Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MESH VENTRIO 8.7 x 10

Facility

$9,775.00

Service Code	HCPCS C1781
Hospital Charge Code	270663620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,150.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

MESH VENTRIO OVAL LG 5.4x7.0

Facility

$6,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270647197
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$1,548.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

MESH VENTRIO OVAL LG 5.4x7.0

Facility

$6,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270647197
Hospital Revenue Code	278
Min. Negotiated Rate	$154.24
Max. Negotiated Rate	$3,200.00
Rate for Payer: Aetna Commercial	$2,432.00
Rate for Payer: Aetna Medicare Advantage	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,632.00
Rate for Payer: Cigna Commercial	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00
Rate for Payer: UnitedHealthcare Community & State	$154.24
Rate for Payer: Wellpoint Medicaid Managed Care	$169.60

MESH VENTRIO OVAL MED 4.3x5.5

Facility

$5,050.00

Service Code	HCPCS C1781
Hospital Charge Code	270647196
Hospital Revenue Code	278
Min. Negotiated Rate	$121.70
Max. Negotiated Rate	$2,525.00
Rate for Payer: Aetna Commercial	$1,919.00
Rate for Payer: Aetna Medicare Advantage	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.75
Rate for Payer: Cigna Commercial	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.00
Rate for Payer: Qualcare PPO/HMO/WC	$757.50
Rate for Payer: UnitedHealthcare Community & State	$121.70
Rate for Payer: Wellpoint Medicaid Managed Care	$133.82

MESH VENTRIO OVAL MED 4.3x5.5

Facility

$5,050.00

Service Code	HCPCS C1781
Hospital Charge Code	270647196
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$1,222.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.00
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

MESH VENTRIO OVAL SM 3.1x4.7

Facility

$3,253.50

Service Code	HCPCS C1781
Hospital Charge Code	270647195
Hospital Revenue Code	278
Min. Negotiated Rate	$78.41
Max. Negotiated Rate	$1,626.75
Rate for Payer: Aetna Commercial	$1,236.33
Rate for Payer: Aetna Medicare Advantage	$976.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.64
Rate for Payer: Cigna Commercial	$1,626.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.77
Rate for Payer: Qualcare PPO/HMO/WC	$488.02
Rate for Payer: UnitedHealthcare Community & State	$78.41
Rate for Payer: Wellpoint Medicaid Managed Care	$86.22

MESH VENTRIO OVAL SM 3.1x4.7

Facility

$3,253.50

Service Code	HCPCS C1781
Hospital Charge Code	270647195
Hospital Revenue Code	278
Min. Negotiated Rate	$488.02
Max. Negotiated Rate	$787.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.77
Rate for Payer: Qualcare PPO/HMO/WC	$488.02

MESH VENTRIO XLG OVAL

Facility

$8,650.00

Service Code	HCPCS C1781
Hospital Charge Code	270664952
Hospital Revenue Code	278
Min. Negotiated Rate	$208.47
Max. Negotiated Rate	$4,325.00
Rate for Payer: Aetna Commercial	$3,287.00
Rate for Payer: Aetna Medicare Advantage	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,205.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,205.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,205.75
Rate for Payer: Cigna Commercial	$4,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,093.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,903.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.50
Rate for Payer: UnitedHealthcare Community & State	$208.47
Rate for Payer: Wellpoint Medicaid Managed Care	$229.22

MESH VENTRIO XLG OVAL

Facility

$8,650.00

Service Code	HCPCS C1781
Hospital Charge Code	270664952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.50
Max. Negotiated Rate	$2,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,093.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,903.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.50

MESH VIABAHN 9MM X 39MM 8 FR

Facility

$17,870.00

Service Code	HCPCS C1874
Hospital Charge Code	270692893
Hospital Revenue Code	278
Min. Negotiated Rate	$430.67
Max. Negotiated Rate	$8,935.00
Rate for Payer: Aetna Commercial	$6,790.60
Rate for Payer: Aetna Medicare Advantage	$5,361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,556.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,556.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,556.85
Rate for Payer: Cigna Commercial	$8,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,324.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,931.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.50
Rate for Payer: UnitedHealthcare Community & State	$430.67
Rate for Payer: Wellpoint Medicaid Managed Care	$473.56

