Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETIN-A 0.01%/15GM

Facility

$101.00

Hospital Charge Code	60633816
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RETIN-A 0.01%/15GM

Facility

$101.00

Hospital Charge Code	60633816
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RETIN-A 0.025%/15GM

Facility

$118.00

Hospital Charge Code	60633818
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

RETIN-A 0.025%/15GM

Facility

$118.00

Hospital Charge Code	60633818
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

RETIN-A 0.025%/20GM

Facility

$127.00

Hospital Charge Code	60633817
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

RETIN-A 0.025%/20GM

Facility

$127.00

Hospital Charge Code	60633817
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

RETIN-A 0.05%/20GM

Facility

$129.00

Hospital Charge Code	60633819
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

RETIN-A 0.05%/20GM

Facility

$129.00

Hospital Charge Code	60633819
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$49.02
Rate for Payer: Aetna Medicare Advantage	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.90
Rate for Payer: Cigna Commercial	$64.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.70
Rate for Payer: Oxford Commercial	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$25.80
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

RETIN-A 0.1%/20GM

Facility

$152.00

Hospital Charge Code	60633820
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

RETIN-A 0.1%/20GM

Facility

$152.00

Hospital Charge Code	60633820
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

RETINOL BINDING PROTEIN

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3002364
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RETINOL BINDING PROTEIN

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3002364
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$171.49
Rate for Payer: Aetna Commercial	$36.99
Rate for Payer: Aetna Medicare Advantage	$44.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: Cigna Medicare Advantage	$13.60
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Medicare Advantage	$13.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

RETINOL BINDING PROTEIN

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	39900448
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RETINOL BINDING PROTEIN

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	39900448
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.99
Rate for Payer: Aetna Medicare Advantage	$44.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.60
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.60
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	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Medicare Advantage	$13.60
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RETINOL BINDING PROTEIN (RBP)

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3038118
Hospital Revenue Code	300
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$171.49
Rate for Payer: Aetna Commercial	$36.99
Rate for Payer: Aetna Medicare Advantage	$44.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: Cigna Medicare Advantage	$13.60
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Medicare Advantage	$13.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

RETINOL BINDING PROTEIN (RBP)

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3038118
Hospital Revenue Code	300
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RETRAC KELLY BLADE180MM102*51

Facility

$1,725.00

Hospital Charge Code	270665985
Hospital Revenue Code	270
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

RETRAC KELLY BLADE180MM102*51

Facility

$1,725.00

Hospital Charge Code	270665985
Hospital Revenue Code	270
Min. Negotiated Rate	$41.57
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.50
Rate for Payer: Oxford Commercial	$345.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$345.00
Rate for Payer: UnitedHealthcare Community & State	$41.57
Rate for Payer: Wellpoint Medicaid Managed Care	$45.71

RETRACTA COIL MWCER-35-14-6

Facility

$3,252.45

Hospital Charge Code	270702166
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COIL MWCER-35-14-6

Facility

$3,252.45

Hospital Charge Code	270702166
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$1,235.93
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87
Rate for Payer: UnitedHealthcare Community & State	$78.38
Rate for Payer: Wellpoint Medicaid Managed Care	$86.19

RETRACTA COIL MWCER-35-7-10

Facility

$3,252.45

Hospital Charge Code	270702164
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COIL MWCER-35-7-10

Facility

$3,252.45

Hospital Charge Code	270702164
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$1,235.93
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87
Rate for Payer: UnitedHealthcare Community & State	$78.38
Rate for Payer: Wellpoint Medicaid Managed Care	$86.19

RETRACTA COILS MWCER-35-14-12

Facility

$3,252.45

Hospital Charge Code	270702169
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COILS MWCER-35-14-12

Facility

$3,252.45

Hospital Charge Code	270702169
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$1,235.93
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.54
Rate for Payer: Qualcare PPO/HMO/WC	$487.87
Rate for Payer: UnitedHealthcare Community & State	$78.38
Rate for Payer: Wellpoint Medicaid Managed Care	$86.19

RETRACT ALEXIS 2.5 6CM LAP SYS

Facility

$1,000.00

Hospital Charge Code	270683713
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

Know your out-of-pocket cost for care.

All Charges