Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
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

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$423.75
Max. Negotiated Rate	$683.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$621.50
Rate for Payer: Qualcare PPO/HMO/WC	$423.75

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$1,412.50
Rate for Payer: Aetna Commercial	$1,073.50
Rate for Payer: Aetna Medicare Advantage	$847.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$720.38
Rate for Payer: Cigna Commercial	$1,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$621.50
Rate for Payer: Qualcare PPO/HMO/WC	$423.75
Rate for Payer: UnitedHealthcare Community & State	$68.08
Rate for Payer: Wellpoint Medicaid Managed Care	$74.86

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$226.54
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,068.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Community & State	$226.54
Rate for Payer: Wellpoint Medicaid Managed Care	$249.10

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,274.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,068.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$1,131.92
Max. Negotiated Rate	$23,483.90
Rate for Payer: Aetna Commercial	$17,847.76
Rate for Payer: Aetna Medicare Advantage	$14,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,976.79
Rate for Payer: Cigna Commercial	$23,483.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,332.92
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17
Rate for Payer: UnitedHealthcare Community & State	$1,131.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1,244.65

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$7,045.17
Max. Negotiated Rate	$11,366.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,332.92
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17

PHASIX ST MESH

Facility

$35,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270686889
Hospital Revenue Code	278
Min. Negotiated Rate	$854.35
Max. Negotiated Rate	$17,725.00
Rate for Payer: Aetna Commercial	$13,471.00
Rate for Payer: Aetna Medicare Advantage	$10,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,039.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,039.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,039.75
Rate for Payer: Cigna Commercial	$17,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,578.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,799.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,317.50
Rate for Payer: UnitedHealthcare Community & State	$854.35
Rate for Payer: Wellpoint Medicaid Managed Care	$939.42

PHASIX ST MESH

Facility

$35,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270686889
Hospital Revenue Code	278
Min. Negotiated Rate	$5,317.50
Max. Negotiated Rate	$8,578.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,578.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,799.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,317.50

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,564.38
Max. Negotiated Rate	$5,750.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,227.75
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$572.68
Max. Negotiated Rate	$11,881.25
Rate for Payer: Aetna Commercial	$9,029.75
Rate for Payer: Aetna Medicare Advantage	$7,128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,059.44
Rate for Payer: Cigna Commercial	$11,881.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,227.75
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38
Rate for Payer: UnitedHealthcare Community & State	$572.68
Rate for Payer: Wellpoint Medicaid Managed Care	$629.71

PHASIX ST MESH 25X30

Facility

$106,755.00

Hospital Charge Code	270703542
Hospital Revenue Code	278
Min. Negotiated Rate	$16,013.25
Max. Negotiated Rate	$25,834.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,834.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,486.10
Rate for Payer: Qualcare PPO/HMO/WC	$16,013.25

PHASIX ST MESH 25X30

Facility

$106,755.00

Hospital Charge Code	270703542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,572.80
Max. Negotiated Rate	$53,377.50
Rate for Payer: Aetna Commercial	$40,566.90
Rate for Payer: Aetna Medicare Advantage	$32,026.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,222.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,222.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,222.53
Rate for Payer: Cigna Commercial	$53,377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,834.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,486.10
Rate for Payer: Qualcare PPO/HMO/WC	$16,013.25
Rate for Payer: UnitedHealthcare Community & State	$2,572.80
Rate for Payer: Wellpoint Medicaid Managed Care	$2,829.01

PHASIX ST MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,274.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,068.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PHASIX ST MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
Hospital Revenue Code	278
Min. Negotiated Rate	$226.54
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,068.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Community & State	$226.54
Rate for Payer: Wellpoint Medicaid Managed Care	$249.10

PHASIX ST MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$2,208.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,007.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

PHASIX ST MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$3,467.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,007.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75
Rate for Payer: UnitedHealthcare Community & State	$219.91
Rate for Payer: Wellpoint Medicaid Managed Care	$241.81

PHAZYME/60MG/TAB

Facility

$1.00

Hospital Charge Code	60633648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PHAZYME/60MG/TAB

Facility

$1.00

Hospital Charge Code	60633648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

PHAZYME 95/95MG/TAB

Facility

$3.00

Hospital Charge Code	60633649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHAZYME 95/95MG/TAB

Facility

$3.00

Hospital Charge Code	60633649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges