Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PISTONS SCHUKT 0.6X4.75 140127

Facility

$457.15

Hospital Charge Code	270620112
Hospital Revenue Code	278
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$228.57
Rate for Payer: Aetna Commercial	$173.72
Rate for Payer: Aetna Medicare Advantage	$137.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.57
Rate for Payer: Cigna Commercial	$228.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.57
Rate for Payer: Qualcare PPO/HMO/WC	$68.57
Rate for Payer: UnitedHealthcare Community & State	$11.02
Rate for Payer: Wellpoint Medicaid Managed Care	$12.11

PITCHER W/LID 36 OZ

Facility

$4.00

Hospital Charge Code	270300501
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PITCHER W/LID 36 OZ

Facility

$4.00

Hospital Charge Code	270300501
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

PITOCIN/10U/1ML

Facility

$7.00

Hospital Charge Code	60633667
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PITOCIN/10U/1ML

Facility

$15.00

Hospital Charge Code	60633666
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

PITOCIN/10U/1ML

Facility

$15.00

Hospital Charge Code	60633666
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PITOCIN/10U/1ML

Facility

$7.00

Hospital Charge Code	60633667
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PITOCIN 10U IN LR 1L

Facility

$9,031.60

Service Code	NDC 61553076904
Hospital Charge Code	60635522
Hospital Revenue Code	250
Min. Negotiated Rate	$217.66
Max. Negotiated Rate	$4,515.80
Rate for Payer: Aetna Commercial	$3,432.01
Rate for Payer: Aetna Medicare Advantage	$2,709.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,303.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,303.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,303.06
Rate for Payer: Cigna Commercial	$4,515.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,709.48
Rate for Payer: Oxford Commercial	$1,806.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.74
Rate for Payer: UnitedHealthcare Commercial	$1,806.32
Rate for Payer: UnitedHealthcare Community & State	$217.66
Rate for Payer: Wellpoint Medicaid Managed Care	$239.34

PITOCIN 10U IN LR 1L

Facility

$9,031.60

Service Code	NDC 61553076904
Hospital Charge Code	60635522
Hospital Revenue Code	250
Min. Negotiated Rate	$1,354.74
Max. Negotiated Rate	$1,354.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.74

PITOCIN 10 UNITS****

Facility

$31.00

Service Code	HCPCS J2590
Hospital Charge Code	6008189
Hospital Revenue Code	259
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PITOCIN 10 UNITS****

Facility

$31.00

Service Code	HCPCS J2590
Hospital Charge Code	6008189
Hospital Revenue Code	259
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.30
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$6.20
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$14.00
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$7.37
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$485.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.12
Rate for Payer: Qualcare PPO/HMO/WC	$300.76

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$1,002.55
Rate for Payer: Aetna Commercial	$761.94
Rate for Payer: Aetna Medicare Advantage	$601.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.30
Rate for Payer: Cigna Commercial	$1,002.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.12
Rate for Payer: Qualcare PPO/HMO/WC	$300.76
Rate for Payer: UnitedHealthcare Community & State	$48.32
Rate for Payer: Wellpoint Medicaid Managed Care	$53.14

PK CUSTOM LAP CHOLE SLC11LPBYC

Facility

$283.25

Hospital Charge Code	270632135
Hospital Revenue Code	272
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.62
Rate for Payer: Aetna Commercial	$107.64
Rate for Payer: Aetna Medicare Advantage	$84.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.23
Rate for Payer: Cigna Commercial	$141.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.97
Rate for Payer: Oxford Commercial	$56.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.49
Rate for Payer: UnitedHealthcare Commercial	$56.65
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

PK CUSTOM LAP CHOLE SLC11LPBYC

Facility

$283.25

Hospital Charge Code	270632135
Hospital Revenue Code	272
Min. Negotiated Rate	$42.49
Max. Negotiated Rate	$42.49
Rate for Payer: Qualcare PPO/HMO/WC	$42.49

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$164.50
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.70
Rate for Payer: Oxford Commercial	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$65.80
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.72

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

PK INTRUMENT CORD G400 GENERAT

Facility

$1,350.00

Hospital Charge Code	270664008
Hospital Revenue Code	270
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.00
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$270.00
Rate for Payer: UnitedHealthcare Community & State	$32.53
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

PK INTRUMENT CORD G400 GENERAT

Facility

$1,350.00

Hospital Charge Code	270664008
Hospital Revenue Code	270
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

PK INTRUMENT CORD PK AND SO GE

Facility

$1,350.00

Hospital Charge Code	270664909
Hospital Revenue Code	270
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

PK INTRUMENT CORD PK AND SO GE

Facility

$1,350.00

Hospital Charge Code	270664909
Hospital Revenue Code	270
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.00
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$270.00
Rate for Payer: UnitedHealthcare Community & State	$32.53
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

Know your out-of-pocket cost for care.

All Charges