Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NANO STEMLESS SHOULDER

Facility

$44,378.25

Service Code	HCPCS C1789
Hospital Charge Code	270706046
Hospital Revenue Code	278
Min. Negotiated Rate	$6,656.74
Max. Negotiated Rate	$10,739.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,875.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,739.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,763.22
Rate for Payer: Qualcare PPO/HMO/WC	$6,656.74

NANO STEMLESS SHOULDER

Facility

$44,378.25

Service Code	HCPCS C1789
Hospital Charge Code	270706046
Hospital Revenue Code	278
Min. Negotiated Rate	$1,069.52
Max. Negotiated Rate	$22,189.12
Rate for Payer: Aetna Commercial	$16,863.74
Rate for Payer: Aetna Medicare Advantage	$13,313.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,316.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,316.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,875.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,316.45
Rate for Payer: Cigna Commercial	$22,189.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,739.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,763.22
Rate for Payer: Qualcare PPO/HMO/WC	$6,656.74
Rate for Payer: UnitedHealthcare Community & State	$1,069.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,176.02

NANO STEMLESS SHOULDER 38MM

Facility

$44,378.25

Service Code	HCPCS C1716
Hospital Charge Code	270705539
Hospital Revenue Code	278
Min. Negotiated Rate	$6,656.74
Max. Negotiated Rate	$10,739.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,875.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,739.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,763.22
Rate for Payer: Qualcare PPO/HMO/WC	$6,656.74

NANO STEMLESS SHOULDER 38MM

Facility

$44,378.25

Service Code	HCPCS C1716
Hospital Charge Code	270705539
Hospital Revenue Code	278
Min. Negotiated Rate	$567.34
Max. Negotiated Rate	$10,739.54
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,875.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,739.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,763.22
Rate for Payer: Qualcare PPO/HMO/WC	$6,656.74
Rate for Payer: UnitedHealthcare Community & State	$1,069.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,176.02

NAPHAZOL ANTAZ OPH SOL 15ML

Facility

$109.45

Hospital Charge Code	6003891
Hospital Revenue Code	252
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

NAPHAZOL ANTAZ OPH SOL 15ML

Facility

$109.45

Hospital Charge Code	6003891
Hospital Revenue Code	252
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

NAPHAZOLINE ANTAZOLINE OPH SOL

Facility

$64.65

Hospital Charge Code	60628075
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.33
Rate for Payer: Aetna Commercial	$24.57
Rate for Payer: Aetna Medicare Advantage	$19.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.49
Rate for Payer: Cigna Commercial	$32.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.39
Rate for Payer: Oxford Commercial	$12.93
Rate for Payer: Qualcare PPO/HMO/WC	$9.70
Rate for Payer: UnitedHealthcare Commercial	$12.93
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

NAPHAZOLINE ANTAZOLINE OPH SOL

Facility

$64.65

Hospital Charge Code	60628075
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$9.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.70

NAPHAZOLINE OPH SOL 0.012%

Facility

$119.25

Hospital Charge Code	60628074
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$59.62
Rate for Payer: Aetna Commercial	$45.31
Rate for Payer: Aetna Medicare Advantage	$35.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.41
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$23.85
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

NAPHAZOLINE OPH SOL 0.012%

Facility

$119.25

Hospital Charge Code	60628074
Hospital Revenue Code	250
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

NAPHAZOLINE OPH SOL .1% 15ML

Facility

$9.65

Hospital Charge Code	6003883
Hospital Revenue Code	252
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

NAPHAZOLINE OPH SOL .1% 15ML

Facility

$9.65

Hospital Charge Code	6003883
Hospital Revenue Code	252
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

NAPHAZOLINE-PHENIRAMINE OPH S

Facility

$127.37

Service Code	NDC 52959010703
Hospital Charge Code	60628837
Hospital Revenue Code	250
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$19.11
Rate for Payer: Qualcare PPO/HMO/WC	$19.11

NAPHAZOLINE-PHENIRAMINE OPH S

Facility

$127.37

Service Code	NDC 52959010703
Hospital Charge Code	60628837
Hospital Revenue Code	250
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.69
Rate for Payer: Aetna Commercial	$48.40
Rate for Payer: Aetna Medicare Advantage	$38.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.48
Rate for Payer: Cigna Commercial	$63.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.21
Rate for Payer: Oxford Commercial	$25.47
Rate for Payer: Qualcare PPO/HMO/WC	$19.11
Rate for Payer: UnitedHealthcare Commercial	$25.47
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

NAPHCON

Facility

$13.00

Hospital Charge Code	60634864
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

NAPHCON

Facility

$13.00

Hospital Charge Code	60634864
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

NAPHCON A/15ML

Facility

$48.00

Hospital Charge Code	60634550
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

NAPHCON A/15ML

Facility

$48.00

Hospital Charge Code	60634550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

NAPHCON FORTE 0.1% OPHTH

Facility

$71.00

Hospital Charge Code	60633493
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

NAPHCON FORTE 0.1% OPHTH

Facility

$71.00

Hospital Charge Code	60633493
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

NA POLYSTYRENE SULF PWDR 15GM

Facility

$90.52

Service Code	NDC 10702003615
Hospital Charge Code	606390210
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$13.58

NA POLYSTYRENE SULF PWDR 15GM

Facility

$90.52

Service Code	NDC 10702003615
Hospital Charge Code	606390210
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$45.26
Rate for Payer: Aetna Commercial	$34.40
Rate for Payer: Aetna Medicare Advantage	$27.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.08
Rate for Payer: Cigna Commercial	$45.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.16
Rate for Payer: Oxford Commercial	$18.10
Rate for Payer: Qualcare PPO/HMO/WC	$13.58
Rate for Payer: UnitedHealthcare Commercial	$18.10
Rate for Payer: UnitedHealthcare Community & State	$2.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

NAPROSYN/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

NAPROSYN/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633497
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

NAPROSYN/375MG/TAB

Facility

$6.00

Hospital Charge Code	60635876
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges