$47.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.59
Rate for Payer: Oxford Commercial	$19.06
Rate for Payer: Qualcare PPO/HMO/WC	$14.29
Rate for Payer: UnitedHealthcare Commercial	$19.06
Rate for Payer: UnitedHealthcare Community & State	$2.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

TRAY SPNL ANESTH SPROT B000110

Facility

$95.29

Hospital Charge Code	270644554
Hospital Revenue Code	272
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$14.29
Rate for Payer: Qualcare PPO/HMO/WC	$14.29

TRAY SPNL NDL W/TTRACAN 333854

Facility

$86.85

Hospital Charge Code	270635807
Hospital Revenue Code	272
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$43.42
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$26.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.15
Rate for Payer: Cigna Commercial	$43.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.05
Rate for Payer: Oxford Commercial	$17.37
Rate for Payer: Qualcare PPO/HMO/WC	$13.03
Rate for Payer: UnitedHealthcare Commercial	$17.37
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.30

TRAY SPNL NDL W/TTRACAN 333854

Facility

$86.85

Hospital Charge Code	270635807
Hospital Revenue Code	272
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$13.03
Rate for Payer: Qualcare PPO/HMO/WC	$13.03

TRAY SUCTION*****

Facility

$2.00

Hospital Charge Code	8001604
Hospital Revenue Code	279
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TRAY SUCTION*****

Facility

$2.00

Hospital Charge Code	8001604
Hospital Revenue Code	279
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TRAY SUCTION 14FR

Facility

$7.25

Hospital Charge Code	270302265
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

TRAY SUCTION 14FR

Facility

$7.25

Hospital Charge Code	270302265
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

TRAY SUCTION 14FR W/SALINE

Facility

$5.11

Hospital Charge Code	270649271
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

TRAY SUCTION 14FR W/SALINE

Facility

$5.11

Hospital Charge Code	270649271
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

TRAY SUCTION 6FR

Facility

$10.45

Hospital Charge Code	270302255
Hospital Revenue Code	272
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

TRAY SUCTION 6FR

Facility

$10.45

Hospital Charge Code	270302255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

TRAY SUCTION 8FR

Facility

$7.25

Hospital Charge Code	270302260
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

TRAY SUCTION 8FR

Facility

$7.25

Hospital Charge Code	270302260
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

TRAY SUPERPUBIC FOLEY

Facility

$272.18

Hospital Charge Code	270663907
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$136.09
Rate for Payer: Aetna Commercial	$103.43
Rate for Payer: Aetna Medicare Advantage	$81.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.41
Rate for Payer: Cigna Commercial	$136.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.65
Rate for Payer: Oxford Commercial	$54.44
Rate for Payer: Qualcare PPO/HMO/WC	$40.83
Rate for Payer: UnitedHealthcare Commercial	$54.44
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

TRAY SUPERPUBIC FOLEY

Facility

$272.18

Hospital Charge Code	270663907
Hospital Revenue Code	272
Min. Negotiated Rate	$40.83
Max. Negotiated Rate	$40.83
Rate for Payer: Qualcare PPO/HMO/WC	$40.83

Know your out-of-pocket cost for care.

All Charges