Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$201.50
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.15
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$267.19
Max. Negotiated Rate	$267.19
Rate for Payer: Qualcare PPO/HMO/WC	$267.19

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$42.93
Max. Negotiated Rate	$890.62
Rate for Payer: Aetna Commercial	$676.88
Rate for Payer: Aetna Medicare Advantage	$534.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$454.22
Rate for Payer: Cigna Commercial	$890.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.38
Rate for Payer: Oxford Commercial	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$267.19
Rate for Payer: UnitedHealthcare Commercial	$356.25
Rate for Payer: UnitedHealthcare Community & State	$42.93
Rate for Payer: Wellpoint Medicaid Managed Care	$47.20

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$208.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

GLOMERULAR BASEMENT MEMBRAME

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3007608
Hospital Revenue Code	301
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

GLOMERULAR BASEMENT MEMBRAME

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3007608
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GLOVE ANSELL RADIATION SZ 7.5

Facility

$164.80

Hospital Charge Code	270640124
Hospital Revenue Code	272
Min. Negotiated Rate	$24.72
Max. Negotiated Rate	$24.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.72

GLOVE ANSELL RADIATION SZ 7.5

Facility

$164.80

Hospital Charge Code	270640124
Hospital Revenue Code	272
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$82.40
Rate for Payer: Aetna Commercial	$62.62
Rate for Payer: Aetna Medicare Advantage	$49.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.02
Rate for Payer: Cigna Commercial	$82.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.44
Rate for Payer: Oxford Commercial	$32.96
Rate for Payer: Qualcare PPO/HMO/WC	$24.72
Rate for Payer: UnitedHealthcare Commercial	$32.96
Rate for Payer: UnitedHealthcare Community & State	$3.97
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

GLOVE ANSELL RADIATION SZ 8

Facility

$142.05

Hospital Charge Code	270658537
Hospital Revenue Code	272
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$71.03
Rate for Payer: Aetna Commercial	$53.98
Rate for Payer: Aetna Medicare Advantage	$42.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.22
Rate for Payer: Cigna Commercial	$71.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.62
Rate for Payer: Oxford Commercial	$28.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.31
Rate for Payer: UnitedHealthcare Commercial	$28.41
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

GLOVE ANSELL RADIATION SZ 8

Facility

$142.05

Hospital Charge Code	270658537
Hospital Revenue Code	272
Min. Negotiated Rate	$21.31
Max. Negotiated Rate	$21.31
Rate for Payer: Qualcare PPO/HMO/WC	$21.31

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.75
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

GLOVE ESTEEM STERILE SZ7

Facility

$8.17

Hospital Charge Code	270060930C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.08
Rate for Payer: Aetna Commercial	$3.10
Rate for Payer: Aetna Medicare Advantage	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.08
Rate for Payer: Cigna Commercial	$4.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.45
Rate for Payer: Oxford Commercial	$1.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.23
Rate for Payer: UnitedHealthcare Commercial	$1.63
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

GLOVE ESTEEM STERILE SZ7

Facility

$8.17

Hospital Charge Code	270060930C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$1.23

GLOVE ESTEEM SURGICAL PF SZ6.5

Facility

$317.35

Hospital Charge Code	270654289
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$47.60
Rate for Payer: Qualcare PPO/HMO/WC	$47.60

GLOVE ESTEEM SURGICAL PF SZ6.5

Facility

$317.35

Hospital Charge Code	270654289
Hospital Revenue Code	270
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$158.68
Rate for Payer: Aetna Commercial	$120.59
Rate for Payer: Aetna Medicare Advantage	$95.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.92
Rate for Payer: Cigna Commercial	$158.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.20
Rate for Payer: Oxford Commercial	$63.47
Rate for Payer: Qualcare PPO/HMO/WC	$47.60
Rate for Payer: UnitedHealthcare Commercial	$63.47
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

GLOVE ESTEEM SZ 6

Facility

$79.34

Hospital Charge Code	270654287
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$11.90
Rate for Payer: Qualcare PPO/HMO/WC	$11.90

GLOVE ESTEEM SZ 6

Facility

$79.34

Hospital Charge Code	270654287
Hospital Revenue Code	270
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$39.67
Rate for Payer: Aetna Commercial	$30.15
Rate for Payer: Aetna Medicare Advantage	$23.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.23
Rate for Payer: Cigna Commercial	$39.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.80
Rate for Payer: Oxford Commercial	$15.87
Rate for Payer: Qualcare PPO/HMO/WC	$11.90
Rate for Payer: UnitedHealthcare Commercial	$15.87
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

GLOVE EXAM NITRILE LG POWDR/LF

Facility

$31.26

Hospital Charge Code	270649549
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.63
Rate for Payer: Aetna Commercial	$11.88
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.38
Rate for Payer: Oxford Commercial	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$6.25
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

GLOVE EXAM NITRILE LG POWDR/LF

Facility

$31.26

Hospital Charge Code	270649549
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

GLOVE EXAM NITRILE MED POWD/LF

Facility

$31.26

Hospital Charge Code	270649550
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

GLOVE EXAM NITRILE MED POWD/LF

Facility

$31.26

Hospital Charge Code	270649550
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.63
Rate for Payer: Aetna Commercial	$11.88
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.38
Rate for Payer: Oxford Commercial	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$6.25
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

GLOVE EXAM NITRILE STER LG

Facility

$0.14

Hospital Charge Code	270649551
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.02

Know your out-of-pocket cost for care.

All Charges