Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CANNULA RESPIRONICS CO2/02

Facility

$127.70

Hospital Charge Code	270704860
Hospital Revenue Code	272
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$63.85
Rate for Payer: Aetna Commercial	$48.53
Rate for Payer: Aetna Medicare Advantage	$38.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.56
Rate for Payer: Cigna Commercial	$63.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.31
Rate for Payer: Oxford Commercial	$25.54
Rate for Payer: Qualcare PPO/HMO/WC	$19.16
Rate for Payer: UnitedHealthcare Commercial	$25.54
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

CANNULA RESPIRONICS CO2/02

Facility

$127.70

Hospital Charge Code	270704860
Hospital Revenue Code	272
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$19.16
Rate for Payer: Qualcare PPO/HMO/WC	$19.16

CANNULA RF 10cM 20ga 7210275

Facility

$175.00

Hospital Charge Code	270639098
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

CANNULA RF 10cM 20ga 7210275

Facility

$175.00

Hospital Charge Code	270639098
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CANNULA RF 22G 100x5mm CRVD

Facility

$357.50

Hospital Charge Code	270671754
Hospital Revenue Code	279
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

CANNULA RF 22G 100x5mm CRVD

Facility

$357.50

Hospital Charge Code	270671754
Hospital Revenue Code	279
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

CANNULA RF NEEDLE 100MM 22G

Facility

$205.75

Hospital Charge Code	270654885
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$102.88
Rate for Payer: Aetna Commercial	$78.19
Rate for Payer: Aetna Medicare Advantage	$61.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.47
Rate for Payer: Cigna Commercial	$102.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.73
Rate for Payer: Oxford Commercial	$41.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.86
Rate for Payer: UnitedHealthcare Commercial	$41.15
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

CANNULA RF NEEDLE 100MM 22G

Facility

$205.75

Hospital Charge Code	270654885
Hospital Revenue Code	272
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$30.86
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

CANNULA RX ERCP BALL TIP 210CM

Facility

$569.35

Hospital Charge Code	270698334
Hospital Revenue Code	272
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$284.68
Rate for Payer: Aetna Commercial	$216.35
Rate for Payer: Aetna Medicare Advantage	$170.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.18
Rate for Payer: Cigna Commercial	$284.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.81
Rate for Payer: Oxford Commercial	$113.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.40
Rate for Payer: UnitedHealthcare Commercial	$113.87
Rate for Payer: UnitedHealthcare Community & State	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$15.09

CANNULA RX ERCP BALL TIP 210CM

Facility

$569.35

Hospital Charge Code	270698334
Hospital Revenue Code	272
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$85.40
Rate for Payer: Qualcare PPO/HMO/WC	$85.40

CANNULA RX ERCP STD TIP 210CM

Facility

$363.90

Hospital Charge Code	270673012
Hospital Revenue Code	272
Min. Negotiated Rate	$54.59
Max. Negotiated Rate	$54.59
Rate for Payer: Qualcare PPO/HMO/WC	$54.59

CANNULA RX ERCP STD TIP 210CM

Facility

$363.90

Hospital Charge Code	270673012
Hospital Revenue Code	272
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$181.95
Rate for Payer: Aetna Commercial	$138.28
Rate for Payer: Aetna Medicare Advantage	$109.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.79
Rate for Payer: Cigna Commercial	$181.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.17
Rate for Payer: Oxford Commercial	$72.78
Rate for Payer: Qualcare PPO/HMO/WC	$54.59
Rate for Payer: UnitedHealthcare Commercial	$72.78
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.64

CANNULA RX ERCP TAPR TIP 210CM

Facility

$569.35

Hospital Charge Code	270698323
Hospital Revenue Code	272
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$284.68
Rate for Payer: Aetna Commercial	$216.35
Rate for Payer: Aetna Medicare Advantage	$170.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.18
Rate for Payer: Cigna Commercial	$284.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.81
Rate for Payer: Oxford Commercial	$113.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.40
Rate for Payer: UnitedHealthcare Commercial	$113.87
Rate for Payer: UnitedHealthcare Community & State	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$15.09

CANNULA RX ERCP TAPR TIP 210CM

Facility

$569.35

Hospital Charge Code	270698323
Hospital Revenue Code	272
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$85.40
Rate for Payer: Qualcare PPO/HMO/WC	$85.40

CANNULA RX STANDARD TIP

Facility

$342.50

Hospital Charge Code	270654333
Hospital Revenue Code	272
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$171.25
Rate for Payer: Aetna Commercial	$130.15
Rate for Payer: Aetna Medicare Advantage	$102.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.34
Rate for Payer: Cigna Commercial	$171.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.75
Rate for Payer: Oxford Commercial	$68.50
Rate for Payer: Qualcare PPO/HMO/WC	$51.38
Rate for Payer: UnitedHealthcare Commercial	$68.50
Rate for Payer: UnitedHealthcare Community & State	$8.25
Rate for Payer: Wellpoint Medicaid Managed Care	$9.08

CANNULA RX STANDARD TIP

Facility

$342.50

Hospital Charge Code	270654333
Hospital Revenue Code	272
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$51.38
Rate for Payer: Qualcare PPO/HMO/WC	$51.38

CANNULA SEAL 5 MM

Facility

$1,750.00

Hospital Charge Code	270666139
Hospital Revenue Code	270
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CANNULA SEAL 5 MM

Facility

$1,750.00

Hospital Charge Code	270666139
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CANNULA SET 6x75mm DISPOSABLE

Facility

$50.00

Hospital Charge Code	270639291
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

CANNULA SET 6x75mm DISPOSABLE

Facility

$50.00

Hospital Charge Code	270639291
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

CANNULA SET 8.4x90mm DISPOSAB-

Facility

$50.00

Hospital Charge Code	270639293
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

CANNULA SET 8.4x90mm DISPOSAB-

Facility

$50.00

Hospital Charge Code	270639293
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

CANNULA SHILEY INNER

Facility

$17.35

Service Code	HCPCS A4623
Hospital Charge Code	270699949
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$6.59
Rate for Payer: Aetna Medicare Advantage	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.42
Rate for Payer: Cigna Commercial	$8.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.21
Rate for Payer: Oxford Commercial	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.60
Rate for Payer: UnitedHealthcare Commercial	$3.47
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CANNULA SHILEY INNER

Facility

$17.35

Service Code	HCPCS A4623
Hospital Charge Code	270699949
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.60

CANNULA SILICONE TIP 27GA

Facility

$19.07

Hospital Charge Code	270657592
Hospital Revenue Code	272
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$2.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.86

Know your out-of-pocket cost for care.

All Charges