Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INVICTUS GUIDEWIRE

Facility

$400.00

Hospital Charge Code	270703549
Hospital Revenue Code	272
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

INVICTUS MIS TI ROD 5.5X60MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703544
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INVICTUS MIS TI ROD 5.5X60MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703544
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

INVICTUS MIS TI ROD 5.5X65MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703543
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

INVICTUS MIS TI ROD 5.5X65MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703543
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INVICTUS REDUCTION SCREW 7.5X5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704967
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

INVICTUS REDUCTION SCREW 7.5X5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704967
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INVIRASE 200MG CAPSULE

Facility

$15.00

Hospital Charge Code	60635113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

INVIRASE 200MG CAPSULE

Facility

$15.00

Hospital Charge Code	60635113
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.11
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$14.07
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$1,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,900.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

IODINATED GLYCEROL/30MG/1

Facility

$3.00

Hospital Charge Code	60633189
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

IODINATED GLYCEROL/30MG/1

Facility

$3.00

Hospital Charge Code	60633189
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IODINATED GLYCEROL W/DM/5

Facility

$3.00

Hospital Charge Code	60633190
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

IODINATED GLYCEROL W/DM/5

Facility

$3.00

Hospital Charge Code	60633190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$459.15
Rate for Payer: Aetna Commercial	$348.95
Rate for Payer: Aetna Medicare Advantage	$275.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.17
Rate for Payer: Cigna Commercial	$459.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.49
Rate for Payer: Oxford Commercial	$183.66
Rate for Payer: Qualcare PPO/HMO/WC	$137.75
Rate for Payer: UnitedHealthcare Commercial	$183.66
Rate for Payer: UnitedHealthcare Community & State	$22.13
Rate for Payer: Wellpoint Medicaid Managed Care	$24.33

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$137.75
Max. Negotiated Rate	$137.75
Rate for Payer: Qualcare PPO/HMO/WC	$137.75

IODINE SOLUTION

Facility

$62.10

Hospital Charge Code	6012660
Hospital Revenue Code	251
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

IODINE SOLUTION

Facility

$62.10

Hospital Charge Code	6012660
Hospital Revenue Code	251
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

IODIXANOL(VISIP)320/ML 100ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630204
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

IODIXANOL(VISIP)320/ML 100ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630204
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$124.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$256.27
Rate for Payer: Aetna Commercial	$194.77
Rate for Payer: Aetna Medicare Advantage	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.70
Rate for Payer: Cigna Commercial	$256.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88
Rate for Payer: UnitedHealthcare Community & State	$12.35
Rate for Payer: Wellpoint Medicaid Managed Care	$13.58

Know your out-of-pocket cost for care.

All Charges