Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONCERTA 18MG TAB

Facility

$65.19

Service Code	NDC 591271501
Hospital Charge Code	6063943086
Hospital Revenue Code	250
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$9.78
Rate for Payer: Qualcare PPO/HMO/WC	$9.78

CONCERTA 27MG TAB

Facility

$50.12

Service Code	NDC 55289097590
Hospital Charge Code	6063943087
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.06
Rate for Payer: Aetna Commercial	$19.05
Rate for Payer: Aetna Medicare Advantage	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.78
Rate for Payer: Cigna Commercial	$25.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.04
Rate for Payer: Oxford Commercial	$10.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.52
Rate for Payer: UnitedHealthcare Commercial	$10.02
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

CONCERTA 27MG TAB

Facility

$50.12

Service Code	NDC 55289097590
Hospital Charge Code	6063943087
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$7.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.52

CONCERTA 36MG TAB

Facility

$52.46

Service Code	NDC 55289085930
Hospital Charge Code	6063943088
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$7.87
Rate for Payer: Qualcare PPO/HMO/WC	$7.87

CONCERTA 36MG TAB

Facility

$52.46

Service Code	NDC 55289085930
Hospital Charge Code	6063943088
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$26.23
Rate for Payer: Aetna Commercial	$19.93
Rate for Payer: Aetna Medicare Advantage	$15.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.38
Rate for Payer: Cigna Commercial	$26.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.74
Rate for Payer: Oxford Commercial	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$7.87
Rate for Payer: UnitedHealthcare Commercial	$10.49
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

CONCERTA 54MG TAB

Facility

$32.16

Service Code	NDC 50458058701
Hospital Charge Code	6063943089
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.82

CONCERTA 54MG TAB

Facility

$32.16

Service Code	NDC 50458058701
Hospital Charge Code	6063943089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.08
Rate for Payer: Aetna Commercial	$12.22
Rate for Payer: Aetna Medicare Advantage	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.20
Rate for Payer: Cigna Commercial	$16.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.65
Rate for Payer: Oxford Commercial	$6.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.82
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$353,602.98

Service Code	MSDRG 212
Min. Negotiated Rate	$107,667.58
Max. Negotiated Rate	$353,602.98
Rate for Payer: Aetna Commercial	$243,222.89
Rate for Payer: Aetna Medicare Advantage	$353,602.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$113,334.29
Rate for Payer: Cigna Commercial	$203,497.91
Rate for Payer: Cigna Medicare Advantage	$113,334.29
Rate for Payer: Clover Medicare Advantage	$107,667.58
Rate for Payer: EmblemHealth Commercial	$340,002.87
Rate for Payer: Humana Medicare Advantage	$116,734.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$113,334.29
Rate for Payer: Oxford Commercial	$146,256.64
Rate for Payer: UnitedHealthcare Commercial	$256,465.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$113,334.29
Rate for Payer: Wellcare Medicare Advantage	$113,334.29

CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$218,252.83

Service Code	MSDRG 317
Min. Negotiated Rate	$66,455.19
Max. Negotiated Rate	$218,252.83
Rate for Payer: Aetna Commercial	$150,221.91
Rate for Payer: Aetna Medicare Advantage	$218,252.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$69,952.83
Rate for Payer: Cigna Commercial	$125,131.16
Rate for Payer: Cigna Medicare Advantage	$69,952.83
Rate for Payer: Clover Medicare Advantage	$66,455.19
Rate for Payer: EmblemHealth Commercial	$209,858.49
Rate for Payer: Humana Medicare Advantage	$72,051.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$69,952.83
Rate for Payer: Oxford Commercial	$89,933.43
Rate for Payer: UnitedHealthcare Commercial	$157,701.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$69,952.83
Rate for Payer: Wellcare Medicare Advantage	$69,952.83

CONCORDE INLINE 9mmX13mmX21mm

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679700
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

CONCORDE INLINE 9mmX13mmX21mm

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679700
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

CONCORD INLINE 5 LOR 9x11x21

Facility

$30,400.00

Hospital Charge Code	270665204
Hospital Revenue Code	278
Min. Negotiated Rate	$732.64
Max. Negotiated Rate	$15,200.00
Rate for Payer: Aetna Commercial	$11,552.00
Rate for Payer: Aetna Medicare Advantage	$9,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,752.00
Rate for Payer: Cigna Commercial	$15,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00
Rate for Payer: UnitedHealthcare Community & State	$732.64
Rate for Payer: Wellpoint Medicaid Managed Care	$805.60

CONCORD INLINE 5 LOR 9x11x21

Facility

$30,400.00

Hospital Charge Code	270665204
Hospital Revenue Code	278
Min. Negotiated Rate	$4,560.00
Max. Negotiated Rate	$7,356.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$23,278.24

Service Code	APR-DRG 0574
Min. Negotiated Rate	$22,821.80
Max. Negotiated Rate	$23,278.24
Rate for Payer: UnitedHealthcare Community & State	$22,821.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,278.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22,821.80

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$14,820.07

Service Code	APR-DRG 0573
Min. Negotiated Rate	$14,529.48
Max. Negotiated Rate	$14,820.07
Rate for Payer: UnitedHealthcare Community & State	$14,529.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,820.07
Rate for Payer: Wellpoint Medicaid Managed Care	$14,529.48

