Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$68.99
Max. Negotiated Rate	$68.99
Rate for Payer: Qualcare PPO/HMO/WC	$68.99

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$229.96
Rate for Payer: Aetna Commercial	$174.77
Rate for Payer: Aetna Medicare Advantage	$137.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.28
Rate for Payer: Cigna Commercial	$229.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.98
Rate for Payer: Oxford Commercial	$91.98
Rate for Payer: Qualcare PPO/HMO/WC	$68.99
Rate for Payer: UnitedHealthcare Commercial	$91.98
Rate for Payer: UnitedHealthcare Community & State	$11.08
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.53
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.36
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

STARLIX 60MG TAB

Facility

$2.00

Hospital Charge Code	60635429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

STARLIX 60MG TAB

Facility

$2.00

Hospital Charge Code	60635429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

START/RE-START IV

Professional

Both

$72.00

Service Code	HCPCS 36000
Hospital Charge Code	2500205
Hospital Revenue Code	981
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$557.34
Rate for Payer: Aetna Commercial	$16.44
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$557.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.34
Rate for Payer: Fidelis All Plans	$25.33
Rate for Payer: Marpai Administrators LLC Commercial	$9.95
Rate for Payer: Wellpoint Medicaid Managed Care	$5.24

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$110.61
Max. Negotiated Rate	$2,294.75
Rate for Payer: Aetna Commercial	$1,744.01
Rate for Payer: Aetna Medicare Advantage	$1,376.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.32
Rate for Payer: Cigna Commercial	$2,294.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,376.85
Rate for Payer: Oxford Commercial	$917.90
Rate for Payer: Qualcare PPO/HMO/WC	$688.42
Rate for Payer: UnitedHealthcare Commercial	$917.90
Rate for Payer: UnitedHealthcare Community & State	$110.61
Rate for Payer: Wellpoint Medicaid Managed Care	$121.62

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$688.42
Max. Negotiated Rate	$688.42
Rate for Payer: Qualcare PPO/HMO/WC	$688.42

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$141.82
Max. Negotiated Rate	$141.82
Rate for Payer: Qualcare PPO/HMO/WC	$141.82

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$472.72
Rate for Payer: Aetna Commercial	$359.27
Rate for Payer: Aetna Medicare Advantage	$283.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.09
Rate for Payer: Cigna Commercial	$472.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.63
Rate for Payer: Oxford Commercial	$189.09
Rate for Payer: Qualcare PPO/HMO/WC	$141.82
Rate for Payer: UnitedHealthcare Commercial	$189.09
Rate for Payer: UnitedHealthcare Community & State	$22.79
Rate for Payer: Wellpoint Medicaid Managed Care	$25.05

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$22.78
Max. Negotiated Rate	$472.70
Rate for Payer: Aetna Commercial	$359.25
Rate for Payer: Aetna Medicare Advantage	$283.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.08
Rate for Payer: Cigna Commercial	$472.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.62
Rate for Payer: Oxford Commercial	$189.08
Rate for Payer: Qualcare PPO/HMO/WC	$141.81
Rate for Payer: UnitedHealthcare Commercial	$189.08
Rate for Payer: UnitedHealthcare Community & State	$22.78
Rate for Payer: Wellpoint Medicaid Managed Care	$25.05

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$141.81
Max. Negotiated Rate	$141.81
Rate for Payer: Qualcare PPO/HMO/WC	$141.81

STATIC CERVICAL 14X12X7MM 7DEG

Facility

$17,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706106
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

STATIC CERVICAL 14X12X7MM 7DEG

Facility

$17,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706106
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

STATIC CERVICAL 14X12X7MM 8DEG

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706187
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

STATIC CERVICAL 14X12X7MM 8DEG

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

STATIC STRUT LRF 60MM

Facility

$497.15

Service Code	HCPCS C1713
Hospital Charge Code	270699594
Hospital Revenue Code	278
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$248.57
Rate for Payer: Aetna Commercial	$188.92
Rate for Payer: Aetna Medicare Advantage	$149.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.77
Rate for Payer: Cigna Commercial	$248.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$109.37
Rate for Payer: Qualcare PPO/HMO/WC	$74.57
Rate for Payer: UnitedHealthcare Community & State	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$13.17

STATIC STRUT LRF 60MM

Facility

$497.15

Service Code	HCPCS C1713
Hospital Charge Code	270699594
Hospital Revenue Code	278
Min. Negotiated Rate	$74.57
Max. Negotiated Rate	$120.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$109.37
Rate for Payer: Qualcare PPO/HMO/WC	$74.57

STATLOCK FOR INTRA AORTIC BALL

Facility

$379.00

Hospital Charge Code	270657663N
Hospital Revenue Code	270
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$56.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.85

STATLOCK FOR INTRA AORTIC BALL

Facility

$379.00

Hospital Charge Code	270657663N
Hospital Revenue Code	270
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$189.50
Rate for Payer: Aetna Commercial	$144.02
Rate for Payer: Aetna Medicare Advantage	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.64
Rate for Payer: Cigna Commercial	$189.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.70
Rate for Payer: Oxford Commercial	$75.80
Rate for Payer: Qualcare PPO/HMO/WC	$56.85
Rate for Payer: UnitedHealthcare Commercial	$75.80
Rate for Payer: UnitedHealthcare Community & State	$9.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.04

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663
Hospital Revenue Code	270
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663S
Hospital Revenue Code	270
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

Know your out-of-pocket cost for care.

All Charges