Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MICRONASE/1.25MG/TAB

Facility

$4.00

Service Code	NDC 23155005601
Hospital Charge Code	60634880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MICRONASE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MICRONASE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MICRONASE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MICRONASE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MICRONASE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MICRONASE/5MG/TAB

Facility

$4.00

Hospital Charge Code	60633426
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MICRONASE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MICRONASE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633427
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MICRONASE/5MG/TAB

Facility

$4.00

Hospital Charge Code	60633426
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MICRONASE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633427
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MICROPHONE SNORE PROTECH FEMAL

Facility

$500.00

Hospital Charge Code	270654236
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MICROPHONE SNORE PROTECH FEMAL

Facility

$500.00

Hospital Charge Code	270654236
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

MICROPORT PER 5 1/1 7 PK11150K

Facility

$2,142.75

Hospital Charge Code	270626551
Hospital Revenue Code	272
Min. Negotiated Rate	$321.41
Max. Negotiated Rate	$321.41
Rate for Payer: Qualcare PPO/HMO/WC	$321.41

MICROPORT PER 5 1/1 7 PK11150K

Facility

$2,142.75

Hospital Charge Code	270626551
Hospital Revenue Code	272
Min. Negotiated Rate	$51.64
Max. Negotiated Rate	$1,071.38
Rate for Payer: Aetna Commercial	$814.25
Rate for Payer: Aetna Medicare Advantage	$642.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$546.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$546.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$546.40
Rate for Payer: Cigna Commercial	$1,071.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$642.83
Rate for Payer: Oxford Commercial	$428.55
Rate for Payer: Qualcare PPO/HMO/WC	$321.41
Rate for Payer: UnitedHealthcare Commercial	$428.55
Rate for Payer: UnitedHealthcare Community & State	$51.64
Rate for Payer: Wellpoint Medicaid Managed Care	$56.78

MICROPUNCTURE 6FRX10CM SHEATH

Facility

$3,550.00

Hospital Charge Code	270705458
Hospital Revenue Code	279
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$532.50
Rate for Payer: Qualcare PPO/HMO/WC	$532.50

MICROPUNCTURE 6FRX10CM SHEATH

Facility

$3,550.00

Hospital Charge Code	270705458
Hospital Revenue Code	279
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$1,775.00
Rate for Payer: Aetna Commercial	$1,349.00
Rate for Payer: Aetna Medicare Advantage	$1,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$905.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$905.25
Rate for Payer: Cigna Commercial	$1,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.00
Rate for Payer: Oxford Commercial	$710.00
Rate for Payer: Qualcare PPO/HMO/WC	$532.50
Rate for Payer: UnitedHealthcare Commercial	$710.00
Rate for Payer: UnitedHealthcare Community & State	$85.56
Rate for Payer: Wellpoint Medicaid Managed Care	$94.08

MICROPUNCTURE INTRO 5FR

Facility

$230.00

Service Code	HCPCS C2629
Hospital Charge Code	270624719
Hospital Revenue Code	278
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

MICROPUNCTURE INTRO 5FR

Facility

$230.00

Service Code	HCPCS C2629
Hospital Charge Code	270624719
Hospital Revenue Code	278
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

MICROPUNCTURE INTRO STFND 10cm

Facility

$340.00

Hospital Charge Code	270624179
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

MICROPUNCTURE INTRO STFND 10cm

Facility

$340.00

Hospital Charge Code	270624179
Hospital Revenue Code	278
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

MICROPUNCTURE INTRO STFND 15cm

Facility

$345.10

Hospital Charge Code	270629630
Hospital Revenue Code	278
Min. Negotiated Rate	$51.77
Max. Negotiated Rate	$83.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.92
Rate for Payer: Qualcare PPO/HMO/WC	$51.77

MICROPUNCTURE INTRO STFND 15cm

Facility

$345.10

Hospital Charge Code	270629630
Hospital Revenue Code	278
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$172.55
Rate for Payer: Aetna Commercial	$131.14
Rate for Payer: Aetna Medicare Advantage	$103.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.00
Rate for Payer: Cigna Commercial	$172.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.92
Rate for Payer: Qualcare PPO/HMO/WC	$51.77
Rate for Payer: UnitedHealthcare Community & State	$8.32
Rate for Payer: Wellpoint Medicaid Managed Care	$9.15

MICROPUNCTURE INTRO STFND 15CM

Facility

$242.80

Hospital Charge Code	270629630C
Hospital Revenue Code	278
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$121.40
Rate for Payer: Aetna Commercial	$92.26
Rate for Payer: Aetna Medicare Advantage	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.91
Rate for Payer: Cigna Commercial	$121.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.42
Rate for Payer: Qualcare PPO/HMO/WC	$36.42
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

MICROPUNCTURE INTRO STFND 15CM

Facility

$242.80

Hospital Charge Code	270629630C
Hospital Revenue Code	278
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.42
Rate for Payer: Qualcare PPO/HMO/WC	$36.42

Know your out-of-pocket cost for care.

All Charges