Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PILLOW ABDUCTION SM

Facility

$147.64

Hospital Charge Code	270600340
Hospital Revenue Code	270
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$22.15
Rate for Payer: Qualcare PPO/HMO/WC	$22.15

PILLOW ABDUCTION SMALL

Facility

$92.29

Hospital Charge Code	270651036
Hospital Revenue Code	272
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna Commercial	$35.07
Rate for Payer: Aetna Medicare Advantage	$27.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.53
Rate for Payer: Cigna Commercial	$46.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.69
Rate for Payer: Oxford Commercial	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$13.84
Rate for Payer: UnitedHealthcare Commercial	$18.46
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

PILLOW ABDUCTION SMALL

Facility

$92.29

Hospital Charge Code	270651036
Hospital Revenue Code	272
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$13.84
Rate for Payer: Qualcare PPO/HMO/WC	$13.84

PILLOW FOOT

Facility

$72.45

Hospital Charge Code	270302940
Hospital Revenue Code	271
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$10.87
Rate for Payer: Qualcare PPO/HMO/WC	$10.87

PILLOW FOOT

Facility

$72.45

Hospital Charge Code	270302940
Hospital Revenue Code	271
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$36.23
Rate for Payer: Aetna Commercial	$27.53
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$36.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.73
Rate for Payer: Oxford Commercial	$14.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.87
Rate for Payer: UnitedHealthcare Commercial	$14.49
Rate for Payer: UnitedHealthcare Community & State	$1.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

PILLOW SHOULDER ABDUCTN LG

Facility

$158.70

Hospital Charge Code	270652248
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$23.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.80

PILLOW SHOULDER ABDUCTN LG

Facility

$158.70

Hospital Charge Code	270652248
Hospital Revenue Code	272
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$79.35
Rate for Payer: Aetna Commercial	$60.31
Rate for Payer: Aetna Medicare Advantage	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.47
Rate for Payer: Cigna Commercial	$79.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.61
Rate for Payer: Oxford Commercial	$31.74
Rate for Payer: Qualcare PPO/HMO/WC	$23.80
Rate for Payer: UnitedHealthcare Commercial	$31.74
Rate for Payer: UnitedHealthcare Community & State	$3.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

PILLOW SHOULDER ABDUCTN MED

Facility

$156.95

Hospital Charge Code	270652246
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$78.47
Rate for Payer: Aetna Commercial	$59.64
Rate for Payer: Aetna Medicare Advantage	$47.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.02
Rate for Payer: Cigna Commercial	$78.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.09
Rate for Payer: Oxford Commercial	$31.39
Rate for Payer: Qualcare PPO/HMO/WC	$23.54
Rate for Payer: UnitedHealthcare Commercial	$31.39
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

PILLOW SHOULDER ABDUCTN MED

Facility

$156.95

Hospital Charge Code	270652246
Hospital Revenue Code	272
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$23.54
Rate for Payer: Qualcare PPO/HMO/WC	$23.54

PILOCAR 1% OPHTH/1ML

Facility

$13.00

Hospital Charge Code	60633664
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

PILOCAR 1% OPHTH/1ML

Facility

$13.00

Hospital Charge Code	60633664
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PILOCAR 6% EPI 1% OPTH

Facility

$23.00

Hospital Charge Code	60635275
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PILOCAR 6% EPI 1% OPTH

Facility

$23.00

Hospital Charge Code	60635275
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

PILOCAR DROPPERETTES 2% O

Facility

$15.00

Hospital Charge Code	60633663
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

PILOCAR DROPPERETTES 2% O

Facility

$15.00

Hospital Charge Code	60633663
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PILOCARPINE 0.5%

Facility

$28.00

Hospital Charge Code	60634766
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

PILOCARPINE 0.5%

Facility

$28.00

Hospital Charge Code	60634766
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

PILOCARPINE-2 EPINEP-1 SOL OPH

Facility

$195.25

Hospital Charge Code	60628057
Hospital Revenue Code	250
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$29.29
Rate for Payer: Qualcare PPO/HMO/WC	$29.29

PILOCARPINE-2 EPINEP-1 SOL OPH

Facility

$195.25

Hospital Charge Code	60628057
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$97.62
Rate for Payer: Aetna Commercial	$74.19
Rate for Payer: Aetna Medicare Advantage	$58.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.79
Rate for Payer: Cigna Commercial	$97.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.58
Rate for Payer: Oxford Commercial	$39.05
Rate for Payer: Qualcare PPO/HMO/WC	$29.29
Rate for Payer: UnitedHealthcare Commercial	$39.05
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

PILOCARPINE-3 EPINEP-1 SOL OPH

Facility

$205.65

Hospital Charge Code	60628058
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$102.83
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$41.13
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

PILOCARPINE-3 EPINEP-1 SOL OPH

Facility

$205.65

Hospital Charge Code	60628058
Hospital Revenue Code	250
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

PILOCARPINE-4 EPINEP-1 SOL OPH

Facility

$218.45

Hospital Charge Code	60628059
Hospital Revenue Code	250
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

PILOCARPINE-4 EPINEP-1 SOL OPH

Facility

$218.45

Hospital Charge Code	60628059
Hospital Revenue Code	250
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$109.22
Rate for Payer: Aetna Commercial	$83.01
Rate for Payer: Aetna Medicare Advantage	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.70
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$43.69
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$43.69
Rate for Payer: UnitedHealthcare Community & State	$5.26
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

PILOCARPINE OPHT 1% 15ML

Facility

$660.35

Service Code	NDC 61314020315
Hospital Charge Code	6004352
Hospital Revenue Code	251
Min. Negotiated Rate	$99.05
Max. Negotiated Rate	$99.05
Rate for Payer: Qualcare PPO/HMO/WC	$99.05

PILOCARPINE OPHT 1% 15ML

Facility

$660.35

Service Code	NDC 61314020315
Hospital Charge Code	6004352
Hospital Revenue Code	251
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.18
Rate for Payer: Aetna Commercial	$250.93
Rate for Payer: Aetna Medicare Advantage	$198.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.39
Rate for Payer: Cigna Commercial	$330.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.10
Rate for Payer: Oxford Commercial	$132.07
Rate for Payer: Qualcare PPO/HMO/WC	$99.05
Rate for Payer: UnitedHealthcare Commercial	$132.07
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.50

Know your out-of-pocket cost for care.

All Charges