Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEPO-PROVERA 150MG SYRING

Facility

$186.00

Hospital Charge Code	60635270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$37.20
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

DEPO-PROVERA 400MG/ML

Facility

$654.00

Hospital Charge Code	60634752
Hospital Revenue Code	250
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$98.10

DEPO-PROVERA 400MG/ML

Facility

$654.00

Hospital Charge Code	60634752
Hospital Revenue Code	250
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$327.00
Rate for Payer: Aetna Commercial	$248.52
Rate for Payer: Aetna Medicare Advantage	$196.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.77
Rate for Payer: Cigna Commercial	$327.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.20
Rate for Payer: Oxford Commercial	$130.80
Rate for Payer: Qualcare PPO/HMO/WC	$98.10
Rate for Payer: UnitedHealthcare Commercial	$130.80
Rate for Payer: UnitedHealthcare Community & State	$15.76
Rate for Payer: Wellpoint Medicaid Managed Care	$17.33

DEPRESSIVE DISORDERS

Facility

$10,895.45

Service Code	APR-DRG 7513
Min. Negotiated Rate	$10,681.81
Max. Negotiated Rate	$10,895.45
Rate for Payer: UnitedHealthcare Community & State	$10,681.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,895.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10,681.81

DEPRESSIVE DISORDERS

Facility

$4,560.40

Service Code	APR-DRG 7511
Min. Negotiated Rate	$4,470.98
Max. Negotiated Rate	$4,560.40
Rate for Payer: UnitedHealthcare Community & State	$4,470.98
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,560.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4,470.98

DEPRESSIVE DISORDERS

Facility

$6,105.20

Service Code	APR-DRG 7512
Min. Negotiated Rate	$5,985.49
Max. Negotiated Rate	$6,105.20
Rate for Payer: UnitedHealthcare Community & State	$5,985.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,105.20
Rate for Payer: Wellpoint Medicaid Managed Care	$5,985.49

DEPRESSIVE DISORDERS

Facility

$23,928.11

Service Code	APR-DRG 7514
Min. Negotiated Rate	$23,458.93
Max. Negotiated Rate	$23,928.11
Rate for Payer: UnitedHealthcare Community & State	$23,458.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,928.11
Rate for Payer: Wellpoint Medicaid Managed Care	$23,458.93

DEPRESSIVE NEUROSES

Facility

$32,545.59

Service Code	MSDRG 881
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$32,545.59
Rate for Payer: Aetna Commercial	$22,619.85
Rate for Payer: Aetna Medicare Advantage	$32,545.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,431.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Cigna Commercial	$17,608.00
Rate for Payer: Cigna Medicare Advantage	$10,431.28
Rate for Payer: Clover Medicare Advantage	$9,909.72
Rate for Payer: EmblemHealth Commercial	$31,293.84
Rate for Payer: Humana Medicare Advantage	$10,744.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,431.28
Rate for Payer: Oxford Commercial	$12,655.10
Rate for Payer: UnitedHealthcare Commercial	$22,191.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,431.28
Rate for Payer: Wellcare Medicare Advantage	$10,431.28

DEPRESSOR TONGUE ADULT STERILE

Facility

$0.16

Hospital Charge Code	270300380
Hospital Revenue Code	272
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna Commercial	$0.06
Rate for Payer: Aetna Medicare Advantage	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.04
Rate for Payer: Cigna Commercial	$0.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.05
Rate for Payer: Oxford Commercial	$0.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.02
Rate for Payer: UnitedHealthcare Commercial	$0.03
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

DEPRESSOR TONGUE ADULT STERILE

Facility

$0.16

Hospital Charge Code	270300380
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.02

DEPROPROVERA MEDICATION*****

Facility

$24.17

Service Code	HCPCS J1055
Hospital Charge Code	9600023
Hospital Revenue Code	259
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$3.63

DEPROPROVERA MEDICATION*****

Facility

$24.17

Service Code	HCPCS J1055
Hospital Charge Code	9600023
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.09
Rate for Payer: Aetna Commercial	$9.18
Rate for Payer: Aetna Medicare Advantage	$7.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.16
Rate for Payer: Cigna Commercial	$12.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$3.63
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEPTH GAUGE FOR NAIL SYSTEM MU

