Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PELVIC LONG STERILE SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270681643
Hospital Revenue Code	278
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

PELVIC LONG STERILE SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270681643
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$75.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

PELVIS 1-2 VIEW

Facility

$5,100.00

Service Code	HCPCS 72170
Hospital Charge Code	94061089
Hospital Revenue Code	320
Min. Negotiated Rate	$31.94
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

PELVIS 1-2 VIEW

Facility

$5,100.00

Service Code	HCPCS 72170
Hospital Charge Code	94061089
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

PELVIS COMPLETE

Facility

$5,100.00

Service Code	HCPCS 72190
Hospital Charge Code	94061091
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

PELVIS COMPLETE

Facility

$5,100.00

Service Code	HCPCS 72190
Hospital Charge Code	94061091
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

PELVIS W/PO CONTRAST ONLY

Facility

$9,500.00

Service Code	HCPCS 72192
Hospital Charge Code	2200152
Hospital Revenue Code	352
Min. Negotiated Rate	$86.94
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$306.90
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

PELVIS W/PO CONTRAST ONLY

Facility

$9,500.00

Service Code	HCPCS 72192
Hospital Charge Code	2200152
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

PEMETREXED 500 MG VIAL

Facility

$24,192.36

Service Code	HCPCS J9305
Hospital Charge Code	60629356
Hospital Revenue Code	636
Min. Negotiated Rate	$3,628.85
Max. Negotiated Rate	$5,854.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,854.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,628.85

PEMETREXED 500 MG VIAL

Facility

$24,192.36

Service Code	HCPCS J9305
Hospital Charge Code	60629356
Hospital Revenue Code	636
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$5,854.55
Rate for Payer: Aetna Commercial	$10.99
Rate for Payer: Aetna Medicare Advantage	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.58
Rate for Payer: Cigna Medicare Advantage	$4.04
Rate for Payer: Clover Medicare Advantage	$3.84
Rate for Payer: EmblemHealth Commercial	$12.12
Rate for Payer: Humana Medicare Advantage	$4.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,854.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,628.85
Rate for Payer: UnitedHealthcare Community & State	$583.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.04
Rate for Payer: Wellcare Medicare Advantage	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$641.10

PEMETREXED DISODIUM 100MG INJ

Facility

$20,424.05

Hospital Charge Code	6063943162
Hospital Revenue Code	636
Min. Negotiated Rate	$3,063.61
Max. Negotiated Rate	$4,942.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,942.62
Rate for Payer: Qualcare PPO/HMO/WC	$3,063.61

PEMETREXED DISODIUM 100MG INJ

Facility

$20,424.05

Hospital Charge Code	6063943162
Hospital Revenue Code	636
Min. Negotiated Rate	$492.22
Max. Negotiated Rate	$10,212.02
Rate for Payer: Aetna Commercial	$7,761.14
Rate for Payer: Aetna Medicare Advantage	$6,127.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,208.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,208.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,208.13
Rate for Payer: Cigna Commercial	$10,212.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,942.62
Rate for Payer: Qualcare PPO/HMO/WC	$3,063.61
Rate for Payer: UnitedHealthcare Community & State	$492.22
Rate for Payer: Wellpoint Medicaid Managed Care	$541.24

PEMOLINE 18.75 MG TAB

Facility

$7.25

Hospital Charge Code	60627837
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PEMOLINE 18.75 MG TAB

Facility

$7.25

Hospital Charge Code	60627837
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

PEN BOVIE SMOKE EVAC 125MM

Facility

$34.15

Hospital Charge Code	270677963
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PEN BOVIE SMOKE EVAC 125MM

Facility

$34.15

Hospital Charge Code	270677963
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$12.98
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.24
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.83
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

PEN BOVIE SMOKE EVAC 165MM

Facility

$34.15

Hospital Charge Code	270677964
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PEN BOVIE SMOKE EVAC 165MM

Facility

$34.15

Hospital Charge Code	270677964
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$12.98
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.24
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.83
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

PEN BOVIE SMOKE EVAC 70MM

Facility

$34.15

Hospital Charge Code	270677962
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$12.98
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.24
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.83
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

PEN BOVIE SMOKE EVAC 70MM

Facility

$34.15

Hospital Charge Code	270677962
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: Aetna Medicare Advantage	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.97
Rate for Payer: Cigna Commercial	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Oxford Commercial	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.33
Rate for Payer: UnitedHealthcare Commercial	$3.11
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

PENCIL ELECTROSURGICAL

Facility

$16.05

Hospital Charge Code	270061165N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.03
Rate for Payer: Aetna Commercial	$6.10
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.09
Rate for Payer: Cigna Commercial	$8.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.82
Rate for Payer: Oxford Commercial	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

PENCIL ELECTROSURGICAL

Facility

$16.05

Hospital Charge Code	270061165N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165
Hospital Revenue Code	270
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

Know your out-of-pocket cost for care.

All Charges