Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NXGN A/P WDG PRCT TIB PLT SZ 5

Facility

$13,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270686883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,980.00
Max. Negotiated Rate	$3,194.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,194.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,980.00

NXGN ARTSUR CD3-4 12MM LPSFLX

Facility

$5,862.10

Hospital Charge Code	270668703
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

NXGN ARTSUR CD3-4 12MM LPSFLX

Facility

$5,862.10

Hospital Charge Code	270668703
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

NXGN LCCK ART SURF GRN 23MM

Facility

$12,840.00

Service Code	HCPCS C1713
Hospital Charge Code	270686882
Hospital Revenue Code	278
Min. Negotiated Rate	$309.44
Max. Negotiated Rate	$6,420.00
Rate for Payer: Aetna Commercial	$4,879.20
Rate for Payer: Aetna Medicare Advantage	$3,852.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,274.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,274.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,274.20
Rate for Payer: Cigna Commercial	$6,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,107.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,824.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.00
Rate for Payer: UnitedHealthcare Community & State	$309.44
Rate for Payer: Wellpoint Medicaid Managed Care	$340.26

NXGN LCCK ART SURF GRN 23MM

Facility

$12,840.00

Service Code	HCPCS C1713
Hospital Charge Code	270686882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.00
Max. Negotiated Rate	$3,107.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,107.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,824.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.00

Nylon cart cover to fit 1436-3

Facility

$425.00

Hospital Charge Code	270665975
Hospital Revenue Code	270
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

Nylon cart cover to fit 1436-3

Facility

$425.00

Hospital Charge Code	270665975
Hospital Revenue Code	270
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

NYSTATIN 100000 U/ML UD

Facility

$8.44

Service Code	NDC 121478505
Hospital Charge Code	60628836
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

NYSTATIN 100000 U/ML UD

Facility

$8.44

Service Code	NDC 121478505
Hospital Charge Code	60628836
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna Commercial	$3.21
Rate for Payer: Aetna Medicare Advantage	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.15
Rate for Payer: Cigna Commercial	$4.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Oxford Commercial	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.27
Rate for Payer: UnitedHealthcare Commercial	$1.69
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

NYSTATIN 100000 UNT/GM OINT 15

Facility

$127.56

Hospital Charge Code	606350906
Hospital Revenue Code	250
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.78
Rate for Payer: Aetna Commercial	$48.47
Rate for Payer: Aetna Medicare Advantage	$38.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.53
Rate for Payer: Cigna Commercial	$63.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.27
Rate for Payer: Oxford Commercial	$25.51
Rate for Payer: Qualcare PPO/HMO/WC	$19.13
Rate for Payer: UnitedHealthcare Commercial	$25.51
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

NYSTATIN 100000 UNT/GM OINT 15

Facility

$127.56

Hospital Charge Code	606350906
Hospital Revenue Code	250
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$19.13
Rate for Payer: Qualcare PPO/HMO/WC	$19.13

NYSTATIN/100KU/1ML

Facility

$42.00

Hospital Charge Code	60633564
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

NYSTATIN/100KU/1ML

Facility

$42.00

Hospital Charge Code	60633564
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

NYSTATIN 500,000U/5ML

Facility

$4.00

Hospital Charge Code	60635511
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

NYSTATIN 500,000U/5ML

Facility

$4.00

Hospital Charge Code	60635511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NYSTATIN 500000 UNITS TAB

Facility

$4.00

Hospital Charge Code	60627250
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NYSTATIN 500000 UNITS TAB

Facility

$4.00

Hospital Charge Code	60627250
Hospital Revenue Code	251
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

NYSTATIN CRM TOP 100,000

Facility

$15.40

Hospital Charge Code	6010029
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

NYSTATIN CRM TOP 100,000

Facility

$15.40

Hospital Charge Code	6010029
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

NYSTATIN/LIDO 1:1 MAGIC MIX 10

Facility

$600.00

Hospital Charge Code	60629928
Hospital Revenue Code	250
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NYSTATIN/LIDO 1:1 MAGIC MIX 10

Facility

$600.00

Hospital Charge Code	60629928
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NYSTATIN LQ 100,000/1ML

Facility

$25.60

Hospital Charge Code	6009963
Hospital Revenue Code	251
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

NYSTATIN LQ 100,000/1ML

Facility

$25.60

Hospital Charge Code	6009963
Hospital Revenue Code	251
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

NYSTATIN OINT 100MU

Facility

$175.88

Service Code	NDC 472016630
Hospital Charge Code	60628343
Hospital Revenue Code	250
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$87.94
Rate for Payer: Aetna Commercial	$66.83
Rate for Payer: Aetna Medicare Advantage	$52.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.85
Rate for Payer: Cigna Commercial	$87.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.76
Rate for Payer: Oxford Commercial	$35.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.38
Rate for Payer: UnitedHealthcare Commercial	$35.18
Rate for Payer: UnitedHealthcare Community & State	$4.24
Rate for Payer: Wellpoint Medicaid Managed Care	$4.66

NYSTATIN OINT 100MU

Facility

$175.88

Service Code	NDC 472016630
Hospital Charge Code	60628343
Hospital Revenue Code	250
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$26.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.38

Know your out-of-pocket cost for care.

All Charges