Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BACITRACIN OINTMENT 15 GM

Facility

$16.00

Hospital Charge Code	60635663
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BACITRACIN OINT PKT

Facility

$4.00

Service Code	NDC 168011109
Hospital Charge Code	60628321
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

BACITRACIN OINT PKT

Facility

$1.95

Hospital Charge Code	6022164
Hospital Revenue Code	257
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

BACITRACIN OINT PKT

Facility

$4.00

Service Code	NDC 168011109
Hospital Charge Code	60628321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACITRACIN OINT PKT

Facility

$1.95

Hospital Charge Code	6022164
Hospital Revenue Code	257
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

BACITRACIN OINT TUBE 28GM

Facility

$7.70

Hospital Charge Code	6012256
Hospital Revenue Code	251
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

BACITRACIN OINT TUBE 28GM

Facility

$7.70

Hospital Charge Code	6012256
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$37.24
Max. Negotiated Rate	$37.24
Rate for Payer: Qualcare PPO/HMO/WC	$37.24

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.12
Rate for Payer: Aetna Commercial	$94.33
Rate for Payer: Aetna Medicare Advantage	$74.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.30
Rate for Payer: Cigna Commercial	$124.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.47
Rate for Payer: Oxford Commercial	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.24
Rate for Payer: UnitedHealthcare Commercial	$49.65
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.58

BACITRACIN PACKETS

Facility

$1.00

Hospital Charge Code	60634960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BACITRACIN PACKETS

Facility

$1.00

Hospital Charge Code	60634960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BACITRACIN POLY

Facility

$15.40

Hospital Charge Code	6008221
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

BACITRACIN POLY

Facility

$15.40

Hospital Charge Code	6008221
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.09
Rate for Payer: Aetna Commercial	$65.43
Rate for Payer: Aetna Medicare Advantage	$51.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.91
Rate for Payer: Cigna Commercial	$86.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.66
Rate for Payer: Oxford Commercial	$34.44
Rate for Payer: Qualcare PPO/HMO/WC	$25.83
Rate for Payer: UnitedHealthcare Commercial	$34.44
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$25.83
Max. Negotiated Rate	$25.83
Rate for Payer: Qualcare PPO/HMO/WC	$25.83

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$335.67
Max. Negotiated Rate	$335.67
Rate for Payer: Qualcare PPO/HMO/WC	$335.67

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$53.93
Max. Negotiated Rate	$1,118.90
Rate for Payer: Aetna Commercial	$850.36
Rate for Payer: Aetna Medicare Advantage	$671.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.64
Rate for Payer: Cigna Commercial	$1,118.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.34
Rate for Payer: Oxford Commercial	$447.56
Rate for Payer: Qualcare PPO/HMO/WC	$335.67
Rate for Payer: UnitedHealthcare Commercial	$447.56
Rate for Payer: UnitedHealthcare Community & State	$53.93
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$66,783.85

Service Code	MSDRG 519
Min. Negotiated Rate	$20,334.83
Max. Negotiated Rate	$66,783.85
Rate for Payer: Aetna Commercial	$46,145.46
Rate for Payer: Aetna Medicare Advantage	$66,783.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,824.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,824.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,405.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,824.17
Rate for Payer: Cigna Commercial	$37,431.74
Rate for Payer: Cigna Medicare Advantage	$21,405.08
Rate for Payer: Clover Medicare Advantage	$20,334.83
Rate for Payer: EmblemHealth Commercial	$64,215.24
Rate for Payer: Humana Medicare Advantage	$22,047.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,405.08
Rate for Payer: Oxford Commercial	$26,902.69
Rate for Payer: UnitedHealthcare Commercial	$47,174.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,405.08
Rate for Payer: Wellcare Medicare Advantage	$21,405.08

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$122,929.81

Service Code	MSDRG 518
Min. Negotiated Rate	$37,430.55
Max. Negotiated Rate	$122,929.81
Rate for Payer: Aetna Commercial	$84,724.14
Rate for Payer: Aetna Medicare Advantage	$122,929.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84,902.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84,902.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$39,400.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84,902.65
Rate for Payer: Cigna Commercial	$69,939.83
Rate for Payer: Cigna Medicare Advantage	$39,400.58
Rate for Payer: Clover Medicare Advantage	$37,430.55
Rate for Payer: EmblemHealth Commercial	$118,201.74
Rate for Payer: Humana Medicare Advantage	$40,582.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$39,400.58
Rate for Payer: Oxford Commercial	$50,266.68
Rate for Payer: UnitedHealthcare Commercial	$88,144.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$39,400.58
Rate for Payer: Wellcare Medicare Advantage	$39,400.58

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$50,419.42

Service Code	MSDRG 520
Min. Negotiated Rate	$15,352.07
Max. Negotiated Rate	$50,419.42
Rate for Payer: Aetna Commercial	$34,901.22
Rate for Payer: Aetna Medicare Advantage	$50,419.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,263.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,263.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,160.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,263.23
Rate for Payer: Cigna Commercial	$27,956.84
Rate for Payer: Cigna Medicare Advantage	$16,160.07
Rate for Payer: Clover Medicare Advantage	$15,352.07
Rate for Payer: EmblemHealth Commercial	$48,480.21
Rate for Payer: Humana Medicare Advantage	$16,644.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,160.07
Rate for Payer: Oxford Commercial	$20,092.96
Rate for Payer: UnitedHealthcare Commercial	$35,233.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,160.07
Rate for Payer: Wellcare Medicare Advantage	$16,160.07

BACKBITER 3.4 MM

Facility

$5,712.95

Hospital Charge Code	270665785
Hospital Revenue Code	270
Min. Negotiated Rate	$137.68
Max. Negotiated Rate	$2,856.47
Rate for Payer: Aetna Commercial	$2,170.92
Rate for Payer: Aetna Medicare Advantage	$1,713.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,456.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,456.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,456.80
Rate for Payer: Cigna Commercial	$2,856.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.88
Rate for Payer: Oxford Commercial	$1,142.59
Rate for Payer: Qualcare PPO/HMO/WC	$856.94
Rate for Payer: UnitedHealthcare Commercial	$1,142.59
Rate for Payer: UnitedHealthcare Community & State	$137.68
Rate for Payer: Wellpoint Medicaid Managed Care	$151.39

BACKBITER 3.4 MM

Facility

$5,712.95

Hospital Charge Code	270665785
Hospital Revenue Code	270
Min. Negotiated Rate	$856.94
Max. Negotiated Rate	$856.94
Rate for Payer: Qualcare PPO/HMO/WC	$856.94

BACK/SEAT SECTION TLT PADS

Facility

$2,528.05

Hospital Charge Code	270656356
Hospital Revenue Code	272
Min. Negotiated Rate	$60.93
Max. Negotiated Rate	$1,264.03
Rate for Payer: Aetna Commercial	$960.66
Rate for Payer: Aetna Medicare Advantage	$758.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$644.65
Rate for Payer: Cigna Commercial	$1,264.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.41
Rate for Payer: Oxford Commercial	$505.61
Rate for Payer: Qualcare PPO/HMO/WC	$379.21
Rate for Payer: UnitedHealthcare Commercial	$505.61
Rate for Payer: UnitedHealthcare Community & State	$60.93
Rate for Payer: Wellpoint Medicaid Managed Care	$66.99

Know your out-of-pocket cost for care.

All Charges