MESH VIABAHN 9MM X 39MM 8 FR

Facility

$17,870.00

Service Code	HCPCS C1874
Hospital Charge Code	270692893
Hospital Revenue Code	278
Min. Negotiated Rate	$2,680.50
Max. Negotiated Rate	$4,324.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,324.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,931.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.50

MESH VISILEX 3 X 6 0112900

Facility

$859.25

Hospital Charge Code	270601202
Hospital Revenue Code	278
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$207.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.03
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

MESH VISILEX 3 X 6 0112900

Facility

$859.25

Hospital Charge Code	270601202
Hospital Revenue Code	278
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.62
Rate for Payer: Aetna Commercial	$326.51
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.03
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

MESH Y UPSYLON

Facility

$5,550.00

Service Code	HCPCS C1763
Hospital Charge Code	270677083
Hospital Revenue Code	278
Min. Negotiated Rate	$133.75
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$2,109.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50
Rate for Payer: UnitedHealthcare Community & State	$133.75
Rate for Payer: Wellpoint Medicaid Managed Care	$147.07

MESH Y UPSYLON

Facility

$5,550.00

Service Code	HCPCS C1763
Hospital Charge Code	270677083
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

MESNA 100 MG/ML INJ (10 ML)

Facility

$1,469.04

Service Code	HCPCS J9209
Hospital Charge Code	60628835
Hospital Revenue Code	636
Min. Negotiated Rate	$220.36
Max. Negotiated Rate	$355.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.51
Rate for Payer: Qualcare PPO/HMO/WC	$220.36

MESNA 100 MG/ML INJ (10 ML)

Facility

$1,469.04

Service Code	HCPCS J9209
Hospital Charge Code	60628835
Hospital Revenue Code	636
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$734.52
Rate for Payer: Aetna Commercial	$558.24
Rate for Payer: Aetna Medicare Advantage	$440.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.61
Rate for Payer: Cigna Commercial	$734.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.51
Rate for Payer: Qualcare PPO/HMO/WC	$220.36
Rate for Payer: UnitedHealthcare Community & State	$35.40
Rate for Payer: Wellpoint Medicaid Managed Care	$38.93

MESNA 200MG

Facility

$1,124.00

Hospital Charge Code	60633379
Hospital Revenue Code	250
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$168.60
Rate for Payer: Qualcare PPO/HMO/WC	$168.60

MESNA 200MG

Facility

$1,124.00

Hospital Charge Code	60633379
Hospital Revenue Code	250
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$562.00
Rate for Payer: Aetna Commercial	$427.12
Rate for Payer: Aetna Medicare Advantage	$337.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.62
Rate for Payer: Cigna Commercial	$562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.20
Rate for Payer: Oxford Commercial	$224.80
Rate for Payer: Qualcare PPO/HMO/WC	$168.60
Rate for Payer: UnitedHealthcare Commercial	$224.80
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

MESNA 200MG INJ

Facility

$122.90

Hospital Charge Code	6000368
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.74
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

MESNA 200MG INJ

Facility

$122.90

Hospital Charge Code	6000368
Hospital Revenue Code	636
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$29.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.74
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

MESNA 400MG TAB

Facility

$63.18

Service Code	NDC 67108356509
Hospital Charge Code	60635803
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.59
Rate for Payer: Aetna Commercial	$24.01
Rate for Payer: Aetna Medicare Advantage	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.11
Rate for Payer: Cigna Commercial	$31.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.95
Rate for Payer: Oxford Commercial	$12.64
Rate for Payer: Qualcare PPO/HMO/WC	$9.48
Rate for Payer: UnitedHealthcare Commercial	$12.64
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

MESNA 400MG TAB

Facility

$63.18

Service Code	NDC 67108356509
Hospital Charge Code	60635803
Hospital Revenue Code	250
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.48

MESNEX/100MG/1ML

Facility

$1,124.00

Hospital Charge Code	60633378
Hospital Revenue Code	636
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$272.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.01
Rate for Payer: Qualcare PPO/HMO/WC	$168.60

MESNEX/100MG/1ML

Facility

$1,124.00

Hospital Charge Code	60633378
Hospital Revenue Code	636
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$562.00
Rate for Payer: Aetna Commercial	$427.12
Rate for Payer: Aetna Medicare Advantage	$337.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.62
Rate for Payer: Cigna Commercial	$562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.01
Rate for Payer: Qualcare PPO/HMO/WC	$168.60
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

Know your out-of-pocket cost for care.

All Charges