Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLAREHAWK 7 SHORT SHELL

Facility

$18,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270692138
Hospital Revenue Code	278
Min. Negotiated Rate	$444.64
Max. Negotiated Rate	$9,225.00
Rate for Payer: Aetna Commercial	$7,011.00
Rate for Payer: Aetna Medicare Advantage	$5,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,704.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,704.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,704.75
Rate for Payer: Cigna Commercial	$9,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,464.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,059.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,767.50
Rate for Payer: UnitedHealthcare Community & State	$444.64
Rate for Payer: Wellpoint Medicaid Managed Care	$488.93

FLAREHAWK 7 SHORT SHELL

Facility

$18,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270692138
Hospital Revenue Code	278
Min. Negotiated Rate	$2,767.50
Max. Negotiated Rate	$4,464.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,464.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,059.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,767.50

FLAREHAWK 7 SHORT SHIM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692139
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHAWK 7 SHORT SHIM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692139
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

FLAREHWK SHELL TALL 25MM TIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697086
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

FLAREHWK SHELL TALL 25MM TIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697086
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHWK SHIM 11/13X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697087
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

FLAREHWK SHIM 11/13X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAREHWK SHIM 11/14X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAREHWK SHIM 11/14X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697088
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

FLAT WASHER

Facility

$400.00

Hospital Charge Code	270680499
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

FLAT WASHER

Facility

$400.00

Hospital Charge Code	270680499
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

FLAT WASHER 6.5..

Facility

$292.50

Hospital Charge Code	270684882
Hospital Revenue Code	278
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$111.15
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Community & State	$7.05
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

FLAT WASHER 6.5..

Facility

$292.50

Hospital Charge Code	270684882
Hospital Revenue Code	278
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$70.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

FLAT WIRE 2.4F PLATINUM CLASS

Facility

$602.40

Hospital Charge Code	270682481
Hospital Revenue Code	272
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$228.91
Rate for Payer: Aetna Medicare Advantage	$180.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.61
Rate for Payer: Cigna Commercial	$301.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.72
Rate for Payer: Oxford Commercial	$120.48
Rate for Payer: Qualcare PPO/HMO/WC	$90.36
Rate for Payer: UnitedHealthcare Commercial	$120.48
Rate for Payer: UnitedHealthcare Community & State	$14.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.96

FLAT WIRE 2.4F PLATINUM CLASS

Facility

$602.40

Hospital Charge Code	270682481
Hospital Revenue Code	272
Min. Negotiated Rate	$90.36
Max. Negotiated Rate	$90.36
Rate for Payer: Qualcare PPO/HMO/WC	$90.36

FLAT WIRE 3FR 18MM 115CM

Facility

$602.40

Hospital Charge Code	270682478
Hospital Revenue Code	272
Min. Negotiated Rate	$90.36
Max. Negotiated Rate	$90.36
Rate for Payer: Qualcare PPO/HMO/WC	$90.36

FLAT WIRE 3FR 18MM 115CM

Facility

$602.40

Hospital Charge Code	270682478
Hospital Revenue Code	272
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$228.91
Rate for Payer: Aetna Medicare Advantage	$180.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.61
Rate for Payer: Cigna Commercial	$301.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.72
Rate for Payer: Oxford Commercial	$120.48
Rate for Payer: Qualcare PPO/HMO/WC	$90.36
Rate for Payer: UnitedHealthcare Commercial	$120.48
Rate for Payer: UnitedHealthcare Community & State	$14.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.96

FLAVOXATE TAB 100MG

Facility

$9.65

Hospital Charge Code	60628467
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

FLAVOXATE TAB 100MG

Facility

$9.65

Hospital Charge Code	60628467
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

FLEBOGAMMA 5% 5G/100ML

Facility

$2,223.00

Hospital Charge Code	60635614
Hospital Revenue Code	636
Min. Negotiated Rate	$333.45
Max. Negotiated Rate	$537.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$537.97
Rate for Payer: Qualcare PPO/HMO/WC	$333.45

FLEBOGAMMA 5% 5G/100ML

Facility

$2,223.00

Hospital Charge Code	60635614
Hospital Revenue Code	636
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$1,111.50
Rate for Payer: Aetna Commercial	$844.74
Rate for Payer: Aetna Medicare Advantage	$666.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.87
Rate for Payer: Cigna Commercial	$1,111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$537.97
Rate for Payer: Qualcare PPO/HMO/WC	$333.45
Rate for Payer: UnitedHealthcare Community & State	$53.57
Rate for Payer: Wellpoint Medicaid Managed Care	$58.91

FLECAINIDE

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3000924
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

FLECAINIDE

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3000924
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

FLECAINIDE***

Facility

$28.00

Hospital Charge Code	3010923
Hospital Revenue Code	301
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

Know your out-of-pocket cost for care.

All Charges