Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BRUSHING CLEANING ENDOSCOPE

Facility

$10.75

Hospital Charge Code	270651669
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.38
Rate for Payer: Aetna Commercial	$4.08
Rate for Payer: Aetna Medicare Advantage	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.15
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

BRUSHING CLEANING ENDOSCOPE

Facility

$10.75

Hospital Charge Code	270651669
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

BRUSH JUMBO BX 7-9MM 00711606

Facility

$62.50

Hospital Charge Code	270643556
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$12.50
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

BRUSH JUMBO BX 7-9MM 00711606

Facility

$62.50

Hospital Charge Code	270643556
Hospital Revenue Code	272
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

BRUSH MCV CATH CYTOL 1601

Facility

$56.00

Hospital Charge Code	270611113
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

BRUSH MCV CATH CYTOL 1601

Facility

$56.00

Hospital Charge Code	270611113
Hospital Revenue Code	272
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

BRUSH MCV CMBO CATH CYTOL 1635

Facility

$842.45

Hospital Charge Code	270601178
Hospital Revenue Code	272
Min. Negotiated Rate	$126.37
Max. Negotiated Rate	$126.37
Rate for Payer: Qualcare PPO/HMO/WC	$126.37

BRUSH MCV CMBO CATH CYTOL 1635

Facility

$842.45

Hospital Charge Code	270601178
Hospital Revenue Code	272
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$421.23
Rate for Payer: Aetna Commercial	$320.13
Rate for Payer: Aetna Medicare Advantage	$252.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.82
Rate for Payer: Cigna Commercial	$421.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.74
Rate for Payer: Oxford Commercial	$168.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.37
Rate for Payer: UnitedHealthcare Commercial	$168.49
Rate for Payer: UnitedHealthcare Community & State	$20.30
Rate for Payer: Wellpoint Medicaid Managed Care	$22.32

BRUSH MCV MICRO SPEC 1650

Facility

$120.00

Hospital Charge Code	270607436
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

BRUSH MCV MICRO SPEC 1650

Facility

$120.00

Hospital Charge Code	270607436
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$24.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

BRUSH PEG CLEANING ******

Facility

$27.00

Hospital Charge Code	2300812
Hospital Revenue Code	279
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

BRUSH PEG CLEANING ******

Facility

$27.00

Hospital Charge Code	2300812
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

BRUSH SCRUB

Facility

$757.55

Hospital Charge Code	270651673
Hospital Revenue Code	272
Min. Negotiated Rate	$113.63
Max. Negotiated Rate	$113.63
Rate for Payer: Qualcare PPO/HMO/WC	$113.63

BRUSH SCRUB

Facility

$757.55

Hospital Charge Code	270651673
Hospital Revenue Code	272
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$378.77
Rate for Payer: Aetna Commercial	$287.87
Rate for Payer: Aetna Medicare Advantage	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.18
Rate for Payer: Cigna Commercial	$378.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.26
Rate for Payer: Oxford Commercial	$151.51
Rate for Payer: Qualcare PPO/HMO/WC	$113.63
Rate for Payer: UnitedHealthcare Commercial	$151.51
Rate for Payer: UnitedHealthcare Community & State	$18.26
Rate for Payer: Wellpoint Medicaid Managed Care	$20.08

BRUSH SCRUB ALOE W/PCMX

Facility

$1.99

Hospital Charge Code	270648959
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

BRUSH SCRUB ALOE W/PCMX

Facility

$1.99

Hospital Charge Code	270648959
Hospital Revenue Code	270
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

BRUSH SCRUB W/IODINE

Facility

$1.35

Hospital Charge Code	270648960
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: Aetna Medicare Advantage	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.34
Rate for Payer: Cigna Commercial	$0.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.41
Rate for Payer: Oxford Commercial	$0.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.20
Rate for Payer: UnitedHealthcare Commercial	$0.27
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

BRUSH SCRUB W/IODINE

Facility

$1.35

Hospital Charge Code	270648960
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

BRUSH STD CHANNEL CLEANING

Facility

$8.50

Hospital Charge Code	270634058
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

BRUSH STD CHANNEL CLEANING

Facility

$8.50

Hospital Charge Code	270634058
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.25
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna Medicare Advantage	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.17
Rate for Payer: Cigna Commercial	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.55
Rate for Payer: Oxford Commercial	$1.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.27
Rate for Payer: UnitedHealthcare Commercial	$1.70
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

BSS

Facility

$193.30

Service Code	NDC 65079550
Hospital Charge Code	606350940
Hospital Revenue Code	250
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$96.65
Rate for Payer: Aetna Commercial	$73.45
Rate for Payer: Aetna Medicare Advantage	$57.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.29
Rate for Payer: Cigna Commercial	$96.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.99
Rate for Payer: Oxford Commercial	$38.66
Rate for Payer: Qualcare PPO/HMO/WC	$29.00
Rate for Payer: UnitedHealthcare Commercial	$38.66
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.12

BSS

Facility

$193.30

Service Code	NDC 65079550
Hospital Charge Code	606350940
Hospital Revenue Code	250
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.00

BSS 20CC *******

Facility

$28.00

Hospital Charge Code	1600766
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

BSS 20CC *******

Facility

$28.00

Hospital Charge Code	1600766
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

BSS 500ML & ALCON NDC OPHTH***

Facility

$75.00

Hospital Charge Code	1600790
Hospital Revenue Code	279
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

Know your out-of-pocket cost for care.

All Charges