Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74117005
Hospital Revenue Code	341
Min. Negotiated Rate	$341.27
Max. Negotiated Rate	$341.27
Rate for Payer: Qualcare PPO/HMO/WC	$341.27

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74115005
Hospital Revenue Code	341
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.54
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.27
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74115005
Hospital Revenue Code	341
Min. Negotiated Rate	$341.27
Max. Negotiated Rate	$341.27
Rate for Payer: Qualcare PPO/HMO/WC	$341.27

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74117005
Hospital Revenue Code	341
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.54
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.27
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74116005
Hospital Revenue Code	341
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.54
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.27
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74116005
Hospital Revenue Code	341
Min. Negotiated Rate	$341.27
Max. Negotiated Rate	$341.27
Rate for Payer: Qualcare PPO/HMO/WC	$341.27

GATIFLOXACIN 400MG/D5W ML IVPB

Facility

$128.00

Service Code	HCPCS S0085
Hospital Charge Code	60629218
Hospital Revenue Code	258
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

GATIFLOXACIN 400MG/D5W ML IVPB

Facility

$128.00

Service Code	HCPCS S0085
Hospital Charge Code	60629218
Hospital Revenue Code	258
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

GATIFLOXACIN INJ 400MG

Facility

$213.65

Hospital Charge Code	60629192
Hospital Revenue Code	250
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$106.83
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Aetna Medicare Advantage	$64.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.48
Rate for Payer: Cigna Commercial	$106.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.09
Rate for Payer: Oxford Commercial	$42.73
Rate for Payer: Qualcare PPO/HMO/WC	$32.05
Rate for Payer: UnitedHealthcare Commercial	$42.73
Rate for Payer: UnitedHealthcare Community & State	$5.15
Rate for Payer: Wellpoint Medicaid Managed Care	$5.66

GATIFLOXACIN INJ 400MG

Facility

$213.65

Hospital Charge Code	60629192
Hospital Revenue Code	250
Min. Negotiated Rate	$32.05
Max. Negotiated Rate	$32.05
Rate for Payer: Qualcare PPO/HMO/WC	$32.05

GATIFLOXACIN TAB 200MG

Facility

$40.85

Hospital Charge Code	60629191
Hospital Revenue Code	250
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

GATIFLOXACIN TAB 200MG

Facility

$40.85

Hospital Charge Code	60629191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: Aetna Medicare Advantage	$12.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.42
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$8.17
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

GATIFLOXACIN TAB 400MG

Facility

$58.45

Hospital Charge Code	60629117
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

GATIFLOXACIN TAB 400MG

Facility

$58.45

Hospital Charge Code	60629117
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

GAUGE DEPTH 2.0MM/2.4MM screws

Facility

$2,530.25

Hospital Charge Code	270677661
Hospital Revenue Code	272
Min. Negotiated Rate	$379.54
Max. Negotiated Rate	$379.54
Rate for Payer: Qualcare PPO/HMO/WC	$379.54

GAUGE DEPTH 2.0MM/2.4MM screws

Facility

$2,530.25

Hospital Charge Code	270677661
Hospital Revenue Code	272
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$1,265.12
Rate for Payer: Aetna Commercial	$961.50
Rate for Payer: Aetna Medicare Advantage	$759.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.21
Rate for Payer: Cigna Commercial	$1,265.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.08
Rate for Payer: Oxford Commercial	$506.05
Rate for Payer: Qualcare PPO/HMO/WC	$379.54
Rate for Payer: UnitedHealthcare Commercial	$506.05
Rate for Payer: UnitedHealthcare Community & State	$60.98
Rate for Payer: Wellpoint Medicaid Managed Care	$67.05

GAUGE DEPTH 2.7/3.5

Facility

$1,509.00

Hospital Charge Code	270672085
Hospital Revenue Code	272
Min. Negotiated Rate	$36.37
Max. Negotiated Rate	$754.50
Rate for Payer: Aetna Commercial	$573.42
Rate for Payer: Aetna Medicare Advantage	$452.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.80
Rate for Payer: Cigna Commercial	$754.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.70
Rate for Payer: Oxford Commercial	$301.80
Rate for Payer: Qualcare PPO/HMO/WC	$226.35
Rate for Payer: UnitedHealthcare Commercial	$301.80
Rate for Payer: UnitedHealthcare Community & State	$36.37
Rate for Payer: Wellpoint Medicaid Managed Care	$39.99

GAUGE DEPTH 2.7/3.5

Facility

$1,509.00

Hospital Charge Code	270672085
Hospital Revenue Code	272
Min. Negotiated Rate	$226.35
Max. Negotiated Rate	$226.35
Rate for Payer: Qualcare PPO/HMO/WC	$226.35

GAUGE MENDEZ DEGREE

Facility

$1,040.00

Hospital Charge Code	270667879
Hospital Revenue Code	272
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.00

GAUGE MENDEZ DEGREE

Facility

$1,040.00

Hospital Charge Code	270667879
Hospital Revenue Code	272
Min. Negotiated Rate	$25.06
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna Commercial	$395.20
Rate for Payer: Aetna Medicare Advantage	$312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.20
Rate for Payer: Cigna Commercial	$520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$208.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.00
Rate for Payer: UnitedHealthcare Commercial	$208.00
Rate for Payer: UnitedHealthcare Community & State	$25.06
Rate for Payer: Wellpoint Medicaid Managed Care	$27.56

GAUGE SHOULDER DEPTH SBDG

Facility

$1,810.45

Hospital Charge Code	270636729
Hospital Revenue Code	272
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$905.23
Rate for Payer: Aetna Commercial	$687.97
Rate for Payer: Aetna Medicare Advantage	$543.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.66
Rate for Payer: Cigna Commercial	$905.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.13
Rate for Payer: Oxford Commercial	$362.09
Rate for Payer: Qualcare PPO/HMO/WC	$271.57
Rate for Payer: UnitedHealthcare Commercial	$362.09
Rate for Payer: UnitedHealthcare Community & State	$43.63
Rate for Payer: Wellpoint Medicaid Managed Care	$47.98

GAUGE SHOULDER DEPTH SBDG

Facility

$1,810.45

Hospital Charge Code	270636729
Hospital Revenue Code	272
Min. Negotiated Rate	$271.57
Max. Negotiated Rate	$271.57
Rate for Payer: Qualcare PPO/HMO/WC	$271.57

GAUZE 3X3 BOX ***********

Facility

$49.00

Hospital Charge Code	8000101
Hospital Revenue Code	279
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

GAUZE 3X3 BOX ***********

Facility

$49.00

Hospital Charge Code	8000101
Hospital Revenue Code	279
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

GAUZE BETADINE VISCUS EA *****

Facility

$9.00

Hospital Charge Code	8000234
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

Know your out-of-pocket cost for care.

All Charges