Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CANNULATED TAP FOR 5MM DUAL SC

Facility

$3,290.00

Hospital Charge Code	270656675
Hospital Revenue Code	272
Min. Negotiated Rate	$79.29
Max. Negotiated Rate	$1,645.00
Rate for Payer: Aetna Commercial	$1,250.20
Rate for Payer: Aetna Medicare Advantage	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$838.95
Rate for Payer: Cigna Commercial	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.00
Rate for Payer: Oxford Commercial	$658.00
Rate for Payer: Qualcare PPO/HMO/WC	$493.50
Rate for Payer: UnitedHealthcare Commercial	$658.00
Rate for Payer: UnitedHealthcare Community & State	$79.29
Rate for Payer: Wellpoint Medicaid Managed Care	$87.19

CANNULATED TAP F/SCREW 3.5x146

Facility

$1,875.65

Service Code	HCPCS C1713
Hospital Charge Code	270643932
Hospital Revenue Code	278
Min. Negotiated Rate	$45.20
Max. Negotiated Rate	$937.83
Rate for Payer: Aetna Commercial	$712.75
Rate for Payer: Aetna Medicare Advantage	$562.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.29
Rate for Payer: Cigna Commercial	$937.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.64
Rate for Payer: Qualcare PPO/HMO/WC	$281.35
Rate for Payer: UnitedHealthcare Community & State	$45.20
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

CANNULATED TAP F/SCREW 3.5x146

Facility

$1,875.65

Service Code	HCPCS C1713
Hospital Charge Code	270643932
Hospital Revenue Code	278
Min. Negotiated Rate	$281.35
Max. Negotiated Rate	$453.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.64
Rate for Payer: Qualcare PPO/HMO/WC	$281.35

CANNULATED TAP F/SCREW 4x147MM

Facility

$1,878.00

Hospital Charge Code	270676252
Hospital Revenue Code	278
Min. Negotiated Rate	$45.26
Max. Negotiated Rate	$939.00
Rate for Payer: Aetna Commercial	$713.64
Rate for Payer: Aetna Medicare Advantage	$563.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.89
Rate for Payer: Cigna Commercial	$939.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.16
Rate for Payer: Qualcare PPO/HMO/WC	$281.70
Rate for Payer: UnitedHealthcare Community & State	$45.26
Rate for Payer: Wellpoint Medicaid Managed Care	$49.77

CANNULATED TAP F/SCREW 4x147MM

Facility

$1,878.00

Hospital Charge Code	270676252
Hospital Revenue Code	278
Min. Negotiated Rate	$281.70
Max. Negotiated Rate	$454.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.16
Rate for Payer: Qualcare PPO/HMO/WC	$281.70

CANNULA THD CLEAR OBT 8.5X90MM

Facility

$830.00

Hospital Charge Code	270670524
Hospital Revenue Code	272
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

CANNULA THD CLEAR OBT 8.5X90MM

Facility

$830.00

Hospital Charge Code	270670524
Hospital Revenue Code	272
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.00
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$166.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

CANNULA THREADED 5.5x55 214104

Facility

$128.00

Hospital Charge Code	270642289
Hospital Revenue Code	272
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CANNULA THREADED 5.5x55 214104

Facility

$128.00

Hospital Charge Code	270642289
Hospital Revenue Code	272
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CANNULA THREADED 5mm 214108

Facility

$625.00

Hospital Charge Code	270640104
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

CANNULA THREADED 5mm 214108

Facility

$625.00

Hospital Charge Code	270640104
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CANNULA THREADED DISO 8.5X72MM

Facility

$156.50

Hospital Charge Code	270681096
Hospital Revenue Code	272
Min. Negotiated Rate	$23.48
Max. Negotiated Rate	$23.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.48

CANNULA THREADED DISO 8.5X72MM

Facility

$156.50

Hospital Charge Code	270681096
Hospital Revenue Code	272
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$78.25
Rate for Payer: Aetna Commercial	$59.47
Rate for Payer: Aetna Medicare Advantage	$46.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.91
Rate for Payer: Cigna Commercial	$78.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.95
Rate for Payer: Oxford Commercial	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$23.48
Rate for Payer: UnitedHealthcare Commercial	$31.30
Rate for Payer: UnitedHealthcare Community & State	$3.77
Rate for Payer: Wellpoint Medicaid Managed Care	$4.15

CANNULATOME LL PC LUMEN SPH

Facility

$130.00

Hospital Charge Code	270325609
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

CANNULATOME LL PC LUMEN SPH

Facility

$130.00

Hospital Charge Code	270325609
Hospital Revenue Code	272
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$26.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

cannula transport 8mm

Facility

$821.95

Hospital Charge Code	270688489
Hospital Revenue Code	272
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$123.29
Rate for Payer: Qualcare PPO/HMO/WC	$123.29

cannula transport 8mm

Facility

$821.95

Hospital Charge Code	270688489
Hospital Revenue Code	272
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$410.98
Rate for Payer: Aetna Commercial	$312.34
Rate for Payer: Aetna Medicare Advantage	$246.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.60
Rate for Payer: Cigna Commercial	$410.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.59
Rate for Payer: Oxford Commercial	$164.39
Rate for Payer: Qualcare PPO/HMO/WC	$123.29
Rate for Payer: UnitedHealthcare Commercial	$164.39
Rate for Payer: UnitedHealthcare Community & State	$19.81
Rate for Payer: Wellpoint Medicaid Managed Care	$21.78

CANNULA TRANSPORT 8MM 4-6

Facility

$473.55

Hospital Charge Code	270670488
Hospital Revenue Code	272
Min. Negotiated Rate	$71.03
Max. Negotiated Rate	$71.03
Rate for Payer: Qualcare PPO/HMO/WC	$71.03

CANNULA TRANSPORT 8MM 4-6

Facility

$473.55

Hospital Charge Code	270670488
Hospital Revenue Code	272
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$236.78
Rate for Payer: Aetna Commercial	$179.95
Rate for Payer: Aetna Medicare Advantage	$142.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.76
Rate for Payer: Cigna Commercial	$236.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.06
Rate for Payer: Oxford Commercial	$94.71
Rate for Payer: Qualcare PPO/HMO/WC	$71.03
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Community & State	$11.41
Rate for Payer: Wellpoint Medicaid Managed Care	$12.55

CANNULA TWIST-IN 7MM

Facility

$125.00

Hospital Charge Code	270635387
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CANNULA TWIST-IN 7MM

Facility

$125.00

Hospital Charge Code	270635387
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CANNULA TWIST IN 8.25MMx9CM

Facility

$125.00

Hospital Charge Code	270672178
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CANNULA TWIST IN 8.25MMx9CM

Facility

$125.00

Hospital Charge Code	270672178
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CANNULA UNIV KIT 5X76MM 012405

Facility

$121.50

Hospital Charge Code	270612232
Hospital Revenue Code	272
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$18.23

CANNULA UNIV KIT 5X76MM 012405

Facility

$121.50

Hospital Charge Code	270612232
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Commercial	$46.17
Rate for Payer: Aetna Medicare Advantage	$36.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.98
Rate for Payer: Cigna Commercial	$60.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.45
Rate for Payer: Oxford Commercial	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.23
Rate for Payer: UnitedHealthcare Commercial	$24.30
Rate for Payer: UnitedHealthcare Community & State	$2.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.22

Know your out-of-pocket cost for care.

All Charges