Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMN SCREW 5X52.5MM

Facility

$1,621.95

Service Code	HCPCS C1713
Hospital Charge Code	270705683
Hospital Revenue Code	278
Min. Negotiated Rate	$243.29
Max. Negotiated Rate	$392.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.29

IMN SCREW 5X52.5MM

Facility

$1,621.95

Service Code	HCPCS C1713
Hospital Charge Code	270705683
Hospital Revenue Code	278
Min. Negotiated Rate	$39.09
Max. Negotiated Rate	$810.98
Rate for Payer: Aetna Commercial	$616.34
Rate for Payer: Aetna Medicare Advantage	$486.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.60
Rate for Payer: Cigna Commercial	$810.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.29
Rate for Payer: UnitedHealthcare Community & State	$39.09
Rate for Payer: Wellpoint Medicaid Managed Care	$42.98

IMODIUM/1MG/5ML

Facility

$5.00

Hospital Charge Code	60633162
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

IMODIUM/1MG/5ML

Facility

$5.00

Hospital Charge Code	60633162
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

IMODIUM/1MG/5ML

Facility

$23.00

Hospital Charge Code	60633163
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

IMODIUM/1MG/5ML

Facility

$23.00

Hospital Charge Code	60633163
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

IMODIUM/2MG/CAP

Facility

$5.00

Hospital Charge Code	60633160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

IMODIUM/2MG/CAP

Facility

$5.00

Hospital Charge Code	60633160
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

IMODIUM/2MG/CAP

Facility

$7.00

Hospital Charge Code	60633161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

IMODIUM/2MG/CAP

Facility

$7.00

Hospital Charge Code	60633161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

IMPACT

Facility

$32.00

Hospital Charge Code	60634850
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

IMPACT

Facility

$32.00

Hospital Charge Code	60634850
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

IMPLA BRST SMOOTH MOD 350-2475

Facility

$3,000.00

Hospital Charge Code	270638757
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

IMPLA BRST SMOOTH MOD 350-2475

Facility

$3,000.00

Hospital Charge Code	270638757
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$304,883.31

Service Code	APR-DRG 1614
Min. Negotiated Rate	$298,905.21
Max. Negotiated Rate	$304,883.31
Rate for Payer: UnitedHealthcare Community & State	$298,905.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$304,883.31
Rate for Payer: Wellpoint Medicaid Managed Care	$298,905.21

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$176,221.63

Service Code	APR-DRG 1611
Min. Negotiated Rate	$172,766.30
Max. Negotiated Rate	$176,221.63
Rate for Payer: UnitedHealthcare Community & State	$172,766.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$176,221.63
Rate for Payer: Wellpoint Medicaid Managed Care	$172,766.30

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$185,273.47

Service Code	APR-DRG 1612
Min. Negotiated Rate	$181,640.66
Max. Negotiated Rate	$185,273.47
Rate for Payer: UnitedHealthcare Community & State	$181,640.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$185,273.47
Rate for Payer: Wellpoint Medicaid Managed Care	$181,640.66

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$231,030.79

Service Code	APR-DRG 1613
Min. Negotiated Rate	$226,500.77
Max. Negotiated Rate	$231,030.79
Rate for Payer: UnitedHealthcare Community & State	$226,500.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$231,030.79
Rate for Payer: Wellpoint Medicaid Managed Care	$226,500.77

IMPLANT ACUTE SYSTEM

Facility

$5,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270668535
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

IMPLANT ACUTE SYSTEM

Facility

$5,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270668535
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

IMPLANT ATHX TRNSFX 40 AR1351

Facility

$1,380.00

Hospital Charge Code	270614433
Hospital Revenue Code	278
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$524.40
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$303.60
Rate for Payer: Qualcare PPO/HMO/WC	$207.00
Rate for Payer: UnitedHealthcare Community & State	$33.26
Rate for Payer: Wellpoint Medicaid Managed Care	$36.57

IMPLANT ATHX TRNSFX 40 AR1351

Facility

$1,380.00

Hospital Charge Code	270614433
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$303.60
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

IMPLANT ATHX TRNSFX 50 AR1351L

Facility

$1,149.65

Hospital Charge Code	270614980
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.47

IMPLANT ATHX TRNSFX 50 AR1351L

Facility

$1,149.65

Hospital Charge Code	270614980
Hospital Revenue Code	278
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

IMPLANT BIOINDUCTIVE ARTH DEL

Facility

$14,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270690425
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

Know your out-of-pocket cost for care.

All Charges