Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CROMOLYN 4% OPHTH SOLN

Facility

$186.25

Hospital Charge Code	60628007
Hospital Revenue Code	250
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$27.94

CROMOLYN AEROSOL

Facility

$38.45

Hospital Charge Code	60628008
Hospital Revenue Code	259
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

CROMOLYN AEROSOL

Facility

$38.45

Hospital Charge Code	60628008
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.23
Rate for Payer: Aetna Commercial	$14.61
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.80
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.54
Rate for Payer: Oxford Commercial	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$7.69
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

CROMOLYN SODIUM NAS SPRY 5.2MG

Facility

$65.65

Hospital Charge Code	60628964
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$13.13
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

CROMOLYN SODIUM NAS SPRY 5.2MG

Facility

$65.65

Hospital Charge Code	60628964
Hospital Revenue Code	259
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

CROMOLYN SOD NSL SPR 5.2MG

Facility

$311.05

Hospital Charge Code	6001424
Hospital Revenue Code	259
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$46.66
Rate for Payer: Qualcare PPO/HMO/WC	$46.66

CROMOLYN SOD NSL SPR 5.2MG

Facility

$311.05

Hospital Charge Code	6001424
Hospital Revenue Code	259
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$155.53
Rate for Payer: Aetna Commercial	$118.20
Rate for Payer: Aetna Medicare Advantage	$93.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.32
Rate for Payer: Cigna Commercial	$155.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.31
Rate for Payer: Oxford Commercial	$62.21
Rate for Payer: Qualcare PPO/HMO/WC	$46.66
Rate for Payer: UnitedHealthcare Commercial	$62.21
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

CROMOLYN SOD RESP CAP 20MG

Facility

$165.80

Hospital Charge Code	6001432
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$82.90
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Aetna Medicare Advantage	$49.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$82.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.74
Rate for Payer: Oxford Commercial	$33.16
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: UnitedHealthcare Commercial	$33.16
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

CROMOLYN SOD RESP CAP 20MG

Facility

$165.80

Hospital Charge Code	6001432
Hospital Revenue Code	250
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$24.87

CROMOLYN SOL INH 20MG/2ML

Facility

$4.00

Hospital Charge Code	60628006
Hospital Revenue Code	259
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

CROMOLYN SOL INH 20MG/2ML

Facility

$4.00

Hospital Charge Code	60628006
Hospital Revenue Code	259
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CROMOLYN SPHT 4% 10 ML

Facility

$158.75

Hospital Charge Code	6001416
Hospital Revenue Code	259
Min. Negotiated Rate	$23.81
Max. Negotiated Rate	$23.81
Rate for Payer: Qualcare PPO/HMO/WC	$23.81

CROMOLYN SPHT 4% 10 ML

Facility

$158.75

Hospital Charge Code	6001416
Hospital Revenue Code	259
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$60.33
Rate for Payer: Aetna Medicare Advantage	$47.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.48
Rate for Payer: Cigna Commercial	$79.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.62
Rate for Payer: Oxford Commercial	$31.75
Rate for Payer: Qualcare PPO/HMO/WC	$23.81
Rate for Payer: UnitedHealthcare Commercial	$31.75
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

CROSS CNTOR SPAN PLATE 2230550

Facility

$2,207.25

Hospital Charge Code	270632117
Hospital Revenue Code	278
Min. Negotiated Rate	$331.09
Max. Negotiated Rate	$534.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09

CROSS CNTOR SPAN PLATE 2230550

Facility

$2,207.25

Hospital Charge Code	270632117
Hospital Revenue Code	278
Min. Negotiated Rate	$53.19
Max. Negotiated Rate	$1,103.62
Rate for Payer: Aetna Commercial	$838.75
Rate for Payer: Aetna Medicare Advantage	$662.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$562.85
Rate for Payer: Cigna Commercial	$1,103.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09
Rate for Payer: UnitedHealthcare Community & State	$53.19
Rate for Payer: Wellpoint Medicaid Managed Care	$58.49

