Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GEL ULTRASOUND AQUASONIC

Facility

$9.30

Hospital Charge Code	270660313
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.65
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.40
Rate for Payer: UnitedHealthcare Commercial	$1.86
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

GEL ULTRASOUND AQUASONIC

Facility

$9.30

Hospital Charge Code	270660313
Hospital Revenue Code	270
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.40

GEL WOUND 1.5 OZ

Facility

$84.57

Hospital Charge Code	270685411
Hospital Revenue Code	272
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$12.69
Rate for Payer: Qualcare PPO/HMO/WC	$12.69

GEL WOUND 1.5 OZ

Facility

$84.57

Hospital Charge Code	270685411
Hospital Revenue Code	272
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.28
Rate for Payer: Aetna Commercial	$32.14
Rate for Payer: Aetna Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.57
Rate for Payer: Cigna Commercial	$42.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.37
Rate for Payer: Oxford Commercial	$16.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.69
Rate for Payer: UnitedHealthcare Commercial	$16.91
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

GEMCITABINE 1000 MG INJ

Facility

$1,125.60

Service Code	HCPCS J9201
Hospital Charge Code	60627386
Hospital Revenue Code	636
Min. Negotiated Rate	$168.84
Max. Negotiated Rate	$272.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.84

GEMCITABINE 1000 MG INJ

Facility

$1,125.60

Service Code	HCPCS J9201
Hospital Charge Code	60627386
Hospital Revenue Code	636
Min. Negotiated Rate	$27.13
Max. Negotiated Rate	$562.80
Rate for Payer: Aetna Commercial	$427.73
Rate for Payer: Aetna Medicare Advantage	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.03
Rate for Payer: Cigna Commercial	$562.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.84
Rate for Payer: UnitedHealthcare Community & State	$27.13
Rate for Payer: Wellpoint Medicaid Managed Care	$29.83

GEMCITABINE 200 MG INJ

Facility

$1,127.01

Service Code	HCPCS J9201
Hospital Charge Code	60627385
Hospital Revenue Code	636
Min. Negotiated Rate	$27.16
Max. Negotiated Rate	$563.50
Rate for Payer: Aetna Commercial	$428.26
Rate for Payer: Aetna Medicare Advantage	$338.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.39
Rate for Payer: Cigna Commercial	$563.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.74
Rate for Payer: Qualcare PPO/HMO/WC	$169.05
Rate for Payer: UnitedHealthcare Community & State	$27.16
Rate for Payer: Wellpoint Medicaid Managed Care	$29.87

GEMCITABINE 200 MG INJ

Facility

$1,127.01

Service Code	HCPCS J9201
Hospital Charge Code	60627385
Hospital Revenue Code	636
Min. Negotiated Rate	$169.05
Max. Negotiated Rate	$272.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.74
Rate for Payer: Qualcare PPO/HMO/WC	$169.05

GEMCITABINE INJ 200MG

Facility

$272.65

Hospital Charge Code	6016497
Hospital Revenue Code	636
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$136.32
Rate for Payer: Aetna Commercial	$103.61
Rate for Payer: Aetna Medicare Advantage	$81.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.53
Rate for Payer: Cigna Commercial	$136.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.98
Rate for Payer: Qualcare PPO/HMO/WC	$40.90
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

GEMCITABINE INJ 200MG

Facility

$272.65

Hospital Charge Code	6016497
Hospital Revenue Code	636
Min. Negotiated Rate	$40.90
Max. Negotiated Rate	$65.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.98
Rate for Payer: Qualcare PPO/HMO/WC	$40.90

GEMCITABINE INJ LG

Facility

$1,361.95

Hospital Charge Code	6016406
Hospital Revenue Code	636
Min. Negotiated Rate	$204.29
Max. Negotiated Rate	$329.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.59
Rate for Payer: Qualcare PPO/HMO/WC	$204.29

