Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLOWRAP DS WET 2x4CM

Facility

$10,640.00

Hospital Charge Code	270678259
Hospital Revenue Code	636
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,574.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00

ALLOWRAP DS WET 2x4CM

Facility

$10,640.00

Hospital Charge Code	270678259
Hospital Revenue Code	636
Min. Negotiated Rate	$256.42
Max. Negotiated Rate	$5,320.00
Rate for Payer: Aetna Commercial	$4,043.20
Rate for Payer: Aetna Medicare Advantage	$3,192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.20
Rate for Payer: Cigna Commercial	$5,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00
Rate for Payer: UnitedHealthcare Community & State	$256.42
Rate for Payer: Wellpoint Medicaid Managed Care	$281.96

ALLOWRAP DS WET 4x4CM

Facility

$7,700.00

Service Code	HCPCS Q4150
Hospital Charge Code	270681551
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

ALLOWRAP DS WET 4x4CM

Facility

$7,700.00

Service Code	HCPCS Q4150
Hospital Charge Code	270681551
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,863.40
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

ALL POLY PAT VE 35MM DIA

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692144
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

ALL POLY PAT VE 35MM DIA

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692144
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

ALL POLY PAY VE 35MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690442
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

ALL POLY PAY VE 35MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690442
Hospital Revenue Code	278
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

ALL POLY STEMMED TIBIAL COMPON

Facility

$5,590.75

Service Code	HCPCS C1776
Hospital Charge Code	270706163
Hospital Revenue Code	278
Min. Negotiated Rate	$838.61
Max. Negotiated Rate	$1,352.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,118.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,352.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,229.96
Rate for Payer: Qualcare PPO/HMO/WC	$838.61

ALL POLY STEMMED TIBIAL COMPON

Facility

$5,590.75

Service Code	HCPCS C1776
Hospital Charge Code	270706163
Hospital Revenue Code	278
Min. Negotiated Rate	$134.74
Max. Negotiated Rate	$2,795.38
Rate for Payer: Aetna Commercial	$2,124.49
Rate for Payer: Aetna Medicare Advantage	$1,677.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,425.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,425.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,118.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,425.64
Rate for Payer: Cigna Commercial	$2,795.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,352.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,229.96
Rate for Payer: Qualcare PPO/HMO/WC	$838.61
Rate for Payer: UnitedHealthcare Community & State	$134.74
Rate for Payer: Wellpoint Medicaid Managed Care	$148.15

ALL SUTURE ANCHOR 1.4MM

Facility

$1,755.00

Hospital Charge Code	270673196
Hospital Revenue Code	272
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.50
Rate for Payer: Oxford Commercial	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Commercial	$351.00
Rate for Payer: UnitedHealthcare Community & State	$42.30
Rate for Payer: Wellpoint Medicaid Managed Care	$46.51

ALL SUTURE ANCHOR 1.4MM

Facility

$1,755.00

Hospital Charge Code	270673196
Hospital Revenue Code	272
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$263.25
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

ALL SUTURE ANCHOR 2.2MM

Facility

$1,755.00

Hospital Charge Code	270673195
Hospital Revenue Code	272
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.50
Rate for Payer: Oxford Commercial	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Commercial	$351.00
Rate for Payer: UnitedHealthcare Community & State	$42.30
Rate for Payer: Wellpoint Medicaid Managed Care	$46.51

ALL SUTURE ANCHOR 2.2MM

Facility

$1,755.00

Hospital Charge Code	270673195
Hospital Revenue Code	272
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$263.25
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

ALL-TIME FAVORITES GAMES

Facility

$739.95

Hospital Charge Code	270662668
Hospital Revenue Code	270
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$369.98
Rate for Payer: Aetna Commercial	$281.18
Rate for Payer: Aetna Medicare Advantage	$221.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.69
Rate for Payer: Cigna Commercial	$369.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.99
Rate for Payer: Oxford Commercial	$147.99
Rate for Payer: Qualcare PPO/HMO/WC	$110.99
Rate for Payer: UnitedHealthcare Commercial	$147.99
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

ALL-TIME FAVORITES GAMES

Facility

$739.95

Hospital Charge Code	270662668
Hospital Revenue Code	270
Min. Negotiated Rate	$110.99
Max. Negotiated Rate	$110.99
Rate for Payer: Qualcare PPO/HMO/WC	$110.99

ALMOND (F20) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900357
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ALMOND (F20) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900357
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALMOTRIPTAN 12.5 MG TAB

Facility

$58.45

Hospital Charge Code	60629139
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.23
Rate for Payer: Aetna Commercial	$22.21
Rate for Payer: Aetna Medicare Advantage	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.54
Rate for Payer: Oxford Commercial	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$11.69
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

ALMOTRIPTAN 12.5 MG TAB

Facility

$58.45

Hospital Charge Code	60629139
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

ALOSETRON 1MG TABLET

Facility

$15.40

Hospital Charge Code	60629072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

ALOSETRON 1MG TABLET

Facility

$15.40

Hospital Charge Code	60629072
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

ALO VERA GEL (CARRASYN H-GEL)

Facility

$69.15

Hospital Charge Code	60628805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$34.58
Rate for Payer: Aetna Commercial	$26.28
Rate for Payer: Aetna Medicare Advantage	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.63
Rate for Payer: Cigna Commercial	$34.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.75
Rate for Payer: Oxford Commercial	$13.83
Rate for Payer: Qualcare PPO/HMO/WC	$10.37
Rate for Payer: UnitedHealthcare Commercial	$13.83
Rate for Payer: UnitedHealthcare Community & State	$1.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

ALO VERA GEL (CARRASYN H-GEL)

Facility

$69.15

Hospital Charge Code	60628805
Hospital Revenue Code	250
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$10.37
Rate for Payer: Qualcare PPO/HMO/WC	$10.37

ALO VERA GEL SPRAY 16OZ

Facility

$32.65

Hospital Charge Code	60628806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna Commercial	$12.41
Rate for Payer: Aetna Medicare Advantage	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.33
Rate for Payer: Cigna Commercial	$16.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.79
Rate for Payer: Oxford Commercial	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$6.53
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

Know your out-of-pocket cost for care.

All Charges