Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BACTRIM DS/TAB

Facility

$12.00

Hospital Charge Code	60632527
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

BACTRIM DS/TAB

Facility

$12.00

Hospital Charge Code	60632527
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

BACTROBAN, 2% CREAM

Facility

$37.00

Hospital Charge Code	60635447
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

BACTROBAN, 2% CREAM

Facility

$37.00

Hospital Charge Code	60635447
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$7.40
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

BACTROBAN,2% CREAM

Facility

$37.00

Hospital Charge Code	60635453
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

BACTROBAN,2% CREAM

Facility

$37.00

Hospital Charge Code	60635453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$7.40
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$50.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$50.20
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
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

BAER EVOKED POTENTIAL AUDITORY

Facility

$672.00

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

BAER EVOKED POTENTIAL AUDITORY

Facility

$672.00

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$255.36
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$16.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAG 605697*****

Facility

$40.20

Hospital Charge Code	270605697
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

BAG 605697*****

Facility

$40.20

Hospital Charge Code	270605697
Hospital Revenue Code	272
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.06
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

BAG AEROSOL DRAINAGE WYE ADAPT

Facility

$223.85

Hospital Charge Code	270651477
Hospital Revenue Code	270
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$111.92
Rate for Payer: Aetna Commercial	$85.06
Rate for Payer: Aetna Medicare Advantage	$67.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.08
Rate for Payer: Cigna Commercial	$111.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.16
Rate for Payer: Oxford Commercial	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$33.58
Rate for Payer: UnitedHealthcare Commercial	$44.77
Rate for Payer: UnitedHealthcare Community & State	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

BAG AEROSOL DRAINAGE WYE ADAPT

Facility

$223.85

Hospital Charge Code	270651477
Hospital Revenue Code	270
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$33.58
Rate for Payer: Qualcare PPO/HMO/WC	$33.58

BAG-A-JET

Facility

$3.70

Hospital Charge Code	270060055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna Commercial	$1.41
Rate for Payer: Aetna Medicare Advantage	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.94
Rate for Payer: Cigna Commercial	$1.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.11
Rate for Payer: Oxford Commercial	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$0.74
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

BAG-A-JET

Facility

$3.70

Hospital Charge Code	270060055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

BAG ALCON SURGICAL ******

Facility

$46.00

Hospital Charge Code	1608215
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

BAG ALCON SURGICAL ******

Facility

$46.00

Hospital Charge Code	1608215
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

BAG AMBU INFANT

Facility

$47.73

Hospital Charge Code	270651479
Hospital Revenue Code	270
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.16

Know your out-of-pocket cost for care.

All Charges