Facility

$4,462.65

Hospital Charge Code	270688274
Hospital Revenue Code	272
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$2,231.32
Rate for Payer: Aetna Commercial	$1,695.81
Rate for Payer: Aetna Medicare Advantage	$1,338.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,137.98
Rate for Payer: Cigna Commercial	$2,231.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,338.80
Rate for Payer: Oxford Commercial	$892.53
Rate for Payer: Qualcare PPO/HMO/WC	$669.40
Rate for Payer: UnitedHealthcare Commercial	$892.53
Rate for Payer: UnitedHealthcare Community & State	$107.55
Rate for Payer: Wellpoint Medicaid Managed Care	$118.26

DEPTH GAUGE FOR NAIL SYSTEM MU

Facility

$4,462.65

Hospital Charge Code	270688274
Hospital Revenue Code	272
Min. Negotiated Rate	$669.40
Max. Negotiated Rate	$669.40
Rate for Payer: Qualcare PPO/HMO/WC	$669.40

DEPTH GAUGE FOR SMALL SCREW

Facility

$1,845.00

Hospital Charge Code	270656229
Hospital Revenue Code	272
Min. Negotiated Rate	$276.75
Max. Negotiated Rate	$276.75
Rate for Payer: Qualcare PPO/HMO/WC	$276.75

DEPTH GAUGE FOR SMALL SCREW

Facility

$1,845.00

Hospital Charge Code	270656229
Hospital Revenue Code	272
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$922.50
Rate for Payer: Aetna Commercial	$701.10
Rate for Payer: Aetna Medicare Advantage	$553.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$470.48
Rate for Payer: Cigna Commercial	$922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.50
Rate for Payer: Oxford Commercial	$369.00
Rate for Payer: Qualcare PPO/HMO/WC	$276.75
Rate for Payer: UnitedHealthcare Commercial	$369.00
Rate for Payer: UnitedHealthcare Community & State	$44.46
Rate for Payer: Wellpoint Medicaid Managed Care	$48.89

DEPTH GAUGE SML FRAG SET 2.7MM

Facility

$1,779.10

Hospital Charge Code	270643522
Hospital Revenue Code	272
Min. Negotiated Rate	$266.87
Max. Negotiated Rate	$266.87
Rate for Payer: Qualcare PPO/HMO/WC	$266.87

DEPTH GAUGE SML FRAG SET 2.7MM

Facility

$1,779.10

Hospital Charge Code	270643522
Hospital Revenue Code	272
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$889.55
Rate for Payer: Aetna Commercial	$676.06
Rate for Payer: Aetna Medicare Advantage	$533.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.67
Rate for Payer: Cigna Commercial	$889.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.73
Rate for Payer: Oxford Commercial	$355.82
Rate for Payer: Qualcare PPO/HMO/WC	$266.87
Rate for Payer: UnitedHealthcare Commercial	$355.82
Rate for Payer: UnitedHealthcare Community & State	$42.88
Rate for Payer: Wellpoint Medicaid Managed Care	$47.15

DEPTH GUAGE

Facility

$2,385.00

Hospital Charge Code	270659777
Hospital Revenue Code	272
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$357.75
Rate for Payer: Qualcare PPO/HMO/WC	$357.75

DEPTH GUAGE

Facility

$2,385.00

Hospital Charge Code	270659777
Hospital Revenue Code	272
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$906.30
Rate for Payer: Aetna Medicare Advantage	$715.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$608.17
Rate for Payer: Cigna Commercial	$1,192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.50
Rate for Payer: Oxford Commercial	$477.00
Rate for Payer: Qualcare PPO/HMO/WC	$357.75
Rate for Payer: UnitedHealthcare Commercial	$477.00
Rate for Payer: UnitedHealthcare Community & State	$57.48
Rate for Payer: Wellpoint Medicaid Managed Care	$63.20

DEPTH REAMER 2.0MM STERILE

Facility

$1,000.00

Hospital Charge Code	270665478
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

DEPTH REAMER 2.0MM STERILE

Facility

$1,000.00

Hospital Charge Code	270665478
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

DERMABOND

Facility

$221.00

Hospital Charge Code	5792185
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

DERMABOND

Facility

$129.00

Hospital Charge Code	60635298
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

DERMABOND

Facility

$221.00

Hospital Charge Code	5792185
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$44.20
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

Know your out-of-pocket cost for care.

All Charges