Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STAVUDINE 40 MG CAP

Facility

$38.00

Hospital Charge Code	60628711
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

STAVUDINE 40MG CAPSULE

Facility

$61.77

Service Code	NDC 3196701
Hospital Charge Code	60632295
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$30.89
Rate for Payer: Aetna Commercial	$23.47
Rate for Payer: Aetna Medicare Advantage	$18.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.75
Rate for Payer: Cigna Commercial	$30.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.53
Rate for Payer: Oxford Commercial	$12.35
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$12.35
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

STAVUDINE 40MG CAPSULE

Facility

$61.77

Service Code	NDC 3196701
Hospital Charge Code	60632295
Hospital Revenue Code	250
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.27

STAYFUSE 3.8 GREY 2227-002-02

Facility

$644.85

Hospital Charge Code	270630416
Hospital Revenue Code	272
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$96.73
Rate for Payer: Qualcare PPO/HMO/WC	$96.73

STAYFUSE 3.8 GREY 2227-002-02

Facility

$644.85

Hospital Charge Code	270630416
Hospital Revenue Code	272
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$322.43
Rate for Payer: Aetna Commercial	$245.04
Rate for Payer: Aetna Medicare Advantage	$193.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.44
Rate for Payer: Cigna Commercial	$322.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.46
Rate for Payer: Oxford Commercial	$128.97
Rate for Payer: Qualcare PPO/HMO/WC	$96.73
Rate for Payer: UnitedHealthcare Commercial	$128.97
Rate for Payer: UnitedHealthcare Community & State	$15.54
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

STAYFUSE 4 3mx6m GRY 222700402

Facility

$694.45

Hospital Charge Code	270630415
Hospital Revenue Code	272
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$104.17
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STAYFUSE 4 3mx6m GRY 222700402

Facility

$694.45

Hospital Charge Code	270630415
Hospital Revenue Code	272
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$263.89
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.34
Rate for Payer: Oxford Commercial	$138.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Commercial	$138.89
Rate for Payer: UnitedHealthcare Community & State	$16.74
Rate for Payer: Wellpoint Medicaid Managed Care	$18.40

STAYFUSE MID 4.3 X 6 2270302

Facility

$680.85

Hospital Charge Code	270625958
Hospital Revenue Code	272
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.43
Rate for Payer: Aetna Commercial	$258.72
Rate for Payer: Aetna Medicare Advantage	$204.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.62
Rate for Payer: Cigna Commercial	$340.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.25
Rate for Payer: Oxford Commercial	$136.17
Rate for Payer: Qualcare PPO/HMO/WC	$102.13
Rate for Payer: UnitedHealthcare Commercial	$136.17
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.04

STAYFUSE MID 4.3 X 6 2270302

Facility

$680.85

Hospital Charge Code	270625958
Hospital Revenue Code	272
Min. Negotiated Rate	$102.13
Max. Negotiated Rate	$102.13
Rate for Payer: Qualcare PPO/HMO/WC	$102.13

STAYFUSE MID 5.0x6GR 222700404

Facility

$694.45

Hospital Charge Code	270633521
Hospital Revenue Code	272
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$263.89
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.34
Rate for Payer: Oxford Commercial	$138.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Commercial	$138.89
Rate for Payer: UnitedHealthcare Community & State	$16.74
Rate for Payer: Wellpoint Medicaid Managed Care	$18.40

STAYFUSE MID 5.0x6GR 222700404

Facility

$694.45

Hospital Charge Code	270633521
Hospital Revenue Code	272
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$104.17
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STAYFUSE PROX 2.8mm 2270101

Facility

$680.85

Hospital Charge Code	270625956
Hospital Revenue Code	272
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.43
Rate for Payer: Aetna Commercial	$258.72
Rate for Payer: Aetna Medicare Advantage	$204.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.62
Rate for Payer: Cigna Commercial	$340.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.25
Rate for Payer: Oxford Commercial	$136.17
Rate for Payer: Qualcare PPO/HMO/WC	$102.13
Rate for Payer: UnitedHealthcare Commercial	$136.17
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.04

STAYFUSE PROX 2.8mm 2270101

Facility

$680.85

Hospital Charge Code	270625956
Hospital Revenue Code	272
Min. Negotiated Rate	$102.13
Max. Negotiated Rate	$102.13
Rate for Payer: Qualcare PPO/HMO/WC	$102.13

