Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MESALAMINE 1000 MG SUPP

Facility

$190.08

Service Code	NDC 58914050142
Hospital Charge Code	60629964
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.04
Rate for Payer: Aetna Commercial	$72.23
Rate for Payer: Aetna Medicare Advantage	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.47
Rate for Payer: Cigna Commercial	$95.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.02
Rate for Payer: Oxford Commercial	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$28.51
Rate for Payer: UnitedHealthcare Commercial	$38.02
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

MESALAMINE 1 BOTTLE NMA

Facility

$162.74

Service Code	NDC 45802009851
Hospital Charge Code	60628163
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$81.37
Rate for Payer: Aetna Commercial	$61.84
Rate for Payer: Aetna Medicare Advantage	$48.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.50
Rate for Payer: Cigna Commercial	$81.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.82
Rate for Payer: Oxford Commercial	$32.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.41
Rate for Payer: UnitedHealthcare Commercial	$32.55
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4.31

MESALAMINE 1 BOTTLE NMA

Facility

$162.74

Service Code	NDC 45802009851
Hospital Charge Code	60628163
Hospital Revenue Code	250
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$24.41

MESALAMINE 400 MG ECT

Facility

$7.37

Service Code	NDC 430075327
Hospital Charge Code	60628161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

MESALAMINE 400 MG ECT

Facility

$7.37

Service Code	NDC 430075327
Hospital Charge Code	60628161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.69
Rate for Payer: Aetna Commercial	$2.80
Rate for Payer: Aetna Medicare Advantage	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.88
Rate for Payer: Cigna Commercial	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$1.47
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MESALAMINE ENEMA 60ML

Facility

$70.40

Hospital Charge Code	6017891
Hospital Revenue Code	252
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

MESALAMINE ENEMA 60ML

Facility

$70.40

Hospital Charge Code	6017891
Hospital Revenue Code	252
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$394.32
Max. Negotiated Rate	$8,181.00
Rate for Payer: Aetna Commercial	$6,217.56
Rate for Payer: Aetna Medicare Advantage	$4,908.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,172.31
Rate for Payer: Cigna Commercial	$8,181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,599.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30
Rate for Payer: UnitedHealthcare Community & State	$394.32
Rate for Payer: Wellpoint Medicaid Managed Care	$433.59

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$2,454.30
Max. Negotiated Rate	$3,959.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,599.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30

MESH 206 X 123MM X 06MM

Facility

$8,690.00

Hospital Charge Code	270667196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.50
Max. Negotiated Rate	$2,102.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,738.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,102.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,911.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.50

MESH 206 X 123MM X 06MM

Facility

$8,690.00

Hospital Charge Code	270667196
Hospital Revenue Code	278
Min. Negotiated Rate	$209.43
Max. Negotiated Rate	$4,345.00
Rate for Payer: Aetna Commercial	$3,302.20
Rate for Payer: Aetna Medicare Advantage	$2,607.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,215.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,215.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,738.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,215.95
Rate for Payer: Cigna Commercial	$4,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,102.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,911.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.50
Rate for Payer: UnitedHealthcare Community & State	$209.43
Rate for Payer: Wellpoint Medicaid Managed Care	$230.28

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$972.38
Rate for Payer: Aetna Commercial	$739.00
Rate for Payer: Aetna Medicare Advantage	$583.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.91
Rate for Payer: Cigna Commercial	$972.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.85
Rate for Payer: Qualcare PPO/HMO/WC	$291.71
Rate for Payer: UnitedHealthcare Community & State	$46.87
Rate for Payer: Wellpoint Medicaid Managed Care	$51.54

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$291.71
Max. Negotiated Rate	$470.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.85
Rate for Payer: Qualcare PPO/HMO/WC	$291.71

MESH 3D MAX 4X6

Facility

$1,500.00

Service Code	HCPCS C1781
Hospital Charge Code	270692643
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

MESH 3D MAX 4X6

Facility

$1,500.00

Service Code	HCPCS C1781
Hospital Charge Code	270692643
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$436.59
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$47.83
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$754.11
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$436.59
Rate for Payer: Qualcare PPO/HMO/WC	$297.68
Rate for Payer: UnitedHealthcare Community & State	$47.83
Rate for Payer: Wellpoint Medicaid Managed Care	$52.59

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$47.83
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$754.11
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$436.59
Rate for Payer: Qualcare PPO/HMO/WC	$297.68
Rate for Payer: UnitedHealthcare Community & State	$47.83
Rate for Payer: Wellpoint Medicaid Managed Care	$52.59

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$436.59
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$49.75
Max. Negotiated Rate	$1,032.22
Rate for Payer: Aetna Commercial	$784.49
Rate for Payer: Aetna Medicare Advantage	$619.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.43
Rate for Payer: Cigna Commercial	$1,032.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$454.18
Rate for Payer: Qualcare PPO/HMO/WC	$309.67
Rate for Payer: UnitedHealthcare Community & State	$49.75
Rate for Payer: Wellpoint Medicaid Managed Care	$54.71

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$499.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$454.18
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3DMAX MID LG RT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693769
Hospital Revenue Code	278
Min. Negotiated Rate	$49.75
Max. Negotiated Rate	$1,032.22
Rate for Payer: Aetna Commercial	$784.49
Rate for Payer: Aetna Medicare Advantage	$619.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.43
Rate for Payer: Cigna Commercial	$1,032.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$454.18
Rate for Payer: Qualcare PPO/HMO/WC	$309.67
Rate for Payer: UnitedHealthcare Community & State	$49.75
Rate for Payer: Wellpoint Medicaid Managed Care	$54.71

MESH 3DMAX MID LG RT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693769
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$499.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$454.18
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

Know your out-of-pocket cost for care.

All Charges