CROSS CONCTOR HEX NUT 22301000

Facility

$446.45

Hospital Charge Code	270632116
Hospital Revenue Code	278
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$223.22
Rate for Payer: Aetna Commercial	$169.65
Rate for Payer: Aetna Medicare Advantage	$133.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.84
Rate for Payer: Cigna Commercial	$223.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.22
Rate for Payer: Qualcare PPO/HMO/WC	$66.97
Rate for Payer: UnitedHealthcare Community & State	$10.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.83

CROSS CONCTOR HEX NUT 22301000

Facility

$446.45

Hospital Charge Code	270632116
Hospital Revenue Code	278
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.22
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

CROSS CONEC SET SCREW 223005SS

Facility

$471.25

Hospital Charge Code	270632115
Hospital Revenue Code	278
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$114.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.67
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

CROSS CONEC SET SCREW 223005SS

Facility

$471.25

Hospital Charge Code	270632115
Hospital Revenue Code	278
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$235.62
Rate for Payer: Aetna Commercial	$179.07
Rate for Payer: Aetna Medicare Advantage	$141.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.17
Rate for Payer: Cigna Commercial	$235.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.67
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Community & State	$11.36
Rate for Payer: Wellpoint Medicaid Managed Care	$12.49

CROSS CONNECTOR 48MM

Facility

$7,298.55

Service Code	HCPCS C1713
Hospital Charge Code	270704749
Hospital Revenue Code	278
Min. Negotiated Rate	$175.90
Max. Negotiated Rate	$3,649.28
Rate for Payer: Aetna Commercial	$2,773.45
Rate for Payer: Aetna Medicare Advantage	$2,189.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,861.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,861.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,459.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,861.13
Rate for Payer: Cigna Commercial	$3,649.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,605.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,094.78
Rate for Payer: UnitedHealthcare Community & State	$175.90
Rate for Payer: Wellpoint Medicaid Managed Care	$193.41

CROSS CONNECTOR 48MM

Facility

$7,298.55

Service Code	HCPCS C1713
Hospital Charge Code	270704749
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.78
Max. Negotiated Rate	$1,766.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,459.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,605.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,094.78

CROSS CONNECTOR J-HOOK 2230635

Facility

$719.25

Hospital Charge Code	270632114
Hospital Revenue Code	278
Min. Negotiated Rate	$107.89
Max. Negotiated Rate	$174.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.24
Rate for Payer: Qualcare PPO/HMO/WC	$107.89

CROSS CONNECTOR J-HOOK 2230635

Facility

$719.25

Hospital Charge Code	270632114
Hospital Revenue Code	278
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.62
Rate for Payer: Aetna Commercial	$273.31
Rate for Payer: Aetna Medicare Advantage	$215.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.41
Rate for Payer: Cigna Commercial	$359.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.24
Rate for Payer: Qualcare PPO/HMO/WC	$107.89
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.06

CROSS CONNECT SYMP OCT30TO42

Facility

$5,892.00

Service Code	HCPCS C1713
Hospital Charge Code	270694400
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,946.00
Rate for Payer: Aetna Commercial	$2,238.96
Rate for Payer: Aetna Medicare Advantage	$1,767.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,502.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,502.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,502.46
Rate for Payer: Cigna Commercial	$2,946.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,296.24
Rate for Payer: Qualcare PPO/HMO/WC	$883.80
Rate for Payer: UnitedHealthcare Community & State	$142.00
Rate for Payer: Wellpoint Medicaid Managed Care	$156.14

CROSS CONNECT SYMP OCT30TO42

Facility

$5,892.00

Service Code	HCPCS C1713
Hospital Charge Code	270694400
Hospital Revenue Code	278
Min. Negotiated Rate	$883.80
Max. Negotiated Rate	$1,425.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,296.24
Rate for Payer: Qualcare PPO/HMO/WC	$883.80

Know your out-of-pocket cost for care.

All Charges