STAYFUSE PROX 3.3M GR 22270201

Facility

$644.85

Hospital Charge Code	270626860
Hospital Revenue Code	272
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$96.73
Rate for Payer: Qualcare PPO/HMO/WC	$96.73

STAYFUSE PROX 3.3M GR 22270201

Facility

$644.85

Hospital Charge Code	270626860
Hospital Revenue Code	272
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$322.43
Rate for Payer: Aetna Commercial	$245.04
Rate for Payer: Aetna Medicare Advantage	$193.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.44
Rate for Payer: Cigna Commercial	$322.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.46
Rate for Payer: Oxford Commercial	$128.97
Rate for Payer: Qualcare PPO/HMO/WC	$96.73
Rate for Payer: UnitedHealthcare Commercial	$128.97
Rate for Payer: UnitedHealthcare Community & State	$15.54
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

STAYFUSE ZIM IMPLANT 22270202

Facility

$694.45

Hospital Charge Code	270625622
Hospital Revenue Code	272
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$104.17
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STAYFUSE ZIM IMPLANT 22270202

Facility

$694.45

Hospital Charge Code	270625622
Hospital Revenue Code	272
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$263.89
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.34
Rate for Payer: Oxford Commercial	$138.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Commercial	$138.89
Rate for Payer: UnitedHealthcare Community & State	$16.74
Rate for Payer: Wellpoint Medicaid Managed Care	$18.40

STAYFUSE ZIM IMPLANT 22270301

Facility

$619.25

Hospital Charge Code	270625957
Hospital Revenue Code	272
Min. Negotiated Rate	$92.89
Max. Negotiated Rate	$92.89
Rate for Payer: Qualcare PPO/HMO/WC	$92.89

STAYFUSE ZIM IMPLANT 22270301

Facility

$619.25

Hospital Charge Code	270625957
Hospital Revenue Code	272
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$309.62
Rate for Payer: Aetna Commercial	$235.31
Rate for Payer: Aetna Medicare Advantage	$185.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.91
Rate for Payer: Cigna Commercial	$309.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.78
Rate for Payer: Oxford Commercial	$123.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.89
Rate for Payer: UnitedHealthcare Commercial	$123.85
Rate for Payer: UnitedHealthcare Community & State	$14.92
Rate for Payer: Wellpoint Medicaid Managed Care	$16.41

STAYFUSE ZIM IMPLANT 22270401

Facility

$619.25

Hospital Charge Code	270625623
Hospital Revenue Code	272
Min. Negotiated Rate	$92.89
Max. Negotiated Rate	$92.89
Rate for Payer: Qualcare PPO/HMO/WC	$92.89

STAYFUSE ZIM IMPLANT 22270401

Facility

$619.25

Hospital Charge Code	270625623
Hospital Revenue Code	272
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$309.62
Rate for Payer: Aetna Commercial	$235.31
Rate for Payer: Aetna Medicare Advantage	$185.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.91
Rate for Payer: Cigna Commercial	$309.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.78
Rate for Payer: Oxford Commercial	$123.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.89
Rate for Payer: UnitedHealthcare Commercial	$123.85
Rate for Payer: UnitedHealthcare Community & State	$14.92
Rate for Payer: Wellpoint Medicaid Managed Care	$16.41

STAYS 5MM 3311-8G

Facility

$41.46

Hospital Charge Code	270608601
Hospital Revenue Code	272
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$6.22
Rate for Payer: Qualcare PPO/HMO/WC	$6.22

STAYS 5MM 3311-8G

Facility

$41.46

Hospital Charge Code	270608601
Hospital Revenue Code	272
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.73
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$12.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.57
Rate for Payer: Cigna Commercial	$20.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.44
Rate for Payer: Oxford Commercial	$8.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.22
Rate for Payer: UnitedHealthcare Commercial	$8.29
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

ST BEH QUAL ANALY VOICE & RESO

Facility

$2,400.00

Service Code	HCPCS 92524GN
Hospital Charge Code	74204045
Hospital Revenue Code	444
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

ST BEH QUAL ANALY VOICE & RESO

Facility

$2,400.00

Service Code	HCPCS 92524GN
Hospital Charge Code	74204045
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

Know your out-of-pocket cost for care.

All Charges