Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SENSOR ADULT ADHESIVE FOREHEAD

Facility

$102.08

Hospital Charge Code	270646541
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.04
Rate for Payer: Aetna Commercial	$38.79
Rate for Payer: Aetna Medicare Advantage	$30.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.03
Rate for Payer: Cigna Commercial	$51.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.62
Rate for Payer: Oxford Commercial	$20.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$20.42
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.71

SENSOR ADULT ADHESIVE FOREHEAD

Facility

$102.08

Hospital Charge Code	270646541
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

SENSOR ADULT FINGER SPO2 HP

Facility

$402.35

Hospital Charge Code	270618437
Hospital Revenue Code	279
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$201.18
Rate for Payer: Aetna Commercial	$152.89
Rate for Payer: Aetna Medicare Advantage	$120.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.60
Rate for Payer: Cigna Commercial	$201.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.70
Rate for Payer: Oxford Commercial	$80.47
Rate for Payer: Qualcare PPO/HMO/WC	$60.35
Rate for Payer: UnitedHealthcare Commercial	$80.47
Rate for Payer: UnitedHealthcare Community & State	$9.70
Rate for Payer: Wellpoint Medicaid Managed Care	$10.66

SENSOR ADULT FINGER SPO2 HP

Facility

$402.35

Hospital Charge Code	270618437
Hospital Revenue Code	279
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$60.35
Rate for Payer: Qualcare PPO/HMO/WC	$60.35

SENSOR ADULT/NEONATAL DISP

Facility

$124.69

Hospital Charge Code	270643750
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.34
Rate for Payer: Aetna Commercial	$47.38
Rate for Payer: Aetna Medicare Advantage	$37.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.80
Rate for Payer: Cigna Commercial	$62.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.41
Rate for Payer: Oxford Commercial	$24.94
Rate for Payer: Qualcare PPO/HMO/WC	$18.70
Rate for Payer: UnitedHealthcare Commercial	$24.94
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.30

SENSOR ADULT/NEONATAL DISP

Facility

$124.69

Hospital Charge Code	270643750
Hospital Revenue Code	272
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$18.70

SENSORCAINE 0.25%/30ML

Facility

$27.47

Service Code	NDC 409155930
Hospital Charge Code	60633863
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.12

SENSORCAINE 0.25%/30ML

Facility

$27.47

Service Code	NDC 409155930
Hospital Charge Code	60633863
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.73
Rate for Payer: Aetna Commercial	$10.44
Rate for Payer: Aetna Medicare Advantage	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.00
Rate for Payer: Cigna Commercial	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.24
Rate for Payer: Oxford Commercial	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.12
Rate for Payer: UnitedHealthcare Commercial	$5.49
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SENSORCAINE 0.25%/30ML

Facility

$28.00

Hospital Charge Code	60633864
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

SENSORCAINE 0.25%/30ML

Facility

$28.00

Hospital Charge Code	60633864
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

SENSORCAINE 0.25% 50ML

Facility

$80.87

Service Code	NDC 63323046557
Hospital Charge Code	6063943296
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.44
Rate for Payer: Aetna Commercial	$30.73
Rate for Payer: Aetna Medicare Advantage	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.62
Rate for Payer: Cigna Commercial	$40.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.26
Rate for Payer: Oxford Commercial	$16.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.13
Rate for Payer: UnitedHealthcare Commercial	$16.17
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

SENSORCAINE 0.25% 50ML

Facility

$80.87

Service Code	NDC 63323046557
Hospital Charge Code	6063943296
Hospital Revenue Code	250
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.13

SENSORCAINE 0.25% W/EPI/3

Facility

$28.54

Service Code	NDC 409904217
Hospital Charge Code	60633865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.27
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$8.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.28
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.56
Rate for Payer: Oxford Commercial	$5.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$5.71
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

SENSORCAINE 0.25% W/EPI/3

Facility

$28.54

Service Code	NDC 409904217
Hospital Charge Code	60633865
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.28

SENSORCAINE 0.5%

Facility

$82.60

Hospital Charge Code	6008197
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.78
Rate for Payer: Oxford Commercial	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$16.52
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

SENSORCAINE 0.5%

Facility

$82.60

Hospital Charge Code	6008197
Hospital Revenue Code	250
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

SENSORCAINE 0.5%/30ML

Facility

$27.00

Service Code	NDC 409153025
Hospital Charge Code	60633866
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

SENSORCAINE 0.5%/30ML

Facility

$27.00

Service Code	NDC 409153025
Hospital Charge Code	60633866
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SENSORCAINE 0.5%/30ML

Facility

$28.00

Hospital Charge Code	60633867
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

SENSORCAINE 0.5%/30ML

Facility

$28.00

Hospital Charge Code	60633867
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

SENSORCAINE 0.5% W/EPI/30

Facility

$32.00

Hospital Charge Code	60633868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SENSORCAINE 0.5% W/EPI/30

Facility

$32.00

Hospital Charge Code	60633868
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SENSORCAINE 0.75%/30ML

Facility

$23.00

Hospital Charge Code	60633869
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SENSORCAINE 0.75%/30ML

Facility

$23.00

Hospital Charge Code	60633869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SENSORCAINE 0.75% W/EPI/1

Facility

$28.00

Hospital Charge Code	60633870
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

Know your out-of-pocket cost for care.

All Charges