Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETRO INJ URETHRA

Facility

$988.84

Service Code	HCPCS 51610
Hospital Charge Code	16000996
Hospital Revenue Code	360
Min. Negotiated Rate	$148.33
Max. Negotiated Rate	$148.33
Rate for Payer: Qualcare PPO/HMO/WC	$148.33

RETRO INJ URETHRA

Facility

$988.84

Service Code	HCPCS 51610
Hospital Charge Code	16000996
Hospital Revenue Code	360
Min. Negotiated Rate	$23.83
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$375.76
Rate for Payer: Aetna Medicare Advantage	$296.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.15
Rate for Payer: Cigna Commercial	$494.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.65
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.33
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.83
Rate for Payer: Wellpoint Medicaid Managed Care	$26.20

RETROPERITONEUM/RENAL

Facility

$6,700.00

Service Code	HCPCS 76770
Hospital Charge Code	94061167
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

RETROPERITONEUM/RENAL

Facility

$6,700.00

Service Code	HCPCS 76770
Hospital Charge Code	94061167
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

RETROVIR/100MG/CAP

Facility

$9.00

Hospital Charge Code	60633822
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

RETROVIR/100MG/CAP

Facility

$14.00

Hospital Charge Code	60633823
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

RETROVIR/100MG/CAP

Facility

$14.00

Hospital Charge Code	60633823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

RETROVIR/100MG/CAP

Facility

$9.00

Hospital Charge Code	60633822
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

RETROVIR/10MG/1ML

Facility

$4.00

Service Code	NDC 65862004824
Hospital Charge Code	60633821
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

RETROVIR/10MG/1ML

Facility

$4.00

Service Code	NDC 65862004824
Hospital Charge Code	60633821
Hospital Revenue Code	250
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

RETROVIR IV

Facility

$122.00

Hospital Charge Code	60635062
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

RETROVIR IV

Facility

$122.00

Hospital Charge Code	60635062
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

REVASC LITHOTR-STENT TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9773
Hospital Charge Code	4110C9773
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,662.42
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$2,382.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2,620.18

REVASC LITHOTR-STENT TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9773
Hospital Charge Code	4110C9773
Hospital Revenue Code	480
Min. Negotiated Rate	$14,831.21
Max. Negotiated Rate	$14,831.21
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21

REVASC LITH-STEN-ATH TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9775
Hospital Charge Code	4110C9775
Hospital Revenue Code	480
Min. Negotiated Rate	$14,831.21
Max. Negotiated Rate	$14,831.21
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21

REVASC LITH-STEN-ATH TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9775
Hospital Charge Code	4110C9775
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,662.42
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$2,382.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2,620.18

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$11.74
Max. Negotiated Rate	$243.50
Rate for Payer: Aetna Commercial	$185.06
Rate for Payer: Aetna Medicare Advantage	$146.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.19
Rate for Payer: Cigna Commercial	$243.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.10
Rate for Payer: Oxford Commercial	$97.40
Rate for Payer: Qualcare PPO/HMO/WC	$73.05
Rate for Payer: UnitedHealthcare Commercial	$97.40
Rate for Payer: UnitedHealthcare Community & State	$11.74
Rate for Payer: Wellpoint Medicaid Managed Care	$12.91

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$73.05
Max. Negotiated Rate	$73.05
Rate for Payer: Qualcare PPO/HMO/WC	$73.05

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$357.95
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$5,643.95
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88
Rate for Payer: UnitedHealthcare Community & State	$357.95
Rate for Payer: Wellpoint Medicaid Managed Care	$393.59

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$357.95
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$5,643.95
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88
Rate for Payer: UnitedHealthcare Community & State	$357.95
Rate for Payer: Wellpoint Medicaid Managed Care	$393.59

REVERSE BODY SCREW AND STD

Facility

$7,711.30

Service Code	HCPCS C1776
Hospital Charge Code	270691400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.69
Max. Negotiated Rate	$1,866.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,542.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,696.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,156.69

Know your out-of-pocket cost for care.

All Charges