Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	7411536
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	7411536
Hospital Revenue Code	361
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$2,585.15
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$124.60
Rate for Payer: Wellpoint Medicaid Managed Care	$137.01

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	321037253
Hospital Revenue Code	361
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$2,585.15
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$124.60
Rate for Payer: Wellpoint Medicaid Managed Care	$137.01

IXABEPILONE 1MG INJ 45MG KIT

Facility

$17,286.80

Hospital Charge Code	60630300
Hospital Revenue Code	636
Min. Negotiated Rate	$2,593.02
Max. Negotiated Rate	$4,183.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,183.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.02

IXABEPILONE 1MG INJ 45MG KIT

Facility

$17,286.80

Hospital Charge Code	60630300
Hospital Revenue Code	636
Min. Negotiated Rate	$416.61
Max. Negotiated Rate	$8,643.40
Rate for Payer: Aetna Commercial	$6,568.98
Rate for Payer: Aetna Medicare Advantage	$5,186.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,408.13
Rate for Payer: Cigna Commercial	$8,643.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,183.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.02
Rate for Payer: UnitedHealthcare Community & State	$416.61
Rate for Payer: Wellpoint Medicaid Managed Care	$458.10

IXABEPILONE PER IMG INJ(15 MG)

Facility

$5,762.27

Hospital Charge Code	60630299
Hospital Revenue Code	636
Min. Negotiated Rate	$138.87
Max. Negotiated Rate	$2,881.14
Rate for Payer: Aetna Commercial	$2,189.66
Rate for Payer: Aetna Medicare Advantage	$1,728.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.38
Rate for Payer: Cigna Commercial	$2,881.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.47
Rate for Payer: Qualcare PPO/HMO/WC	$864.34
Rate for Payer: UnitedHealthcare Community & State	$138.87
Rate for Payer: Wellpoint Medicaid Managed Care	$152.70

IXABEPILONE PER IMG INJ(15 MG)

Facility

$5,762.27

Hospital Charge Code	60630299
Hospital Revenue Code	636
Min. Negotiated Rate	$864.34
Max. Negotiated Rate	$1,394.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.47
Rate for Payer: Qualcare PPO/HMO/WC	$864.34

IXEMPRA 1MG KIT

Facility

$249.18

Hospital Charge Code	60630002
Hospital Revenue Code	636
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$60.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

IXEMPRA 1MG KIT

Facility

$249.18

Hospital Charge Code	60630002
Hospital Revenue Code	636
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$124.59
Rate for Payer: Aetna Commercial	$94.69
Rate for Payer: Aetna Medicare Advantage	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.54
Rate for Payer: Cigna Commercial	$124.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Community & State	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

JACKET MASTER COLOR CODED

Facility

$476.10

Hospital Charge Code	270652497
Hospital Revenue Code	272
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$238.05
Rate for Payer: Aetna Commercial	$180.92
Rate for Payer: Aetna Medicare Advantage	$142.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.41
Rate for Payer: Cigna Commercial	$238.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.83
Rate for Payer: Oxford Commercial	$95.22
Rate for Payer: Qualcare PPO/HMO/WC	$71.42
Rate for Payer: UnitedHealthcare Commercial	$95.22
Rate for Payer: UnitedHealthcare Community & State	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$12.62

JACKET MASTER COLOR CODED

Facility

$476.10

Hospital Charge Code	270652497
Hospital Revenue Code	272
Min. Negotiated Rate	$71.42
Max. Negotiated Rate	$71.42
Rate for Payer: Qualcare PPO/HMO/WC	$71.42

JACKSON-PRATT T-TUBE DRAIN

Facility

$124.00

Hospital Charge Code	270330872
Hospital Revenue Code	272
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$47.12
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.20
Rate for Payer: Oxford Commercial	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$24.80
Rate for Payer: UnitedHealthcare Community & State	$2.99
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

JACKSON-PRATT T-TUBE DRAIN

Facility

$124.00

Hospital Charge Code	270330872
Hospital Revenue Code	272
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

JACKSON SPINAL TOP PATIENT KIT

Facility

$160.55

Hospital Charge Code	270339537
Hospital Revenue Code	272
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$24.08
Rate for Payer: Qualcare PPO/HMO/WC	$24.08

JACKSON SPINAL TOP PATIENT KIT

Facility

$160.55

Hospital Charge Code	270339537
Hospital Revenue Code	272
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$80.28
Rate for Payer: Aetna Commercial	$61.01
Rate for Payer: Aetna Medicare Advantage	$48.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.94
Rate for Payer: Cigna Commercial	$80.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.16
Rate for Payer: Oxford Commercial	$32.11
Rate for Payer: Qualcare PPO/HMO/WC	$24.08
Rate for Payer: UnitedHealthcare Commercial	$32.11
Rate for Payer: UnitedHealthcare Community & State	$3.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.25

