Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663S
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$34.01
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Oxford Commercial	$17.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$17.90
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$34.01
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Oxford Commercial	$17.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$17.90
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

STATLOCK INTRA AOR BALL CATH

Facility

$1,895.00

Hospital Charge Code	2709003702
Hospital Revenue Code	272
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.50
Rate for Payer: Oxford Commercial	$379.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$379.00
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$50.22

STATLOCK INTRA AOR BALL CATH

Facility

$1,895.00

Hospital Charge Code	2709003702
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

STATLOCK SWIVEL FOLEY DEVICE

Facility

$18.64

Hospital Charge Code	270650188
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.80

STATLOCK SWIVEL FOLEY DEVICE

Facility

$18.64

Hospital Charge Code	270650188
Hospital Revenue Code	270
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.32
Rate for Payer: Aetna Commercial	$7.08
Rate for Payer: Aetna Medicare Advantage	$5.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.75
Rate for Payer: Cigna Commercial	$9.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.80
Rate for Payer: UnitedHealthcare Commercial	$3.73
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

STAT TACK FIZATION 5MM

Facility

$828.65

Hospital Charge Code	270619730
Hospital Revenue Code	272
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$414.32
Rate for Payer: Aetna Commercial	$314.89
Rate for Payer: Aetna Medicare Advantage	$248.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.31
Rate for Payer: Cigna Commercial	$414.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.59
Rate for Payer: Oxford Commercial	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$124.30
Rate for Payer: UnitedHealthcare Commercial	$165.73
Rate for Payer: UnitedHealthcare Community & State	$19.97
Rate for Payer: Wellpoint Medicaid Managed Care	$21.96

STAT TACK FIZATION 5MM

Facility

$828.65

Hospital Charge Code	270619730
Hospital Revenue Code	272
Min. Negotiated Rate	$124.30
Max. Negotiated Rate	$124.30
Rate for Payer: Qualcare PPO/HMO/WC	$124.30

ST AUDIOMETRIC SCREENING

Facility

$66.00

Service Code	HCPCS 92551GN
Hospital Charge Code	74204001
Hospital Revenue Code	440
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

ST AUDIOMETRIC SCREENING

Facility

$66.00

Service Code	HCPCS 92551GN
Hospital Charge Code	74204001
Hospital Revenue Code	440
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

ST AUG DEVICE EVALUATION

Facility

$646.00

Service Code	HCPCS 92597GN
Hospital Charge Code	74204019
Hospital Revenue Code	440
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

ST AUG DEVICE EVALUATION

Facility

$646.00

Service Code	HCPCS 92597GN
Hospital Charge Code	74204019
Hospital Revenue Code	440
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

ST AURAL REHABILITATION

Facility

$959.00

Service Code	HCPCS 92506GN
Hospital Charge Code	74204009
Hospital Revenue Code	444
Min. Negotiated Rate	$23.11
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$364.42
Rate for Payer: Aetna Medicare Advantage	$287.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.54
Rate for Payer: Cigna Commercial	$479.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$23.11
Rate for Payer: Wellpoint Medicaid Managed Care	$25.41

ST AURAL REHABILITATION

Facility

$959.00

Service Code	HCPCS 92506GN
Hospital Charge Code	74204009
Hospital Revenue Code	444
Min. Negotiated Rate	$143.85
Max. Negotiated Rate	$143.85
Rate for Payer: Qualcare PPO/HMO/WC	$143.85

STAVUDINE 15 MG CAP

Facility

$33.80

Hospital Charge Code	60628708
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.07

STAVUDINE 15 MG CAP

Facility

$33.80

Hospital Charge Code	60628708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Commercial	$12.84
Rate for Payer: Aetna Medicare Advantage	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.62
Rate for Payer: Cigna Commercial	$16.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$6.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.07
Rate for Payer: UnitedHealthcare Commercial	$6.76
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

STAVUDINE 20 MG CAP

Facility

$35.15

Hospital Charge Code	60628709
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

STAVUDINE 20 MG CAP

Facility

$35.15

Hospital Charge Code	60628709
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$17.57
Rate for Payer: Aetna Commercial	$13.36
Rate for Payer: Aetna Medicare Advantage	$10.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.96
Rate for Payer: Cigna Commercial	$17.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.54
Rate for Payer: Oxford Commercial	$7.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

STAVUDINE 20MG CAPSULE

Facility

$57.08

Service Code	NDC 3196501
Hospital Charge Code	60632297
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$28.54
Rate for Payer: Aetna Commercial	$21.69
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.56
Rate for Payer: Cigna Commercial	$28.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.12
Rate for Payer: Oxford Commercial	$11.42
Rate for Payer: Qualcare PPO/HMO/WC	$8.56
Rate for Payer: UnitedHealthcare Commercial	$11.42
Rate for Payer: UnitedHealthcare Community & State	$1.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

STAVUDINE 20MG CAPSULE

Facility

$57.08

Service Code	NDC 3196501
Hospital Charge Code	60632297
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$8.56
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

STAVUDINE 30 MG CAP

Facility

$37.30

Hospital Charge Code	60628710
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$5.59

STAVUDINE 30 MG CAP

Facility

$37.30

Hospital Charge Code	60628710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.65
Rate for Payer: Aetna Commercial	$14.17
Rate for Payer: Aetna Medicare Advantage	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.51
Rate for Payer: Cigna Commercial	$18.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.19
Rate for Payer: Oxford Commercial	$7.46
Rate for Payer: Qualcare PPO/HMO/WC	$5.59
Rate for Payer: UnitedHealthcare Commercial	$7.46
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

STAVUDINE 30MG CAPSULE

Facility

$60.64

Service Code	NDC 3196601
Hospital Charge Code	60632296
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$30.32
Rate for Payer: Aetna Commercial	$23.04
Rate for Payer: Aetna Medicare Advantage	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.46
Rate for Payer: Cigna Commercial	$30.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.19
Rate for Payer: Oxford Commercial	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.10
Rate for Payer: UnitedHealthcare Commercial	$12.13
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

STAVUDINE 30MG CAPSULE

Facility

$60.64

Service Code	NDC 3196601
Hospital Charge Code	60632296
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$9.10
Rate for Payer: Qualcare PPO/HMO/WC	$9.10

STAVUDINE 40 MG CAP

Facility

$38.00

Hospital Charge Code	60628711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

Know your out-of-pocket cost for care.

All Charges