Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TUBE IRRIGATION POLY

Facility

$235.00

Hospital Charge Code	270669171
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

TUBE IRRIGATION POLY

Facility

$235.00

Hospital Charge Code	270669171
Hospital Revenue Code	272
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

TUBE IRRIGATION SET

Facility

$90.20

Hospital Charge Code	270664634
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.10
Rate for Payer: Aetna Commercial	$34.28
Rate for Payer: Aetna Medicare Advantage	$27.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.00
Rate for Payer: Cigna Commercial	$45.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.06
Rate for Payer: Oxford Commercial	$18.04
Rate for Payer: Qualcare PPO/HMO/WC	$13.53
Rate for Payer: UnitedHealthcare Commercial	$18.04
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

TUBE IRRIGATION SET

Facility

$90.20

Hospital Charge Code	270664634
Hospital Revenue Code	272
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$13.53
Rate for Payer: Qualcare PPO/HMO/WC	$13.53

TUBE JEJUNAL***

Facility

$226.00

Service Code	HCPCS 999999
Hospital Charge Code	2300523
Hospital Revenue Code	279
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$85.88
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.80
Rate for Payer: Oxford Commercial	$45.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$45.20
Rate for Payer: UnitedHealthcare Community & State	$5.45
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

TUBE JEJUNAL***

Facility

$226.00

Service Code	HCPCS 999999
Hospital Charge Code	2300523
Hospital Revenue Code	279
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

TUBE JEJUNOSTOMY 20FRx270CM

Facility

$647.35

Hospital Charge Code	270621564
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$323.68
Rate for Payer: Aetna Commercial	$245.99
Rate for Payer: Aetna Medicare Advantage	$194.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.07
Rate for Payer: Cigna Commercial	$323.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.21
Rate for Payer: Oxford Commercial	$129.47
Rate for Payer: Qualcare PPO/HMO/WC	$97.10
Rate for Payer: UnitedHealthcare Commercial	$129.47
Rate for Payer: UnitedHealthcare Community & State	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$17.15

TUBE JEJUNOSTOMY 20FRx270CM

Facility

$647.35

Hospital Charge Code	270621564
Hospital Revenue Code	272
Min. Negotiated Rate	$97.10
Max. Negotiated Rate	$97.10
Rate for Payer: Qualcare PPO/HMO/WC	$97.10

TUBE JEJUNOSTOMY FLEXIFLO 10FR

Facility

$931.15

Hospital Charge Code	270649937
Hospital Revenue Code	272
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$465.57
Rate for Payer: Aetna Commercial	$353.84
Rate for Payer: Aetna Medicare Advantage	$279.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.44
Rate for Payer: Cigna Commercial	$465.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.35
Rate for Payer: Oxford Commercial	$186.23
Rate for Payer: Qualcare PPO/HMO/WC	$139.67
Rate for Payer: UnitedHealthcare Commercial	$186.23
Rate for Payer: UnitedHealthcare Community & State	$22.44
Rate for Payer: Wellpoint Medicaid Managed Care	$24.68

TUBE JEJUNOSTOMY FLEXIFLO 10FR

Facility

$931.15

Hospital Charge Code	270649937
Hospital Revenue Code	272
Min. Negotiated Rate	$139.67
Max. Negotiated Rate	$139.67
Rate for Payer: Qualcare PPO/HMO/WC	$139.67

TUBE JONES 3.0x18mm FLANGE

Facility

$310.00

Hospital Charge Code	270650020
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x18mm FLANGE

Facility

$310.00

Hospital Charge Code	270650020
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x19mm FLANGE

Facility

$310.00

Hospital Charge Code	270650024
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x19mm FLANGE

Facility

$310.00

Hospital Charge Code	270650024
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x20mm FLANGE

Facility

$310.00

Hospital Charge Code	270650025
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x20mm FLANGE

Facility

$310.00

Hospital Charge Code	270650025
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x21mm FLANGE

Facility

$310.00

Hospital Charge Code	270650027
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x21mm FLANGE

Facility

$310.00

Hospital Charge Code	270650027
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x22mm FLANGE

Facility

$310.00

Hospital Charge Code	270650028
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x22mm FLANGE

Facility

$310.00

Hospital Charge Code	270650028
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x22mm W/ANGLED

Facility

$310.00

Hospital Charge Code	270650032
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE JONES 3.0x22mm W/ANGLED

Facility

$310.00

Hospital Charge Code	270650032
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x23mm FLANGE

Facility

$310.00

Hospital Charge Code	270650030
Hospital Revenue Code	272
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$62.00
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

TUBE JONES 3.0x23mm FLANGE

Facility

$310.00

Hospital Charge Code	270650030
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

TUBE KANGAROO FEEDING

Facility

$55.27

Hospital Charge Code	270649938
Hospital Revenue Code	272
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$8.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.29

Know your out-of-pocket cost for care.

All Charges