Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GANTRISIN 4% OPHTH/15ML

Facility

$49.00

Hospital Charge Code	60633033
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

GANTRISIN 4% OPHTH/15ML

Facility

$49.00

Hospital Charge Code	60633033
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

GANTRISIN/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633032
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GANTRISIN/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633032
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$33.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.89
Rate for Payer: Oxford Commercial	$22.59
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$22.59
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.00

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$63.35
Rate for Payer: Aetna Commercial	$48.15
Rate for Payer: Aetna Medicare Advantage	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.31
Rate for Payer: Cigna Commercial	$63.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.01
Rate for Payer: Oxford Commercial	$25.34
Rate for Payer: Qualcare PPO/HMO/WC	$19.00
Rate for Payer: UnitedHealthcare Commercial	$25.34
Rate for Payer: UnitedHealthcare Community & State	$3.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.36

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$591.67
Rate for Payer: Aetna Commercial	$449.67
Rate for Payer: Aetna Medicare Advantage	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.75
Rate for Payer: Cigna Commercial	$591.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50
Rate for Payer: UnitedHealthcare Community & State	$28.52
Rate for Payer: Wellpoint Medicaid Managed Care	$31.36

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$286.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$103.74
Rate for Payer: Aetna Medicare Advantage	$81.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.61
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Community & State	$6.58
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$66.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$181.57
Max. Negotiated Rate	$292.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$29.17
Max. Negotiated Rate	$605.25
Rate for Payer: Aetna Commercial	$459.99
Rate for Payer: Aetna Medicare Advantage	$363.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.67
Rate for Payer: Cigna Commercial	$605.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57
Rate for Payer: UnitedHealthcare Community & State	$29.17
Rate for Payer: Wellpoint Medicaid Managed Care	$32.08

GAS CRYOSURGICAL HISTOFREEZ

Facility

$1,935.00

Hospital Charge Code	270658830
Hospital Revenue Code	272
Min. Negotiated Rate	$290.25
Max. Negotiated Rate	$290.25
Rate for Payer: Qualcare PPO/HMO/WC	$290.25

GAS CRYOSURGICAL HISTOFREEZ

Facility

$1,935.00

Hospital Charge Code	270658830
Hospital Revenue Code	272
Min. Negotiated Rate	$46.63
Max. Negotiated Rate	$967.50
Rate for Payer: Aetna Commercial	$735.30
Rate for Payer: Aetna Medicare Advantage	$580.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$493.43
Rate for Payer: Cigna Commercial	$967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.50
Rate for Payer: Oxford Commercial	$387.00
Rate for Payer: Qualcare PPO/HMO/WC	$290.25
Rate for Payer: UnitedHealthcare Commercial	$387.00
Rate for Payer: UnitedHealthcare Community & State	$46.63
Rate for Payer: Wellpoint Medicaid Managed Care	$51.28

GASE NITRUS OXIDE 20 POUNDS

Facility

$240.00

Hospital Charge Code	270663700
Hospital Revenue Code	279
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

GASE NITRUS OXIDE 20 POUNDS

Facility

$240.00

Hospital Charge Code	270663700
Hospital Revenue Code	279
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

GAS RESTRICT PROC WO GAS BYPAS

Facility

$112,126.91

Service Code	HCPCS 43843
Hospital Charge Code	1600182
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$42,608.23
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33,638.07
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$2,702.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2,971.36

GAS RESTRICT PROC WO GAS BYPAS

Facility

$112,126.91

Service Code	HCPCS 43843
Hospital Charge Code	1600182
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASRESTRPROCWSHORTLIMBROUXENY

Facility

$112,126.91

Service Code	HCPCS 43846
Hospital Charge Code	1600183
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$42,608.23
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33,638.07
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$2,702.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2,971.36

GASRESTRPROCWSHORTLIMBROUXENY

Facility

$112,126.91

Service Code	HCPCS 43846
Hospital Charge Code	1600183
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASRESTR PROCWSMALLINTESTRECON

Facility

$112,126.91

Service Code	HCPCS 43847
Hospital Charge Code	1600184
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASRESTR PROCWSMALLINTESTRECON

Facility

$112,126.91

Service Code	HCPCS 43847
Hospital Charge Code	1600184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$42,608.23
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33,638.07
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$2,702.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2,971.36

GASTRECTOMY P DIST; W ROUX-EN

Facility

$23,535.00

Service Code	HCPCS 43633
Hospital Charge Code	1600000636
Hospital Revenue Code	360
Min. Negotiated Rate	$567.19
Max. Negotiated Rate	$11,767.50
Rate for Payer: Aetna Commercial	$8,943.30
Rate for Payer: Aetna Medicare Advantage	$7,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,001.43
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	$6,001.43
Rate for Payer: Cigna Commercial	$11,767.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,060.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$567.19
Rate for Payer: Wellpoint Medicaid Managed Care	$623.68

Know your out-of-pocket cost for care.

All Charges