Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

PHARMACOKINETIC CONSULTATION

Facility

$215.05

Hospital Charge Code	6010102
Hospital Revenue Code	949
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$81.72
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.52
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

PHARMACOKINETIC CONSULTATION

Facility

$215.05

Hospital Charge Code	6010102
Hospital Revenue Code	949
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

PHARMACOKINETIC FOLLOW-UP

Facility

$90.90

Hospital Charge Code	6010110
Hospital Revenue Code	949
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.27
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

PHARMACOKINETIC FOLLOW-UP

Facility

$90.90

Hospital Charge Code	6010110
Hospital Revenue Code	949
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

PHARMACOLOGICAL MANAGEMENT

Facility

$428.58

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$214.29
Rate for Payer: Aetna Commercial	$162.86
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.29
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

PHARMACOLOGICAL MANAGEMENT

Facility

$428.58

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

PHARMACOLOGIC MANAGEMENT

Facility

$474.90

Service Code	HCPCS 90862
Hospital Charge Code	9310120
Hospital Revenue Code	914
Min. Negotiated Rate	$71.23
Max. Negotiated Rate	$71.23
Rate for Payer: Qualcare PPO/HMO/WC	$71.23

PHARMACOLOGIC MANAGEMENT

Facility

$474.90

Service Code	HCPCS 90862
Hospital Charge Code	9310120
Hospital Revenue Code	914
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.45
Rate for Payer: Aetna Commercial	$180.46
Rate for Payer: Aetna Medicare Advantage	$142.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.10
Rate for Payer: Cigna Commercial	$237.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.47
Rate for Payer: Qualcare PPO/HMO/WC	$71.23
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.58

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	270695944
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.70
Max. Negotiated Rate	$24,018.75
Rate for Payer: Aetna Commercial	$18,254.25
Rate for Payer: Aetna Medicare Advantage	$14,411.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,249.56
Rate for Payer: Cigna Commercial	$24,018.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,568.25
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62
Rate for Payer: UnitedHealthcare Community & State	$1,157.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,272.99

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	27069544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.70
Max. Negotiated Rate	$24,018.75
Rate for Payer: Aetna Commercial	$18,254.25
Rate for Payer: Aetna Medicare Advantage	$14,411.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,249.56
Rate for Payer: Cigna Commercial	$24,018.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,568.25
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62
Rate for Payer: UnitedHealthcare Community & State	$1,157.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,272.99

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	27069544
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$11,625.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,568.25
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	270695944
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$11,625.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,568.25
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$71.09
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$71.09
Rate for Payer: Wellpoint Medicaid Managed Care	$78.17

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$69.29
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$1,092.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.50
Rate for Payer: Qualcare PPO/HMO/WC	$431.25
Rate for Payer: UnitedHealthcare Community & State	$69.29
Rate for Payer: Wellpoint Medicaid Managed Care	$76.19

Know your out-of-pocket cost for care.

All Charges