Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ISTENT INJECTION

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270687704
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISTENT INJECTION

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270687704
Hospital Revenue Code	278
Min. Negotiated Rate	$328.36
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$5,177.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

ISTENT INJECT W INSERTER

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270690811
Hospital Revenue Code	278
Min. Negotiated Rate	$328.36
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$5,177.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

ISTENT INJECT W INSERTER

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270690811
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,997.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISUPREL/0.2MG/1ML

Facility

$640.32

Service Code	NDC 51927429500
Hospital Charge Code	60633225
Hospital Revenue Code	250
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$96.05
Rate for Payer: Qualcare PPO/HMO/WC	$96.05

ISUPREL/0.2MG/1ML

Facility

$640.32

Service Code	NDC 51927429500
Hospital Charge Code	60633225
Hospital Revenue Code	250
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$320.16
Rate for Payer: Aetna Commercial	$243.32
Rate for Payer: Aetna Medicare Advantage	$192.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.28
Rate for Payer: Cigna Commercial	$320.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.10
Rate for Payer: Oxford Commercial	$128.06
Rate for Payer: Qualcare PPO/HMO/WC	$96.05
Rate for Payer: UnitedHealthcare Commercial	$128.06
Rate for Payer: UnitedHealthcare Community & State	$15.43
Rate for Payer: Wellpoint Medicaid Managed Care	$16.97

ITA PATELLA IMPLANT - BIOMET

Facility

$3,010.00

Hospital Charge Code	270639912
Hospital Revenue Code	278
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$1,505.00
Rate for Payer: Aetna Commercial	$1,143.80
Rate for Payer: Aetna Medicare Advantage	$903.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$767.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$767.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$767.55
Rate for Payer: Cigna Commercial	$1,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$662.20
Rate for Payer: Qualcare PPO/HMO/WC	$451.50
Rate for Payer: UnitedHealthcare Community & State	$72.54
Rate for Payer: Wellpoint Medicaid Managed Care	$79.77

ITA PATELLA IMPLANT - BIOMET

Facility

$3,010.00

Hospital Charge Code	270639912
Hospital Revenue Code	278
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$728.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$662.20
Rate for Payer: Qualcare PPO/HMO/WC	$451.50

ITRACONAZOLE 100 MG CAP

Facility

$44.00

Hospital Charge Code	6016257
Hospital Revenue Code	252
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

ITRACONAZOLE 100 MG CAP

Facility

$44.00

Hospital Charge Code	6016257
Hospital Revenue Code	252
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

IUD INSERTION

Facility

$406.00

Service Code	HCPCS 58300
Hospital Charge Code	87502610
Hospital Revenue Code	761
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$203.00
Rate for Payer: Aetna Commercial	$154.28
Rate for Payer: Aetna Medicare Advantage	$121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.53
Rate for Payer: Cigna Commercial	$203.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.80
Rate for Payer: Oxford Commercial	$81.20
Rate for Payer: Qualcare PPO/HMO/WC	$60.90
Rate for Payer: UnitedHealthcare Commercial	$81.20
Rate for Payer: UnitedHealthcare Community & State	$9.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

IUD INSERTION

Facility

$406.00

Service Code	HCPCS 58300
Hospital Charge Code	87502610
Hospital Revenue Code	761
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$60.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.90

IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	87502575
Hospital Revenue Code	761
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$1,306.82
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.70
Rate for Payer: Oxford Commercial	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$133.80
Rate for Payer: UnitedHealthcare Community & State	$16.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.73

IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	87502575
Hospital Revenue Code	761
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

IUD REMOVAL/PARAGARD INSERT***

Facility

$204.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600020
Hospital Revenue Code	519
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

IUD REMOVAL/PARAGARD INSERT***

Facility

$204.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600020
Hospital Revenue Code	519
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

IUD REMOVAL PROGESTASERT****

Facility

$139.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600021
Hospital Revenue Code	519
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

IUD REMOVAL PROGESTASERT****

Facility

$139.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600021
Hospital Revenue Code	519
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

IUD REMOVAL WHC******

Facility

$18.04

Service Code	HCPCS 58301
Hospital Charge Code	9600022
Hospital Revenue Code	519
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

IUD REMOVAL WHC******

Facility

$18.04

Service Code	HCPCS 58301
Hospital Charge Code	9600022
Hospital Revenue Code	519
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1,306.82
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

IV4 VACC NO PRSV 0.25 ML IM

Facility

$83.65

Service Code	HCPCS 90685
Hospital Charge Code	412390685
Hospital Revenue Code	636
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

IV4 VACC NO PRSV 0.25 ML IM

Facility

$83.65

Service Code	HCPCS 90685
Hospital Charge Code	412390685
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IV .9% NACL 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650211
Hospital Revenue Code	258
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

IV .9% NACL 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650211
Hospital Revenue Code	258
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

IV .9% NACL 50ML SINGLE

Facility

$10.80

Hospital Charge Code	270650212
Hospital Revenue Code	258
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna Commercial	$4.10
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.24
Rate for Payer: Oxford Commercial	$2.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$2.16
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

Know your out-of-pocket cost for care.

All Charges