Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLASSES, FITOVER TORTOISE

Facility

$1,245.00

Hospital Charge Code	270660852
Hospital Revenue Code	270
Min. Negotiated Rate	$186.75
Max. Negotiated Rate	$186.75
Rate for Payer: Qualcare PPO/HMO/WC	$186.75

GLATIRAMER 20 MG/ML INJ

Facility

$1,180.00

Hospital Charge Code	60628810
Hospital Revenue Code	636
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$285.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.56
Rate for Payer: Qualcare PPO/HMO/WC	$177.00

GLATIRAMER 20 MG/ML INJ

Facility

$1,180.00

Hospital Charge Code	60628810
Hospital Revenue Code	636
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$590.00
Rate for Payer: Aetna Commercial	$448.40
Rate for Payer: Aetna Medicare Advantage	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.90
Rate for Payer: Cigna Commercial	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.56
Rate for Payer: Qualcare PPO/HMO/WC	$177.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$31.27

GLATIRAMER ACETATE INJ 20MG

Facility

$7,325.45

Hospital Charge Code	60629269
Hospital Revenue Code	636
Min. Negotiated Rate	$1,098.82
Max. Negotiated Rate	$1,772.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,772.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,098.82

GLATIRAMER ACETATE INJ 20MG

Facility

$7,325.45

Hospital Charge Code	60629269
Hospital Revenue Code	636
Min. Negotiated Rate	$176.54
Max. Negotiated Rate	$3,662.72
Rate for Payer: Aetna Commercial	$2,783.67
Rate for Payer: Aetna Medicare Advantage	$2,197.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,867.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,867.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,867.99
Rate for Payer: Cigna Commercial	$3,662.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,772.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,098.82
Rate for Payer: UnitedHealthcare Community & State	$176.54
Rate for Payer: Wellpoint Medicaid Managed Care	$194.12

GLAUCON 1% OPHTH/10ML

Facility

$81.00

Hospital Charge Code	60633046
Hospital Revenue Code	250
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GLAUCON 1% OPHTH/10ML

Facility

$81.00

Hospital Charge Code	60633046
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

GLDW .035 260CM S ANGL GS350

Facility

$306.10

Service Code	HCPCS C1769
Hospital Charge Code	270637622N
Hospital Revenue Code	278
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$153.05
Rate for Payer: Aetna Commercial	$116.32
Rate for Payer: Aetna Medicare Advantage	$91.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.06
Rate for Payer: Cigna Commercial	$153.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.34
Rate for Payer: Qualcare PPO/HMO/WC	$45.91
Rate for Payer: UnitedHealthcare Community & State	$7.38
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

GLDW .035 260CM S ANGL GS350

Facility

$306.10

Service Code	HCPCS C1769
Hospital Charge Code	270637622N
Hospital Revenue Code	278
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$74.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.34
Rate for Payer: Qualcare PPO/HMO/WC	$45.91

GLDW .035 260CM S ANGL GS350

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270637622C
Hospital Revenue Code	278
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$140.75
Rate for Payer: Aetna Commercial	$106.97
Rate for Payer: Aetna Medicare Advantage	$84.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.78
Rate for Payer: Cigna Commercial	$140.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23
Rate for Payer: UnitedHealthcare Community & State	$6.78
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

GLDW .035 260CM S ANGL GS350

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270637622C
Hospital Revenue Code	278
Min. Negotiated Rate	$42.23
Max. Negotiated Rate	$68.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23

GLDWRE .035 180 ANGL GR3508

Facility

$1,219.00

Hospital Charge Code	270938087C
Hospital Revenue Code	278
Min. Negotiated Rate	$182.85
Max. Negotiated Rate	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.18
Rate for Payer: Qualcare PPO/HMO/WC	$182.85

GLDWRE .035 180 ANGL GR3508

Facility

$1,219.00

Hospital Charge Code	270938087C
Hospital Revenue Code	278
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$609.50
Rate for Payer: Aetna Commercial	$463.22
Rate for Payer: Aetna Medicare Advantage	$365.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.85
Rate for Payer: Cigna Commercial	$609.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.18
Rate for Payer: Qualcare PPO/HMO/WC	$182.85
Rate for Payer: UnitedHealthcare Community & State	$29.38
Rate for Payer: Wellpoint Medicaid Managed Care	$32.30

GLEEVEC 100MG TAB

Facility

$88.00

Hospital Charge Code	60635507
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$17.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$17.60
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

GLEEVEC 100MG TAB

Facility

$88.00

Hospital Charge Code	60635507
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

GLENIOD CAGE BETA LARGE

Facility

$7,405.00

Hospital Charge Code	270675723
Hospital Revenue Code	278
Min. Negotiated Rate	$178.46
Max. Negotiated Rate	$3,702.50
Rate for Payer: Aetna Commercial	$2,813.90
Rate for Payer: Aetna Medicare Advantage	$2,221.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,888.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,888.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,481.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,888.28
Rate for Payer: Cigna Commercial	$3,702.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,792.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,629.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.75
Rate for Payer: UnitedHealthcare Community & State	$178.46
Rate for Payer: Wellpoint Medicaid Managed Care	$196.23

GLENIOD CAGE BETA LARGE

Facility

$7,405.00

Hospital Charge Code	270675723
Hospital Revenue Code	278
Min. Negotiated Rate	$1,110.75
Max. Negotiated Rate	$1,792.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,481.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,792.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,629.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.75

GLENIOD CAGE BETA MEDIUM

Facility

$7,405.00

Service Code	HCPCS C1713
Hospital Charge Code	270686660
Hospital Revenue Code	278
Min. Negotiated Rate	$178.46
Max. Negotiated Rate	$3,702.50
Rate for Payer: Aetna Commercial	$2,813.90
Rate for Payer: Aetna Medicare Advantage	$2,221.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,888.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,888.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,481.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,888.28
Rate for Payer: Cigna Commercial	$3,702.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,792.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,629.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.75
Rate for Payer: UnitedHealthcare Community & State	$178.46
Rate for Payer: Wellpoint Medicaid Managed Care	$196.23

GLENIOD CAGE BETA MEDIUM

Facility

$7,405.00

Service Code	HCPCS C1713
Hospital Charge Code	270686660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,110.75
Max. Negotiated Rate	$1,792.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,481.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,792.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,629.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.75

GLENOID BASE 4MM SM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687323
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

GLENOID BASE 4MM SM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687323
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

GLENOID BASE PLATE

Facility

$12,057.50

Service Code	HCPCS C1776
Hospital Charge Code	270688866
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

GLENOID BASE PLATE

Facility

$12,057.50

Service Code	HCPCS C1776
Hospital Charge Code	270688866
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$290.59
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

GLENOID BASEPLATE

Facility

$6,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270688088
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

GLENOID BASEPLATE

Facility

$6,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270688088
Hospital Revenue Code	278
Min. Negotiated Rate	$151.83
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$151.83
Rate for Payer: Wellpoint Medicaid Managed Care	$166.95

Know your out-of-pocket cost for care.

All Charges