Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$235.78
Rate for Payer: Aetna Commercial	$179.19
Rate for Payer: Aetna Medicare Advantage	$141.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.25
Rate for Payer: Cigna Commercial	$235.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.47
Rate for Payer: Oxford Commercial	$94.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.73
Rate for Payer: UnitedHealthcare Commercial	$94.31
Rate for Payer: UnitedHealthcare Community & State	$11.36
Rate for Payer: Wellpoint Medicaid Managed Care	$12.50

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$70.73
Max. Negotiated Rate	$70.73
Rate for Payer: Qualcare PPO/HMO/WC	$70.73

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$16.09
Max. Negotiated Rate	$333.75
Rate for Payer: Aetna Commercial	$253.65
Rate for Payer: Aetna Medicare Advantage	$200.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.21
Rate for Payer: Cigna Commercial	$333.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.25
Rate for Payer: Oxford Commercial	$133.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.12
Rate for Payer: UnitedHealthcare Commercial	$133.50
Rate for Payer: UnitedHealthcare Community & State	$16.09
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$100.12
Max. Negotiated Rate	$100.12
Rate for Payer: Qualcare PPO/HMO/WC	$100.12

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$72.58
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.30
Rate for Payer: Oxford Commercial	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$38.20
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

ULTRATOME 2 LUMEN 0

Facility

$1,276.85

Hospital Charge Code	270604767
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 0

Facility

$1,276.85

Hospital Charge Code	270604767
Hospital Revenue Code	270
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

ULTRATOME 2 LUMEN 1

Facility

$1,276.85

Hospital Charge Code	270604768
Hospital Revenue Code	270
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

ULTRATOME 2 LUMEN 1

Facility

$1,276.85

Hospital Charge Code	270604768
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 2

Facility

$1,276.85

Hospital Charge Code	270604769
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 2

Facility

$1,276.85

Hospital Charge Code	270604769
Hospital Revenue Code	270
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

ULTRATOME 2 LUMEN 3

Facility

$1,276.85

Hospital Charge Code	270604770
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 3

Facility

$1,276.85

Hospital Charge Code	270604770
Hospital Revenue Code	270
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

ULTRATOME 3 LUMEN 20 3590-05

Facility

$1,747.25

Hospital Charge Code	270608084
Hospital Revenue Code	272
Min. Negotiated Rate	$42.11
Max. Negotiated Rate	$873.62
Rate for Payer: Aetna Commercial	$663.96
Rate for Payer: Aetna Medicare Advantage	$524.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$445.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$445.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$445.55
Rate for Payer: Cigna Commercial	$873.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.17
Rate for Payer: Oxford Commercial	$349.45
Rate for Payer: Qualcare PPO/HMO/WC	$262.09
Rate for Payer: UnitedHealthcare Commercial	$349.45
Rate for Payer: UnitedHealthcare Community & State	$42.11
Rate for Payer: Wellpoint Medicaid Managed Care	$46.30

ULTRATOME 3 LUMEN 20 3590-05

Facility

$1,747.25

Hospital Charge Code	270608084
Hospital Revenue Code	272
Min. Negotiated Rate	$262.09
Max. Negotiated Rate	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$262.09

ULTRATOME 3 LUMEN 20 L 3591-05

Facility

$1,310.45

Hospital Charge Code	270612457
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ULTRATOME 3 LUMEN 20 L 3591-05

Facility

$1,310.45

Hospital Charge Code	270612457
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$497.97
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.13
Rate for Payer: Oxford Commercial	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$262.09
Rate for Payer: UnitedHealthcare Community & State	$31.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34.73

ULTRATOME 3 LUMEN 30 L 3593-05

Facility

$1,310.45

Hospital Charge Code	270612459
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ULTRATOME 3 LUMEN 30 L 3593-05

Facility

$1,310.45

Hospital Charge Code	270612459
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$497.97
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.13
Rate for Payer: Oxford Commercial	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$262.09
Rate for Payer: UnitedHealthcare Community & State	$31.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34.73

ULTRATOME MCV XL 30MM 3592

Facility

$1,584.00

Hospital Charge Code	270604765
Hospital Revenue Code	270
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: Aetna Medicare Advantage	$475.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.92
Rate for Payer: Cigna Commercial	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$475.20
Rate for Payer: Oxford Commercial	$316.80
Rate for Payer: Qualcare PPO/HMO/WC	$237.60
Rate for Payer: UnitedHealthcare Commercial	$316.80
Rate for Payer: UnitedHealthcare Community & State	$38.17
Rate for Payer: Wellpoint Medicaid Managed Care	$41.98

ULTRATOME MCV XL 30MM 3592

Facility

$1,584.00

Hospital Charge Code	270604765
Hospital Revenue Code	270
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.60

ULTRATOME SPHYNCTERO SHT

Facility

$1,482.45

Hospital Charge Code	270600940
Hospital Revenue Code	270
Min. Negotiated Rate	$35.73
Max. Negotiated Rate	$741.23
Rate for Payer: Aetna Commercial	$563.33
Rate for Payer: Aetna Medicare Advantage	$444.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.02
Rate for Payer: Cigna Commercial	$741.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.74
Rate for Payer: Oxford Commercial	$296.49
Rate for Payer: Qualcare PPO/HMO/WC	$222.37
Rate for Payer: UnitedHealthcare Commercial	$296.49
Rate for Payer: UnitedHealthcare Community & State	$35.73
Rate for Payer: Wellpoint Medicaid Managed Care	$39.28

Know your out-of-pocket cost for care.

All Charges