Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESURFACING PATELLA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677547
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

RESUSCITATION ADULT*****

Facility

$133.10

Hospital Charge Code	9500448
Hospital Revenue Code	279
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.55
Rate for Payer: Aetna Commercial	$50.58
Rate for Payer: Aetna Medicare Advantage	$39.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.94
Rate for Payer: Cigna Commercial	$66.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.93
Rate for Payer: Oxford Commercial	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.96
Rate for Payer: UnitedHealthcare Commercial	$26.62
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

RESUSCITATION ADULT*****

Facility

$133.10

Hospital Charge Code	9500448
Hospital Revenue Code	279
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$19.96
Rate for Payer: Qualcare PPO/HMO/WC	$19.96

RESUSCITATION PEDIATRIC/INFANT

Facility

$264.85

Hospital Charge Code	9501230
Hospital Revenue Code	270
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$132.43
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: Aetna Medicare Advantage	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.54
Rate for Payer: Cigna Commercial	$132.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.45
Rate for Payer: Oxford Commercial	$52.97
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$52.97
Rate for Payer: UnitedHealthcare Community & State	$6.38
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

RESUSCITATION PEDIATRIC/INFANT

Facility

$264.85

Hospital Charge Code	9501230
Hospital Revenue Code	270
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

RESUSCITATOR ADULT MANUAL

Facility

$193.00

Hospital Charge Code	270331414
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.50
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.90
Rate for Payer: Oxford Commercial	$38.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$38.60
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

RESUSCITATOR ADULT MANUAL

Facility

$193.00

Hospital Charge Code	270331414
Hospital Revenue Code	272
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

RETACRIT ALFAEPBX 20000U/2MLVL

Facility

$1,239.50

Service Code	NDC 69131810
Hospital Charge Code	606390491
Hospital Revenue Code	635
Min. Negotiated Rate	$185.93
Max. Negotiated Rate	$185.93
Rate for Payer: Qualcare PPO/HMO/WC	$185.93

RETACRIT ALFAEPBX 20000U/2MLVL

Facility

$1,239.50

Service Code	NDC 69131810
Hospital Charge Code	606390491
Hospital Revenue Code	635
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$619.75
Rate for Payer: Aetna Commercial	$471.01
Rate for Payer: Aetna Medicare Advantage	$371.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.07
Rate for Payer: Cigna Commercial	$619.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.85
Rate for Payer: Oxford Commercial	$247.90
Rate for Payer: Qualcare PPO/HMO/WC	$185.93
Rate for Payer: UnitedHealthcare Commercial	$247.90
Rate for Payer: UnitedHealthcare Community & State	$29.87
Rate for Payer: Wellpoint Medicaid Managed Care	$32.85

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$26.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.47
Rate for Payer: Aetna Commercial	$67.24
Rate for Payer: Aetna Medicare Advantage	$53.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.12
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.09
Rate for Payer: Oxford Commercial	$35.39
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$53.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$53.20
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$132.66
Max. Negotiated Rate	$132.66
Rate for Payer: Qualcare PPO/HMO/WC	$132.66

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$21.31
Max. Negotiated Rate	$442.20
Rate for Payer: Aetna Commercial	$336.07
Rate for Payer: Aetna Medicare Advantage	$265.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.52
Rate for Payer: Cigna Commercial	$442.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.32
Rate for Payer: Oxford Commercial	$176.88
Rate for Payer: Qualcare PPO/HMO/WC	$132.66
Rate for Payer: UnitedHealthcare Commercial	$176.88
Rate for Payer: UnitedHealthcare Community & State	$21.31
Rate for Payer: Wellpoint Medicaid Managed Care	$23.44

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$174.20
Rate for Payer: Aetna Commercial	$132.39
Rate for Payer: Aetna Medicare Advantage	$104.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.84
Rate for Payer: Cigna Commercial	$174.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.52
Rate for Payer: Oxford Commercial	$69.68
Rate for Payer: Qualcare PPO/HMO/WC	$52.26
Rate for Payer: UnitedHealthcare Commercial	$69.68
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.23

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$52.26

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$19.73
Rate for Payer: Qualcare PPO/HMO/WC	$19.73

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$65.75
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.53
Rate for Payer: Cigna Commercial	$65.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.45
Rate for Payer: Oxford Commercial	$26.30
Rate for Payer: Qualcare PPO/HMO/WC	$19.73
Rate for Payer: UnitedHealthcare Commercial	$26.30
Rate for Payer: UnitedHealthcare Community & State	$3.17
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

RETAINER VISCERA MEDIUM*******

Facility

$73.00

Hospital Charge Code	1605831
Hospital Revenue Code	279
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

RETAINER VISCERA MEDIUM*******

Facility

$73.00

Hospital Charge Code	1605831
Hospital Revenue Code	279
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$205.14
Max. Negotiated Rate	$4,256.10
Rate for Payer: Aetna Commercial	$3,234.64
Rate for Payer: Aetna Medicare Advantage	$2,553.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,170.61
Rate for Payer: Cigna Commercial	$4,256.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,872.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83
Rate for Payer: UnitedHealthcare Community & State	$205.14
Rate for Payer: Wellpoint Medicaid Managed Care	$225.57

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.83
Max. Negotiated Rate	$2,059.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,872.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83

Know your out-of-pocket cost for care.

All Charges