Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POLYMYXIN BACIT SPRY 90GM

Facility

$37.80

Hospital Charge Code	6004493
Hospital Revenue Code	252
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

POLYMYXIN BACIT SPRY 90GM

Facility

$37.80

Hospital Charge Code	6004493
Hospital Revenue Code	252
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

POLYMYXIN B SULF IRRG 500,000U

Facility

$52.50

Hospital Charge Code	6004469
Hospital Revenue Code	251
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

POLYMYXIN B SULF IRRG 500,000U

Facility

$52.50

Hospital Charge Code	6004469
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

POLYMYXIN B/TRIMETHOPRIM OPTH

Facility

$442.07

Service Code	NDC 23782410
Hospital Charge Code	60632326
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$221.03
Rate for Payer: Aetna Commercial	$167.99
Rate for Payer: Aetna Medicare Advantage	$132.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.73
Rate for Payer: Cigna Commercial	$221.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.62
Rate for Payer: Oxford Commercial	$88.41
Rate for Payer: Qualcare PPO/HMO/WC	$66.31
Rate for Payer: UnitedHealthcare Commercial	$88.41
Rate for Payer: UnitedHealthcare Community & State	$10.65
Rate for Payer: Wellpoint Medicaid Managed Care	$11.71

POLYMYXIN B/TRIMETHOPRIM OPTH

Facility

$442.07

Service Code	NDC 23782410
Hospital Charge Code	60632326
Hospital Revenue Code	250
Min. Negotiated Rate	$66.31
Max. Negotiated Rate	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$66.31

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$51.60
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.38
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.38
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

POLYPRED/5ML

Facility

$84.00

Hospital Charge Code	60635899
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

POLYPRED/5ML

Facility

$84.00

Hospital Charge Code	60635899
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$148.58
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.30
Rate for Payer: Oxford Commercial	$78.20
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$78.20
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10.36

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

POLY SCREW 6.5X55MM

Facility

$3,555.00

Service Code	HCPCS C1713
Hospital Charge Code	270704458
Hospital Revenue Code	278
Min. Negotiated Rate	$533.25
Max. Negotiated Rate	$860.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$711.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$782.10
Rate for Payer: Qualcare PPO/HMO/WC	$533.25

POLY SCREW 6.5X55MM

Facility

$3,555.00

Service Code	HCPCS C1713
Hospital Charge Code	270704458
Hospital Revenue Code	278
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$1,777.50
Rate for Payer: Aetna Commercial	$1,350.90
Rate for Payer: Aetna Medicare Advantage	$1,066.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.52
Rate for Payer: Cigna Commercial	$1,777.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$782.10
Rate for Payer: Qualcare PPO/HMO/WC	$533.25
Rate for Payer: UnitedHealthcare Community & State	$85.68
Rate for Payer: Wellpoint Medicaid Managed Care	$94.21

POLYSONOGRAPHY

Facility

$3,830.45

Service Code	HCPCS 95808
Hospital Charge Code	9500700
Hospital Revenue Code	920
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.13
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

Know your out-of-pocket cost for care.

All Charges