JAG REVOLUTION WIRE 260 CM

Facility

$1,719.95

Service Code	HCPCS C1769
Hospital Charge Code	270690162
Hospital Revenue Code	278
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$859.98
Rate for Payer: Aetna Commercial	$653.58
Rate for Payer: Aetna Medicare Advantage	$515.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.59
Rate for Payer: Cigna Commercial	$859.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$378.39
Rate for Payer: Qualcare PPO/HMO/WC	$257.99
Rate for Payer: UnitedHealthcare Community & State	$41.45
Rate for Payer: Wellpoint Medicaid Managed Care	$45.58

JAG REVOLUTION WIRE 260 CM

Facility

$1,719.95

Service Code	HCPCS C1769
Hospital Charge Code	270690162
Hospital Revenue Code	278
Min. Negotiated Rate	$257.99
Max. Negotiated Rate	$416.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$378.39
Rate for Payer: Qualcare PPO/HMO/WC	$257.99

JAGTOME RX

Facility

$1,510.95

Hospital Charge Code	270680466
Hospital Revenue Code	272
Min. Negotiated Rate	$226.64
Max. Negotiated Rate	$226.64
Rate for Payer: Qualcare PPO/HMO/WC	$226.64

JAGTOME RX

Facility

$1,510.95

Hospital Charge Code	270680466
Hospital Revenue Code	272
Min. Negotiated Rate	$36.41
Max. Negotiated Rate	$755.48
Rate for Payer: Aetna Commercial	$574.16
Rate for Payer: Aetna Medicare Advantage	$453.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.29
Rate for Payer: Cigna Commercial	$755.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.29
Rate for Payer: Oxford Commercial	$302.19
Rate for Payer: Qualcare PPO/HMO/WC	$226.64
Rate for Payer: UnitedHealthcare Commercial	$302.19
Rate for Payer: UnitedHealthcare Community & State	$36.41
Rate for Payer: Wellpoint Medicaid Managed Care	$40.04

JAGTOME RX 49

Facility

$1,515.00

Hospital Charge Code	270660081
Hospital Revenue Code	272
Min. Negotiated Rate	$36.51
Max. Negotiated Rate	$757.50
Rate for Payer: Aetna Commercial	$575.70
Rate for Payer: Aetna Medicare Advantage	$454.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$386.32
Rate for Payer: Cigna Commercial	$757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.50
Rate for Payer: Oxford Commercial	$303.00
Rate for Payer: Qualcare PPO/HMO/WC	$227.25
Rate for Payer: UnitedHealthcare Commercial	$303.00
Rate for Payer: UnitedHealthcare Community & State	$36.51
Rate for Payer: Wellpoint Medicaid Managed Care	$40.15

JAGTOME RX 49

Facility

$1,515.00

Hospital Charge Code	270660081
Hospital Revenue Code	272
Min. Negotiated Rate	$227.25
Max. Negotiated Rate	$227.25
Rate for Payer: Qualcare PPO/HMO/WC	$227.25

JAGTOME RX SHINECTEROTOME .035

Facility

$1,562.25

Hospital Charge Code	270655970
Hospital Revenue Code	272
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$781.12
Rate for Payer: Aetna Commercial	$593.65
Rate for Payer: Aetna Medicare Advantage	$468.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.37
Rate for Payer: Cigna Commercial	$781.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.68
Rate for Payer: Oxford Commercial	$312.45
Rate for Payer: Qualcare PPO/HMO/WC	$234.34
Rate for Payer: UnitedHealthcare Commercial	$312.45
Rate for Payer: UnitedHealthcare Community & State	$37.65
Rate for Payer: Wellpoint Medicaid Managed Care	$41.40

JAGTOME RX SHINECTEROTOME .035

Facility

$1,562.25

Hospital Charge Code	270655970
Hospital Revenue Code	272
Min. Negotiated Rate	$234.34
Max. Negotiated Rate	$234.34
Rate for Payer: Qualcare PPO/HMO/WC	$234.34

JAGTOME SHORTWIRE 0.25

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696133
Hospital Revenue Code	272
Min. Negotiated Rate	$48.92
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$771.30
Rate for Payer: Aetna Medicare Advantage	$608.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.59
Rate for Payer: Cigna Commercial	$1,014.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$608.92
Rate for Payer: Oxford Commercial	$405.95
Rate for Payer: Qualcare PPO/HMO/WC	$304.46
Rate for Payer: UnitedHealthcare Commercial	$405.95
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$53.79

JAGTOME SHORTWIRE 0.25

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696133
Hospital Revenue Code	272
Min. Negotiated Rate	$304.46
Max. Negotiated Rate	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$304.46

Know your out-of-pocket cost for care.

All Charges