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$10,138.36

Service Code	APR-DRG 0572
Min. Negotiated Rate	$9,939.57
Max. Negotiated Rate	$10,138.36
Rate for Payer: UnitedHealthcare Community & State	$9,939.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,138.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9,939.57

CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA

Facility

$6,710.41

Service Code	APR-DRG 0571
Min. Negotiated Rate	$6,578.83
Max. Negotiated Rate	$6,710.41
Rate for Payer: UnitedHealthcare Community & State	$6,578.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,710.41
Rate for Payer: Wellpoint Medicaid Managed Care	$6,578.83

CONCUSSION WITH CC

Facility

$37,642.61

Service Code	MSDRG 089
Min. Negotiated Rate	$11,461.69
Max. Negotiated Rate	$37,642.61
Rate for Payer: Aetna Medicare Advantage	$37,642.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,750.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,750.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,064.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,750.15
Rate for Payer: Cigna Commercial	$20,559.20
Rate for Payer: Cigna Medicare Advantage	$12,064.94
Rate for Payer: Clover Medicare Advantage	$11,461.69
Rate for Payer: EmblemHealth Commercial	$36,194.82
Rate for Payer: Humana Medicare Advantage	$12,426.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,064.94
Rate for Payer: Oxford Commercial	$14,776.17
Rate for Payer: UnitedHealthcare Commercial	$25,910.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,064.94
Rate for Payer: Wellcare Medicare Advantage	$12,064.94

CONCUSSION WITH MCC

Facility

$45,826.47

Service Code	MSDRG 088
Min. Negotiated Rate	$13,953.57
Max. Negotiated Rate	$45,826.47
Rate for Payer: Aetna Medicare Advantage	$45,826.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,589.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,589.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,687.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,589.33
Rate for Payer: Cigna Commercial	$25,297.59
Rate for Payer: Cigna Medicare Advantage	$14,687.97
Rate for Payer: Clover Medicare Advantage	$13,953.57
Rate for Payer: EmblemHealth Commercial	$44,063.91
Rate for Payer: Humana Medicare Advantage	$15,128.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,687.97
Rate for Payer: Oxford Commercial	$18,181.71
Rate for Payer: UnitedHealthcare Commercial	$31,882.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,687.97
Rate for Payer: Wellcare Medicare Advantage	$14,687.97

CONCUSSION WITHOUT CC/MCC

Facility

$28,741.28

Service Code	MSDRG 090
Min. Negotiated Rate	$8,751.35
Max. Negotiated Rate	$28,741.28
Rate for Payer: Aetna Medicare Advantage	$28,741.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,632.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,632.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,211.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,632.73
Rate for Payer: Cigna Commercial	$15,405.36
Rate for Payer: Cigna Medicare Advantage	$9,211.95
Rate for Payer: Clover Medicare Advantage	$8,751.35
Rate for Payer: EmblemHealth Commercial	$27,635.85
Rate for Payer: Humana Medicare Advantage	$9,488.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,211.95
Rate for Payer: Oxford Commercial	$11,072.04
Rate for Payer: UnitedHealthcare Commercial	$19,415.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,211.95
Rate for Payer: Wellcare Medicare Advantage	$9,211.95

CONDITIONER SKIN AV 4OZ

Facility

$3.39

Hospital Charge Code	270649379
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna Commercial	$1.29
Rate for Payer: Aetna Medicare Advantage	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.86
Rate for Payer: Cigna Commercial	$1.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.02
Rate for Payer: Oxford Commercial	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.51
Rate for Payer: UnitedHealthcare Commercial	$0.68
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

CONDITIONER SKIN AV 4OZ

Facility

$3.39

Hospital Charge Code	270649379
Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Qualcare PPO/HMO/WC	$0.51

CONDUIT DPY GRANULES 276101005

Facility

$1,430.00

Hospital Charge Code	270628749
Hospital Revenue Code	272
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$715.00
Rate for Payer: Aetna Commercial	$543.40
Rate for Payer: Aetna Medicare Advantage	$429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.65
Rate for Payer: Cigna Commercial	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.00
Rate for Payer: Oxford Commercial	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.50
Rate for Payer: UnitedHealthcare Commercial	$286.00
Rate for Payer: UnitedHealthcare Community & State	$34.46
Rate for Payer: Wellpoint Medicaid Managed Care	$37.90

CONDUIT DPY GRANULES 276101005

Facility

$1,430.00

Hospital Charge Code	270628749
Hospital Revenue Code	272
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$214.50

CONDUIT TCP 276101030

Facility

$5,406.45

Hospital Charge Code	270633178
Hospital Revenue Code	272
Min. Negotiated Rate	$130.30
Max. Negotiated Rate	$2,703.22
Rate for Payer: Aetna Commercial	$2,054.45
Rate for Payer: Aetna Medicare Advantage	$1,621.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,378.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,378.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,378.64
Rate for Payer: Cigna Commercial	$2,703.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.93
Rate for Payer: Oxford Commercial	$1,081.29
Rate for Payer: Qualcare PPO/HMO/WC	$810.97
Rate for Payer: UnitedHealthcare Commercial	$1,081.29
Rate for Payer: UnitedHealthcare Community & State	$130.30
Rate for Payer: Wellpoint Medicaid Managed Care	$143.27

Know your out-of-pocket cost for care.

All Charges