Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RODVALENBULLNOSECURVE5.5X55MM

Facility

$3,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270698327
Hospital Revenue Code	278
Min. Negotiated Rate	$80.73
Max. Negotiated Rate	$1,675.00
Rate for Payer: Aetna Commercial	$1,273.00
Rate for Payer: Aetna Medicare Advantage	$1,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.25
Rate for Payer: Cigna Commercial	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$737.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.50
Rate for Payer: UnitedHealthcare Community & State	$80.73
Rate for Payer: Wellpoint Medicaid Managed Care	$88.78

ROD VALENCIA CRV BULL 5.5X40MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695258
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

ROD VALENCIA CRV BULL 5.5X40MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695258
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD VALENCIA CURVED 5.5X50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695038
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD VALENCIA CURVED 5.5X50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695038
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

ROD W/LINE 40MM PRE-LORDOSE

Facility

$3,075.00

Hospital Charge Code	270667359
Hospital Revenue Code	278
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$744.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

ROD W/LINE 40MM PRE-LORDOSE

Facility

$3,075.00

Hospital Charge Code	270667359
Hospital Revenue Code	278
Min. Negotiated Rate	$74.11
Max. Negotiated Rate	$1,537.50
Rate for Payer: Aetna Commercial	$1,168.50
Rate for Payer: Aetna Medicare Advantage	$922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.12
Rate for Payer: Cigna Commercial	$1,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Community & State	$74.11
Rate for Payer: Wellpoint Medicaid Managed Care	$81.49

ROFECOXIB TAB 25MG

Facility

$12.20

Hospital Charge Code	60629204
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.10
Rate for Payer: Aetna Commercial	$4.64
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

ROFECOXIB TAB 25MG

Facility

$12.20

Hospital Charge Code	60629204
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.87
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.87
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROGAINE 2%/180ML

Facility

$830.00

Hospital Charge Code	60633844
Hospital Revenue Code	250
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

ROGAINE 2%/180ML

Facility

$830.00

Hospital Charge Code	60633844
Hospital Revenue Code	250
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.00
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$166.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

ROGAINE 2%/60ML

Facility

$315.00

Hospital Charge Code	60633843
Hospital Revenue Code	250
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$47.25
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

ROGAINE 2%/60ML

Facility

$315.00

Hospital Charge Code	60633843
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Aetna Medicare Advantage	$94.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.33
Rate for Payer: Cigna Commercial	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.50
Rate for Payer: Oxford Commercial	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.25
Rate for Payer: UnitedHealthcare Commercial	$63.00
Rate for Payer: UnitedHealthcare Community & State	$7.59
Rate for Payer: Wellpoint Medicaid Managed Care	$8.35

ROI-C PEEK OPTIMA LT-1 TANTALU

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690880
Hospital Revenue Code	278
Min. Negotiated Rate	$281.13
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$4,432.70
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75
Rate for Payer: UnitedHealthcare Community & State	$281.13
Rate for Payer: Wellpoint Medicaid Managed Care	$309.12

ROI-C PEEK OPTIMA LT-1 TANTALU

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

ROMI II

Facility

$48.00

Hospital Charge Code	3052438
Hospital Revenue Code	309
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

ROMI II

Facility

$48.00

Hospital Charge Code	3052438
Hospital Revenue Code	309
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

ROMI I-LD

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	3032120
Hospital Revenue Code	301
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.92
Rate for Payer: Aetna Medicare Advantage	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.01
Rate for Payer: Cigna Commercial	$61.72
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$37.41
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.47
Rate for Payer: Wellcare Medicare Advantage	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

ROMI I-LD

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	3032120
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

ROMI LD IS***

Facility

$64.00

Service Code	HCPCS 83520
Hospital Charge Code	3032463
Hospital Revenue Code	309
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

ROMI LD IS***

Facility

$64.00

Service Code	HCPCS 83520
Hospital Charge Code	3032463
Hospital Revenue Code	309
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

Know your out-of-pocket cost for care.

All Charges