Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ARISTA HEMOSTAT 1 GRAM

Facility

$407.50

Hospital Charge Code	270687373
Hospital Revenue Code	272
Min. Negotiated Rate	$61.12
Max. Negotiated Rate	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$61.12

ARISTA HEMOSTAT 3 GRAM

Facility

$812.50

Hospital Charge Code	270687374
Hospital Revenue Code	272
Min. Negotiated Rate	$19.58
Max. Negotiated Rate	$406.25
Rate for Payer: Aetna Commercial	$308.75
Rate for Payer: Aetna Medicare Advantage	$243.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.19
Rate for Payer: Cigna Commercial	$406.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.75
Rate for Payer: Oxford Commercial	$162.50
Rate for Payer: Qualcare PPO/HMO/WC	$121.88
Rate for Payer: UnitedHealthcare Commercial	$162.50
Rate for Payer: UnitedHealthcare Community & State	$19.58
Rate for Payer: Wellpoint Medicaid Managed Care	$21.53

ARISTA HEMOSTAT 3 GRAM

Facility

$812.50

Hospital Charge Code	270687374
Hospital Revenue Code	272
Min. Negotiated Rate	$121.88
Max. Negotiated Rate	$121.88
Rate for Payer: Qualcare PPO/HMO/WC	$121.88

ARLIDIN/12MG/TAB

Facility

$6.00

Hospital Charge Code	60634350
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ARLIDIN/12MG/TAB

Facility

$6.00

Hospital Charge Code	60634350
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ARMADA 35 PTA 7.0mmx80mmx80cm

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270680400
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

ARMADA 35 PTA 7.0mmx80mmx80cm

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270680400
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

ARM AIMING RADIOLUCENT

Facility

$9,504.00

Hospital Charge Code	270671055
Hospital Revenue Code	272
Min. Negotiated Rate	$229.05
Max. Negotiated Rate	$4,752.00
Rate for Payer: Aetna Commercial	$3,611.52
Rate for Payer: Aetna Medicare Advantage	$2,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,423.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,423.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,423.52
Rate for Payer: Cigna Commercial	$4,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,851.20
Rate for Payer: Oxford Commercial	$1,900.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.60
Rate for Payer: UnitedHealthcare Commercial	$1,900.80
Rate for Payer: UnitedHealthcare Community & State	$229.05
Rate for Payer: Wellpoint Medicaid Managed Care	$251.86

ARM AIMING RADIOLUCENT

Facility

$9,504.00

Hospital Charge Code	270671055
Hospital Revenue Code	272
Min. Negotiated Rate	$1,425.60
Max. Negotiated Rate	$1,425.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.60

ARMBOARD CHILD IV 6x2

Facility

$21.45

Hospital Charge Code	270651432
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.43
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$4.29
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

ARMBOARD CHILD IV 6x2

Facility

$21.45

Hospital Charge Code	270651432
Hospital Revenue Code	270
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

ARMBOARD CHILD SM 4x2

Facility

$19.35

Hospital Charge Code	270651433
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna Commercial	$7.35
Rate for Payer: Aetna Medicare Advantage	$5.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.93
Rate for Payer: Cigna Commercial	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.80
Rate for Payer: Oxford Commercial	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.87
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

ARMBOARD CHILD SM 4x2

Facility

$19.35

Hospital Charge Code	270651433
Hospital Revenue Code	270
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

ARM BOARD, DISPOSABLE 3.25X18

Facility

$14.00

Hospital Charge Code	270332274
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

ARM BOARD, DISPOSABLE 3.25X18

Facility

$14.00

Hospital Charge Code	270332274
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

ARMBOARD DISPOSABLE NEO 1 X 4

Facility

$2.56

Hospital Charge Code	270662690
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna Commercial	$0.97
Rate for Payer: Aetna Medicare Advantage	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.65
Rate for Payer: Cigna Commercial	$1.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.77
Rate for Payer: Oxford Commercial	$0.51
Rate for Payer: Qualcare PPO/HMO/WC	$0.38
Rate for Payer: UnitedHealthcare Commercial	$0.51
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

ARMBOARD DISPOSABLE NEO 1 X 4

Facility

$2.56

Hospital Charge Code	270662690
Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Qualcare PPO/HMO/WC	$0.38

ARMBOARD INFANT 9

Facility

$2.33

Hospital Charge Code	270300070
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.35

ARMBOARD INFANT 9

Facility

$2.33

Hospital Charge Code	270300070
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna Commercial	$0.89
Rate for Payer: Aetna Medicare Advantage	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.59
Rate for Payer: Cigna Commercial	$1.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.35
Rate for Payer: UnitedHealthcare Commercial	$0.47
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

ARM BOARD PADS

Facility

$531.75

Hospital Charge Code	270691391
Hospital Revenue Code	270
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$265.88
Rate for Payer: Aetna Commercial	$202.06
Rate for Payer: Aetna Medicare Advantage	$159.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.60
Rate for Payer: Cigna Commercial	$265.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.53
Rate for Payer: Oxford Commercial	$106.35
Rate for Payer: Qualcare PPO/HMO/WC	$79.76
Rate for Payer: UnitedHealthcare Commercial	$106.35
Rate for Payer: UnitedHealthcare Community & State	$12.82
Rate for Payer: Wellpoint Medicaid Managed Care	$14.09

ARM BOARD PADS

Facility

$531.75

Hospital Charge Code	270691391
Hospital Revenue Code	270
Min. Negotiated Rate	$79.76
Max. Negotiated Rate	$79.76
Rate for Payer: Qualcare PPO/HMO/WC	$79.76

ARM MOUNTAIN LONG

Facility

$3,463.85

Hospital Charge Code	270679746
Hospital Revenue Code	272
Min. Negotiated Rate	$83.48
Max. Negotiated Rate	$1,731.92
Rate for Payer: Aetna Commercial	$1,316.26
Rate for Payer: Aetna Medicare Advantage	$1,039.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$883.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$883.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$883.28
Rate for Payer: Cigna Commercial	$1,731.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,039.15
Rate for Payer: Oxford Commercial	$692.77
Rate for Payer: Qualcare PPO/HMO/WC	$519.58
Rate for Payer: UnitedHealthcare Commercial	$692.77
Rate for Payer: UnitedHealthcare Community & State	$83.48
Rate for Payer: Wellpoint Medicaid Managed Care	$91.79

ARM MOUNTAIN LONG

Facility

$3,463.85

Hospital Charge Code	270679746
Hospital Revenue Code	272
Min. Negotiated Rate	$519.58
Max. Negotiated Rate	$519.58
Rate for Payer: Qualcare PPO/HMO/WC	$519.58

ARMODAFINIL 50 MG TAB

Facility

$19.40

Hospital Charge Code	60630075
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.70
Rate for Payer: Aetna Commercial	$7.37
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.95
Rate for Payer: Cigna Commercial	$9.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.82
Rate for Payer: Oxford Commercial	$3.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.91
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

ARMODAFINIL 50 MG TAB

Facility

$19.40

Hospital Charge Code	60630075
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.91

Know your out-of-pocket cost for care.

All Charges