GEMCITABINE INJ LG

Facility

$1,361.95

Hospital Charge Code	6016406
Hospital Revenue Code	636
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$680.98
Rate for Payer: Aetna Commercial	$517.54
Rate for Payer: Aetna Medicare Advantage	$408.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.30
Rate for Payer: Cigna Commercial	$680.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.59
Rate for Payer: Qualcare PPO/HMO/WC	$204.29
Rate for Payer: UnitedHealthcare Community & State	$32.82
Rate for Payer: Wellpoint Medicaid Managed Care	$36.09

GEMFIBROZIL 600 MG TAB

Facility

$7.64

Service Code	NDC 71073720
Hospital Charge Code	60627620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

GEMFIBROZIL 600 MG TAB

Facility

$7.64

Service Code	NDC 71073720
Hospital Charge Code	60627620
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

GEMTUZUMAB 5 MG INJ

Facility

$14,415.50

Hospital Charge Code	60628992
Hospital Revenue Code	636
Min. Negotiated Rate	$2,162.32
Max. Negotiated Rate	$3,488.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,488.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,162.32

GEMTUZUMAB 5 MG INJ

Facility

$14,415.50

Hospital Charge Code	60628992
Hospital Revenue Code	636
Min. Negotiated Rate	$347.41
Max. Negotiated Rate	$7,207.75
Rate for Payer: Aetna Commercial	$5,477.89
Rate for Payer: Aetna Medicare Advantage	$4,324.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,675.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,675.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,675.95
Rate for Payer: Cigna Commercial	$7,207.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,488.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,162.32
Rate for Payer: UnitedHealthcare Community & State	$347.41
Rate for Payer: Wellpoint Medicaid Managed Care	$382.01

GEN.CYT. FILTER METHOD ONLY

Facility

$259.00

Service Code	HCPCS 88106
Hospital Charge Code	38474085
Hospital Revenue Code	311
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$58.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

GEN.CYT. FILTER METHOD ONLY

Facility

$259.00

Service Code	HCPCS 88106
Hospital Charge Code	38474085
Hospital Revenue Code	311
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

GENDER PFJ FEM COMP SIZE 2-RT

Facility

$25,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270681300
Hospital Revenue Code	278
Min. Negotiated Rate	$3,834.00
Max. Negotiated Rate	$6,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,623.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,834.00

GENDER PFJ FEM COMP SIZE 2-RT

Facility

$25,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270681300
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$12,780.00
Rate for Payer: Aetna Commercial	$9,712.80
Rate for Payer: Aetna Medicare Advantage	$7,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,517.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,517.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,517.80
Rate for Payer: Cigna Commercial	$12,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,623.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,834.00
Rate for Payer: UnitedHealthcare Community & State	$616.00
Rate for Payer: Wellpoint Medicaid Managed Care	$677.34

GENDER PFJ MILL BURR STANDARD

Facility

$720.00

Hospital Charge Code	270681303
Hospital Revenue Code	272
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$273.60
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.00
Rate for Payer: Oxford Commercial	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00
Rate for Payer: UnitedHealthcare Commercial	$144.00
Rate for Payer: UnitedHealthcare Community & State	$17.35
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

GENDER PFJ MILL BURR STANDARD

Facility

$720.00

Hospital Charge Code	270681303
Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

GENDER RELATED PROCEDURES

Facility

$23,223.31

Service Code	APR-DRG 8512
Min. Negotiated Rate	$22,767.95
Max. Negotiated Rate	$23,223.31
Rate for Payer: UnitedHealthcare Community & State	$22,767.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,223.31
Rate for Payer: Wellpoint Medicaid Managed Care	$22,767.95

GENDER RELATED PROCEDURES

Facility

$20,166.87

Service Code	APR-DRG 8511
Min. Negotiated Rate	$19,771.44
Max. Negotiated Rate	$20,166.87
Rate for Payer: UnitedHealthcare Community & State	$19,771.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,166.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19,771.44

GENDER RELATED PROCEDURES

Facility

$105,223.82

Service Code	APR-DRG 8514
Min. Negotiated Rate	$103,160.61
Max. Negotiated Rate	$105,223.82
Rate for Payer: UnitedHealthcare Community & State	$103,160.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$105,223.82
Rate for Payer: Wellpoint Medicaid Managed Care	$103,160.61

Know your out-of-pocket cost for care.

All Charges