Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COLY-MYCIN

Facility

$1,855.90

Service Code	NDC 63481042105
Hospital Charge Code	606390221
Hospital Revenue Code	250
Min. Negotiated Rate	$278.38
Max. Negotiated Rate	$278.38
Rate for Payer: Qualcare PPO/HMO/WC	$278.38

COLY-MYCIN S OTIC/10ML

Facility

$101.00

Hospital Charge Code	60632728
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

COLY-MYCIN S OTIC/10ML

Facility

$101.00

Hospital Charge Code	60632728
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

COLY-MYCIN S OTIC/5ML

Facility

$61.00

Hospital Charge Code	60632727
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

COLY-MYCIN S OTIC/5ML

Facility

$61.00

Hospital Charge Code	60632727
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

COLYTE/3785ML

Facility

$84.00

Hospital Charge Code	60632730
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

COLYTE/3785ML

Facility

$84.00

Hospital Charge Code	60632730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

COLYTE/4000ML

Facility

$90.00

Hospital Charge Code	60632729
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

COLYTE/4000ML

Facility

$90.00

Hospital Charge Code	60632729
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

COMB 5 BLACK

Facility

$4.00

Hospital Charge Code	270300665
Hospital Revenue Code	270
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

COMB 5 BLACK

Facility

$4.00

Hospital Charge Code	270300665
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$293,339.19

Service Code	MSDRG 429
Min. Negotiated Rate	$89,318.02
Max. Negotiated Rate	$293,339.19
Rate for Payer: Aetna Commercial	$201,814.80
Rate for Payer: Aetna Medicare Advantage	$293,339.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$94,018.97
Rate for Payer: Cigna Commercial	$168,605.65
Rate for Payer: Cigna Medicare Advantage	$94,018.97
Rate for Payer: Clover Medicare Advantage	$89,318.02
Rate for Payer: EmblemHealth Commercial	$282,056.91
Rate for Payer: Humana Medicare Advantage	$96,839.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$94,018.97
Rate for Payer: Oxford Commercial	$121,179.12
Rate for Payer: UnitedHealthcare Commercial	$212,491.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$94,018.97
Rate for Payer: Wellcare Medicare Advantage	$94,018.97

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$188,536.26

Service Code	MSDRG 430
Min. Negotiated Rate	$57,406.88
Max. Negotiated Rate	$188,536.26
Rate for Payer: Aetna Commercial	$129,803.21
Rate for Payer: Aetna Medicare Advantage	$188,536.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$60,428.29
Rate for Payer: Cigna Commercial	$107,925.51
Rate for Payer: Cigna Medicare Advantage	$60,428.29
Rate for Payer: Clover Medicare Advantage	$57,406.88
Rate for Payer: EmblemHealth Commercial	$181,284.87
Rate for Payer: Humana Medicare Advantage	$62,241.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$60,428.29
Rate for Payer: Oxford Commercial	$77,567.49
Rate for Payer: UnitedHealthcare Commercial	$136,017.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$60,428.29
Rate for Payer: Wellcare Medicare Advantage	$60,428.29

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC

Facility

$142,357.32

Service Code	MSDRG 454
Min. Negotiated Rate	$142,357.32
Max. Negotiated Rate	$142,357.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142,357.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142,357.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142,357.32

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC

Facility

$206,092.46

Service Code	MSDRG 453
Min. Negotiated Rate	$206,092.46
Max. Negotiated Rate	$206,092.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206,092.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206,092.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206,092.46

COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC

Facility

$107,233.21

Service Code	MSDRG 455
Min. Negotiated Rate	$107,233.21
Max. Negotiated Rate	$107,233.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107,233.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107,233.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107,233.21

COMBIVENT RESPIMAT 4GM

Facility

$1,155.85

Hospital Charge Code	60630190
Hospital Revenue Code	250
Min. Negotiated Rate	$27.86
Max. Negotiated Rate	$577.92
Rate for Payer: Aetna Commercial	$439.22
Rate for Payer: Aetna Medicare Advantage	$346.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.74
Rate for Payer: Cigna Commercial	$577.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.75
Rate for Payer: Oxford Commercial	$231.17
Rate for Payer: Qualcare PPO/HMO/WC	$173.38
Rate for Payer: UnitedHealthcare Commercial	$231.17
Rate for Payer: UnitedHealthcare Community & State	$27.86
Rate for Payer: Wellpoint Medicaid Managed Care	$30.63

COMBIVENT RESPIMAT 4GM

Facility

$1,155.85

Hospital Charge Code	60630190
Hospital Revenue Code	250
Min. Negotiated Rate	$173.38
Max. Negotiated Rate	$173.38
Rate for Payer: Qualcare PPO/HMO/WC	$173.38

COMBIVIR 150/300 TAB

Facility

$60.00

Hospital Charge Code	60635200
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

COMBIVIR 150/300 TAB

Facility

$60.00

Hospital Charge Code	60635200
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

COMB RHC + LHC

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	366893460
Hospital Revenue Code	481
Min. Negotiated Rate	$620.27
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,721.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$620.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$682.03

COMB RHC + LHC

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	366893460
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

COMB RHC + LHC

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	7411241
Hospital Revenue Code	481
Min. Negotiated Rate	$620.27
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,721.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$620.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$682.03

COMB RHC + LHC

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	7411241
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

COMET II PRESSURE GUIDEWIRE

Facility

$6,375.00

Hospital Charge Code	270703404
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

Know your out-of-pocket cost for care.

All Charges