Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANAPROX/275MG/TAB

Facility

$5.00

Hospital Charge Code	60632459
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

ANAPROX/275MG/TAB

Facility

$5.00

Hospital Charge Code	60632459
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ANAPROX/275MG/TAB

Facility

$15.34

Service Code	NDC 53746019301
Hospital Charge Code	60632458
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.30

ANAPROX DS/550MG/TAB

Facility

$23.92

Service Code	NDC 53746019401
Hospital Charge Code	60632460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$11.96
Rate for Payer: Aetna Commercial	$9.09
Rate for Payer: Aetna Medicare Advantage	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.10
Rate for Payer: Cigna Commercial	$11.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.59
Rate for Payer: UnitedHealthcare Commercial	$4.78
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

ANAPROX DS/550MG/TAB

Facility

$23.92

Service Code	NDC 53746019401
Hospital Charge Code	60632460
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.59

ANAPROX DS/550MG/TAB

Facility

$5.00

Hospital Charge Code	60632461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

ANAPROX DS/550MG/TAB

Facility

$5.00

Hospital Charge Code	60632461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ANA SCREEN IFA W RFLX TITR/PAT

Facility

$390.00

Service Code	HCPCS 86038
Hospital Charge Code	401387449
Hospital Revenue Code	302
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Aetna Medicare Advantage	$39.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.64
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$11.49
Rate for Payer: EmblemHealth Commercial	$36.27
Rate for Payer: Humana Medicare Advantage	$12.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.09
Rate for Payer: Wellcare Medicare Advantage	$12.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANA SCREEN IFA W RFLX TITR/PAT

Facility

$390.00

Service Code	HCPCS 86038
Hospital Charge Code	401387449
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANA SCREEN W/ REFLEX DS-DNA

Facility

$164.85

Service Code	HCPCS 86038
Hospital Charge Code	3006776
Hospital Revenue Code	302
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Aetna Medicare Advantage	$39.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.64
Rate for Payer: Cigna Commercial	$82.42
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$11.49
Rate for Payer: EmblemHealth Commercial	$36.27
Rate for Payer: Humana Medicare Advantage	$12.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.09
Rate for Payer: Wellcare Medicare Advantage	$12.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

ANA SCREEN W/ REFLEX DS-DNA

Facility

$164.85

Service Code	HCPCS 86038
Hospital Charge Code	3006776
Hospital Revenue Code	302
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$24.73
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

ANASPAZ/0.125MG/TAB

Facility

$3.00

Hospital Charge Code	60632462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ANASPAZ/0.125MG/TAB

Facility

$3.00

Hospital Charge Code	60632462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ANASTROZOLE 1 MG TAB

Facility

$127.90

Service Code	NDC 310020130
Hospital Charge Code	60627362
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

ANASTROZOLE 1 MG TAB

Facility

$127.90

Service Code	NDC 310020130
Hospital Charge Code	60627362
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$63.95
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$63.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.37
Rate for Payer: Oxford Commercial	$25.58
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$25.58
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

ANA TITER

Facility

$427.00

Service Code	HCPCS 86039
Hospital Charge Code	38476046
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$213.50
Rate for Payer: Aetna Commercial	$30.36
Rate for Payer: Aetna Medicare Advantage	$36.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.28
Rate for Payer: Cigna Commercial	$213.50
Rate for Payer: Cigna Medicare Advantage	$11.16
Rate for Payer: Clover Medicare Advantage	$10.60
Rate for Payer: EmblemHealth Commercial	$33.48
Rate for Payer: Humana Medicare Advantage	$11.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.16
Rate for Payer: Wellcare Medicare Advantage	$11.16
Rate for Payer: Wellpoint Medicaid Managed Care	$11.32

ANA TITER

Facility

$390.00

Service Code	HCPCS 86039
Hospital Charge Code	39900192
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$30.36
Rate for Payer: Aetna Medicare Advantage	$36.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.16
Rate for Payer: Clover Medicare Advantage	$10.60
Rate for Payer: EmblemHealth Commercial	$33.48
Rate for Payer: Humana Medicare Advantage	$11.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.16
Rate for Payer: Wellcare Medicare Advantage	$11.16
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANA TITER

Facility

$427.00

Service Code	HCPCS 86039
Hospital Charge Code	38476046
Hospital Revenue Code	302
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$64.05

ANA TITER

Facility

$390.00

Service Code	HCPCS 86039
Hospital Charge Code	39900192
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANATOMIC BODY 128DEGREE SZ 6/8

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685583
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

ANATOMIC BODY 128DEGREE SZ 6/8

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685583
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

ANATOMIC FIB LOCK LEFT 6H

Facility

$3,666.00

Service Code	HCPCS C1713
Hospital Charge Code	270682380
Hospital Revenue Code	278
Min. Negotiated Rate	$549.90
Max. Negotiated Rate	$887.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$887.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$806.52
Rate for Payer: Qualcare PPO/HMO/WC	$549.90

ANATOMIC FIB LOCK LEFT 6H

Facility

$3,666.00

Service Code	HCPCS C1713
Hospital Charge Code	270682380
Hospital Revenue Code	278
Min. Negotiated Rate	$88.35
Max. Negotiated Rate	$1,833.00
Rate for Payer: Aetna Commercial	$1,393.08
Rate for Payer: Aetna Medicare Advantage	$1,099.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$934.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$934.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$934.83
Rate for Payer: Cigna Commercial	$1,833.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$887.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$806.52
Rate for Payer: Qualcare PPO/HMO/WC	$549.90
Rate for Payer: UnitedHealthcare Community & State	$88.35
Rate for Payer: Wellpoint Medicaid Managed Care	$97.15

ANATOMIC HEAD 36MM +5MM

Facility

$11,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270675960
Hospital Revenue Code	278
Min. Negotiated Rate	$284.26
Max. Negotiated Rate	$5,897.50
Rate for Payer: Aetna Commercial	$4,482.10
Rate for Payer: Aetna Medicare Advantage	$3,538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,007.72
Rate for Payer: Cigna Commercial	$5,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,594.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25
Rate for Payer: UnitedHealthcare Community & State	$284.26
Rate for Payer: Wellpoint Medicaid Managed Care	$312.57

ANATOMIC HEAD 36MM +5MM

Facility

$11,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270675960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.25
Max. Negotiated Rate	$2,854.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,594.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25

Know your out-of-pocket cost for care.

All Charges