Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DELTA V-40 CERAMIC HEAD 36/+2.

Facility

$14,330.00

Service Code	HCPCS C1776
Hospital Charge Code	270684554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.50
Max. Negotiated Rate	$3,467.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,467.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,152.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,149.50

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$238.59
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$238.59
Rate for Payer: Wellpoint Medicaid Managed Care	$262.35

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$336.56
Max. Negotiated Rate	$6,982.50
Rate for Payer: Aetna Commercial	$5,306.70
Rate for Payer: Aetna Medicare Advantage	$4,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,561.07
Rate for Payer: Cigna Commercial	$6,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,072.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75
Rate for Payer: UnitedHealthcare Community & State	$336.56
Rate for Payer: Wellpoint Medicaid Managed Care	$370.07

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$2,094.75
Max. Negotiated Rate	$3,379.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,072.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$2,640.17
Max. Negotiated Rate	$2,640.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$424.19
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$6,688.44
Rate for Payer: Aetna Medicare Advantage	$5,280.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,488.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,488.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,488.29
Rate for Payer: Cigna Commercial	$8,800.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,280.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$424.19
Rate for Payer: Wellpoint Medicaid Managed Care	$466.43

DEL US-GUIDE- AMNIOCENTESIS

Facility

$420.00

Service Code	HCPCS 76946
Hospital Charge Code	73190081
Hospital Revenue Code	402
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

DEL US-GUIDE- AMNIOCENTESIS

Facility

$420.00

Service Code	HCPCS 76946
Hospital Charge Code	73190081
Hospital Revenue Code	402
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

DEL US-NUCHAL TRANSLUCEN-1ST

Facility

$423.00

Service Code	HCPCS 76813
Hospital Charge Code	73190065
Hospital Revenue Code	402
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.90
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.45
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$10.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$11.21

DEL US-NUCHAL TRANSLUCEN-1ST

Facility

$423.00

Service Code	HCPCS 76813
Hospital Charge Code	73190065
Hospital Revenue Code	402
Min. Negotiated Rate	$63.45
Max. Negotiated Rate	$63.45
Rate for Payer: Qualcare PPO/HMO/WC	$63.45

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$243.41
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.47

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.57
Rate for Payer: Aetna Commercial	$8.80
Rate for Payer: Aetna Medicare Advantage	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.90
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.95
Rate for Payer: Oxford Commercial	$4.63
Rate for Payer: Qualcare PPO/HMO/WC	$3.47
Rate for Payer: UnitedHealthcare Commercial	$4.63
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$7.74
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.11
Rate for Payer: Oxford Commercial	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$4.07
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

DEMADEX 20 MG U/D TAB

Facility

$2.00

Hospital Charge Code	60635308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DEMADEX 20 MG U/D TAB

Facility

$2.00

Hospital Charge Code	60635308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

DEMADEX 5MG TAB

Facility

$2.00

Hospital Charge Code	60635385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DEMADEX 5MG TAB

Facility

$2.00

Hospital Charge Code	60635385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

Know your out-of-pocket cost for care.

All Charges