Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Apixaban 5mg tab

Facility

$42.21

Service Code	NDC 3089431
Hospital Charge Code	6000435
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Oxford Commercial	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$8.44
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

Apixaban 5mg tab

Facility

$42.21

Service Code	NDC 3089431
Hospital Charge Code	6000435
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

APLIGRAF 44 SQ CM

Facility

$7,570.00

Hospital Charge Code	270619908W
Hospital Revenue Code	636
Min. Negotiated Rate	$182.44
Max. Negotiated Rate	$3,785.00
Rate for Payer: Aetna Commercial	$2,876.60
Rate for Payer: Aetna Medicare Advantage	$2,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,930.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,930.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,930.35
Rate for Payer: Cigna Commercial	$3,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,831.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,135.50
Rate for Payer: UnitedHealthcare Community & State	$182.44
Rate for Payer: Wellpoint Medicaid Managed Care	$200.60

APLIGRAF 44 SQ CM

Facility

$7,570.00

Hospital Charge Code	270619908W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,135.50
Max. Negotiated Rate	$1,831.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,831.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,135.50

APLIGRAF 7.5CM

Facility

$6,475.00

Service Code	HCPCS Q4101
Hospital Charge Code	270619908
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,566.95
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

APLIGRAF 7.5CM

Facility

$6,475.00

Service Code	HCPCS Q4101
Hospital Charge Code	270619908
Hospital Revenue Code	636
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

APLIGRAFT TISSUE 199

Facility

$11,083.30

Service Code	HCPCS Q4101
Hospital Charge Code	270655637
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,682.16
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.49
Rate for Payer: UnitedHealthcare Community & State	$267.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$293.71

APLIGRAFT TISSUE 199

Facility

$11,083.30

Service Code	HCPCS Q4101
Hospital Charge Code	270655637
Hospital Revenue Code	636
Min. Negotiated Rate	$1,662.49
Max. Negotiated Rate	$2,682.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.49

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632473
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632473
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632474
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

APLY BNE FIXATION DEVC>1 PLANE

Facility

$30,595.00

Service Code	HCPCS 20692
Hospital Charge Code	1600000412
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

APLY BNE FIXATION DEVC>1 PLANE

Facility

$30,595.00

Service Code	HCPCS 20692
Hospital Charge Code	1600000412
Hospital Revenue Code	360
Min. Negotiated Rate	$737.34
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,178.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$737.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,593.91
Rate for Payer: Wellpoint Medicaid Managed Care	$33,915.60

APLY BNE FIXATION DEVC 1PLANE

Facility

$30,595.00

Service Code	HCPCS 20690
Hospital Charge Code	16000372
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

APLY BNE FIXATION DEVC 1PLANE

Facility

$30,595.00

Service Code	HCPCS 20690
Hospital Charge Code	16000372
Hospital Revenue Code	360
Min. Negotiated Rate	$737.34
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,178.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$737.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57
Rate for Payer: Wellpoint Medicaid Managed Care	$15,569.19

APLY SPINE PROSTH DEVICE

Facility

$23,774.45

Service Code	HCPCS 22853
Hospital Charge Code	16000242
Hospital Revenue Code	360
Min. Negotiated Rate	$3,566.17
Max. Negotiated Rate	$3,566.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.17

APLY SPINE PROSTH DEVICE

Facility

$23,774.45

Service Code	HCPCS 22853
Hospital Charge Code	16000242
Hospital Revenue Code	360
Min. Negotiated Rate	$572.96
Max. Negotiated Rate	$11,887.23
Rate for Payer: Aetna Commercial	$9,034.29
Rate for Payer: Aetna Medicare Advantage	$7,132.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,062.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,062.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,062.48
Rate for Payer: Cigna Commercial	$11,887.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,132.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$572.96

APO A1 + B I

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527A
Hospital Revenue Code	300
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

APO A1 + B I

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527A
Hospital Revenue Code	300
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.36
Rate for Payer: Aetna Medicare Advantage	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.13
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: Cigna Medicare Advantage	$21.09
Rate for Payer: Clover Medicare Advantage	$20.04
Rate for Payer: EmblemHealth Commercial	$63.27
Rate for Payer: Humana Medicare Advantage	$21.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.09
Rate for Payer: Wellcare Medicare Advantage	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

APO A1 + B II

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527B
Hospital Revenue Code	300
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.36
Rate for Payer: Aetna Medicare Advantage	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.13
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: Cigna Medicare Advantage	$21.09
Rate for Payer: Clover Medicare Advantage	$20.04
Rate for Payer: EmblemHealth Commercial	$63.27
Rate for Payer: Humana Medicare Advantage	$21.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.09
Rate for Payer: Wellcare Medicare Advantage	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

Know your out-of-pocket cost for care.

All Charges