Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PAD STERILE GAUZE SPONGE

Facility

$12.10

Hospital Charge Code	270655052
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.05
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Aetna Medicare Advantage	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.42
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

PAD STERILE GAUZE SPONGE

Facility

$12.10

Hospital Charge Code	270655052
Hospital Revenue Code	270
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

PAD TRENDELENBURG/ TABLE GEL

Facility

$255.04

Hospital Charge Code	270664519
Hospital Revenue Code	270
Min. Negotiated Rate	$38.26
Max. Negotiated Rate	$38.26
Rate for Payer: Qualcare PPO/HMO/WC	$38.26

PAD TRENDELENBURG/ TABLE GEL

Facility

$255.04

Hospital Charge Code	270664519
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$127.52
Rate for Payer: Aetna Commercial	$96.92
Rate for Payer: Aetna Medicare Advantage	$76.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$127.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.51
Rate for Payer: Oxford Commercial	$51.01
Rate for Payer: Qualcare PPO/HMO/WC	$38.26
Rate for Payer: UnitedHealthcare Commercial	$51.01
Rate for Payer: UnitedHealthcare Community & State	$6.15
Rate for Payer: Wellpoint Medicaid Managed Care	$6.76

PAD VL ELECTRODE

Facility

$13.98

Hospital Charge Code	270061155
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

PAD VL ELECTRODE

Facility

$13.98

Hospital Charge Code	270061155
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.99
Rate for Payer: Aetna Commercial	$5.31
Rate for Payer: Aetna Medicare Advantage	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.56
Rate for Payer: Cigna Commercial	$6.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.19
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

PAD WITCH HAZEL (TUCKS)

Facility

$4.00

Hospital Charge Code	270301315
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PAD WITCH HAZEL (TUCKS)

Facility

$4.00

Hospital Charge Code	270301315
Hospital Revenue Code	270
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

PAI-1

Facility

$897.05

Service Code	HCPCS 85415
Hospital Charge Code	401048415
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$448.52
Rate for Payer: Aetna Commercial	$46.76
Rate for Payer: Aetna Medicare Advantage	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.05
Rate for Payer: Cigna Commercial	$448.52
Rate for Payer: Cigna Medicare Advantage	$17.19
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.19
Rate for Payer: Wellcare Medicare Advantage	$17.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

PAI-1

Facility

$897.05

Service Code	HCPCS 85415
Hospital Charge Code	401048415
Hospital Revenue Code	301
Min. Negotiated Rate	$134.56
Max. Negotiated Rate	$134.56
Rate for Payer: Qualcare PPO/HMO/WC	$134.56

PAIN,MEPERIDINE,QN,U

Facility

$133.70

Service Code	HCPCS 80300
Hospital Charge Code	39900114
Hospital Revenue Code	301
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

PAIN,MEPERIDINE,QN,U

Facility

$133.70

Service Code	HCPCS 80300
Hospital Charge Code	39900114
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.81
Rate for Payer: Aetna Medicare Advantage	$40.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.09
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

PAJAMA ADULT

Facility

$11.25

Hospital Charge Code	270658720
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PAJAMA ADULT

Facility

$11.25

Hospital Charge Code	270658720
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

PAK INTREPID ULTRASLEEVE .9MM

Facility

$1,090.00

Hospital Charge Code	270670985
Hospital Revenue Code	272
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Qualcare PPO/HMO/WC	$163.50

PAK INTREPID ULTRASLEEVE .9MM

Facility

$1,090.00

Hospital Charge Code	270670985
Hospital Revenue Code	272
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$545.00
Rate for Payer: Aetna Commercial	$414.20
Rate for Payer: Aetna Medicare Advantage	$327.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$277.95
Rate for Payer: Cigna Commercial	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.00
Rate for Payer: Oxford Commercial	$218.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.50
Rate for Payer: UnitedHealthcare Commercial	$218.00
Rate for Payer: UnitedHealthcare Community & State	$26.27
Rate for Payer: Wellpoint Medicaid Managed Care	$28.89

PALACO BONE CEMENT

Facility

$885.00

Hospital Charge Code	270657659
Hospital Revenue Code	278
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$214.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$194.70
Rate for Payer: Qualcare PPO/HMO/WC	$132.75

PALACO BONE CEMENT

Facility

$885.00

Hospital Charge Code	270657659
Hospital Revenue Code	278
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna Commercial	$336.30
Rate for Payer: Aetna Medicare Advantage	$265.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.68
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$194.70
Rate for Payer: Qualcare PPO/HMO/WC	$132.75
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$23.45

PALACO R 1CX40 CEMENT

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	270635157
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$98.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.10
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

PALACO R 1CX40 CEMENT

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	270635157
Hospital Revenue Code	278
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.10
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

PALACOS R+G 1X40 SINGLE (W GEN

Facility

$2,000.05

Hospital Charge Code	270657051
Hospital Revenue Code	278
Min. Negotiated Rate	$300.01
Max. Negotiated Rate	$484.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01

PALACOS R+G 1X40 SINGLE (W GEN

Facility

$2,000.05

Hospital Charge Code	270657051
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.02
Rate for Payer: Aetna Commercial	$760.02
Rate for Payer: Aetna Medicare Advantage	$600.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.01
Rate for Payer: Cigna Commercial	$1,000.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PALACOS R+G 1X40 SINGLE WITH G

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270657049
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PALACOS R+G 1X40 SINGLE WITH G

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270657049
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PALACOS R+G SINGLE 1 X 40

Facility

$2,000.00

Hospital Charge Code	270658749
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges