Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$4,878.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,435.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$485.86
Max. Negotiated Rate	$10,080.00
Rate for Payer: Aetna Commercial	$7,660.80
Rate for Payer: Aetna Medicare Advantage	$6,048.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,140.80
Rate for Payer: Cigna Commercial	$10,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,435.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00
Rate for Payer: UnitedHealthcare Community & State	$485.86
Rate for Payer: Wellpoint Medicaid Managed Care	$534.24

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.38
Max. Negotiated Rate	$1,622.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,474.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$161.53
Max. Negotiated Rate	$3,351.25
Rate for Payer: Aetna Commercial	$2,546.95
Rate for Payer: Aetna Medicare Advantage	$2,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.14
Rate for Payer: Cigna Commercial	$3,351.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,474.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38
Rate for Payer: UnitedHealthcare Community & State	$161.53
Rate for Payer: Wellpoint Medicaid Managed Care	$177.62

GOLD PROBE ARGON COAGULATOR

Facility

$443.00

Hospital Charge Code	270334803
Hospital Revenue Code	272
Min. Negotiated Rate	$66.45
Max. Negotiated Rate	$66.45
Rate for Payer: Qualcare PPO/HMO/WC	$66.45

GOLD PROBE ARGON COAGULATOR

Facility

$443.00

Hospital Charge Code	270334803
Hospital Revenue Code	272
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$221.50
Rate for Payer: Aetna Commercial	$168.34
Rate for Payer: Aetna Medicare Advantage	$132.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.97
Rate for Payer: Cigna Commercial	$221.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.90
Rate for Payer: Oxford Commercial	$88.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.45
Rate for Payer: UnitedHealthcare Commercial	$88.60
Rate for Payer: UnitedHealthcare Community & State	$10.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.74

GOLYTELY 1 GAL

Facility

$53.80

Hospital Charge Code	6007330
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

GOLYTELY 1 GAL

Facility

$53.80

Hospital Charge Code	6007330
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

GOMCO Suction Machine

Facility

$63.25

Hospital Charge Code	2708001521
Hospital Revenue Code	279
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.62
Rate for Payer: Aetna Commercial	$24.04
Rate for Payer: Aetna Medicare Advantage	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.13
Rate for Payer: Cigna Commercial	$31.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$12.65
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

GOMCO Suction Machine

Facility

$63.25

Hospital Charge Code	2708001521
Hospital Revenue Code	279
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

GONADORELIN HYDROCH100MCG

Facility

$324.00

Hospital Charge Code	60632968
Hospital Revenue Code	636
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$78.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

GONADORELIN HYDROCH100MCG

Facility

$324.00

Hospital Charge Code	60632968
Hospital Revenue Code	636
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

GONIO LENS

Facility

$300.00

Hospital Charge Code	270687726
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GONIO LENS

Facility

$300.00

Hospital Charge Code	270687726
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

GONIOSOL OPHTH

Facility

$84.00

Hospital Charge Code	60635032
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

GONIOSOL OPHTH

Facility

$84.00

Hospital Charge Code	60635032
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

GOODWIRE ASAHI PROWATER 180CM

Facility

$2,250.00

Hospital Charge Code	270636741C
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

GOODWIRE ASAHI PROWATER 180CM

Facility

$2,250.00

Hospital Charge Code	270636741C
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

GORE ACUSEAL VASCULAR GRAFT

Facility

$7,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679633
Hospital Revenue Code	278
Min. Negotiated Rate	$1,124.25
Max. Negotiated Rate	$1,813.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,648.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,124.25

GORE ACUSEAL VASCULAR GRAFT

Facility

$7,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679633
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,747.50
Rate for Payer: Aetna Commercial	$2,848.10
Rate for Payer: Aetna Medicare Advantage	$2,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,911.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,911.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,911.22
Rate for Payer: Cigna Commercial	$3,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,648.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,124.25
Rate for Payer: UnitedHealthcare Community & State	$180.63
Rate for Payer: Wellpoint Medicaid Managed Care	$198.62

GORETEX DUALMESH BIO 75-96SQ C

Facility

$128.00

Hospital Charge Code	270335386
Hospital Revenue Code	278
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.16
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

GORETEX DUALMESH BIO 75-96SQ C

Facility

$128.00

Hospital Charge Code	270335386
Hospital Revenue Code	278
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) NJ Health	$25.60
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	$30.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.16
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

GOUGE BMT 8MM DISP 423876

Facility

$1,556.85

Hospital Charge Code	270615810
Hospital Revenue Code	272
Min. Negotiated Rate	$233.53
Max. Negotiated Rate	$233.53
Rate for Payer: Qualcare PPO/HMO/WC	$233.53

GOUGE BMT 8MM DISP 423876

Facility

$1,556.85

Hospital Charge Code	270615810
Hospital Revenue Code	272
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$778.42
Rate for Payer: Aetna Commercial	$591.60
Rate for Payer: Aetna Medicare Advantage	$467.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.00
Rate for Payer: Cigna Commercial	$778.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.06
Rate for Payer: Oxford Commercial	$311.37
Rate for Payer: Qualcare PPO/HMO/WC	$233.53
Rate for Payer: UnitedHealthcare Commercial	$311.37
Rate for Payer: UnitedHealthcare Community & State	$37.52
Rate for Payer: Wellpoint Medicaid Managed Care	$41.26

GOWN BAIR PAWS STD

Facility

$62.69

Hospital Charge Code	270649747
Hospital Revenue Code	272
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.40

Know your out-of-pocket cost for care.

All Charges