Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

UGI W BX. SGL/MULTIPLE

Facility

$8,280.20

Service Code	HCPCS 27268
Hospital Charge Code	16000874
Hospital Revenue Code	360
Min. Negotiated Rate	$1,242.03
Max. Negotiated Rate	$1,242.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.03

UGI W BX. SGL/MULTIPLE

Facility

$8,280.20

Service Code	HCPCS 27268
Hospital Charge Code	16000874
Hospital Revenue Code	360
Min. Negotiated Rate	$199.55
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.06
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.03
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$199.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$219.43

UGI W BX_SGL/MULTIPLE

Facility

$7,963.40

Service Code	HCPCS 43239
Hospital Charge Code	16000175
Hospital Revenue Code	360
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$191.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$211.03

UGI W BX_SGL/MULTIPLE

Facility

$7,963.40

Service Code	HCPCS 43239
Hospital Charge Code	16000175
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI W REMOVAL OF FB

Facility

$7,963.40

Service Code	HCPCS 43247
Hospital Charge Code	16000200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI W REMOVAL OF FB

Facility

$7,963.40

Service Code	HCPCS 43247
Hospital Charge Code	16000200
Hospital Revenue Code	360
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$191.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$211.03

UGI W SUBMUCOS INJ

Facility

$7,963.40

Service Code	HCPCS 43236
Hospital Charge Code	16000961
Hospital Revenue Code	360
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$191.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,531.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2,482.30

UGI W SUBMUCOS INJ

Facility

$7,963.40

Service Code	HCPCS 43236
Hospital Charge Code	16000961
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGT1AI GENE POLYMORPHISM

Facility

$478.88

Service Code	HCPCS 81350
Hospital Charge Code	397080009
Hospital Revenue Code	306
Min. Negotiated Rate	$71.83
Max. Negotiated Rate	$71.83
Rate for Payer: Qualcare PPO/HMO/WC	$71.83

UGT1AI GENE POLYMORPHISM

Facility

$478.88

Service Code	HCPCS 81350
Hospital Charge Code	397080009
Hospital Revenue Code	306
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$844.67
Rate for Payer: Aetna Commercial	$636.48
Rate for Payer: Aetna Medicare Advantage	$758.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$844.67
Rate for Payer: Cigna Commercial	$239.44
Rate for Payer: Cigna Medicare Advantage	$234.00
Rate for Payer: Clover Medicare Advantage	$222.30
Rate for Payer: EmblemHealth Commercial	$702.00
Rate for Payer: Humana Medicare Advantage	$241.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$187.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$234.00
Rate for Payer: Wellcare Medicare Advantage	$234.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.69

UHR UNIV BIPOLAR HEAD OD 53X26

Facility

$3,669.90

Service Code	HCPCS C1776
Hospital Charge Code	270691243
Hospital Revenue Code	278
Min. Negotiated Rate	$550.49
Max. Negotiated Rate	$888.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$807.38
Rate for Payer: Qualcare PPO/HMO/WC	$550.49

UHR UNIV BIPOLAR HEAD OD 53X26

Facility

$3,669.90

Service Code	HCPCS C1776
Hospital Charge Code	270691243
Hospital Revenue Code	278
Min. Negotiated Rate	$88.44
Max. Negotiated Rate	$1,834.95
Rate for Payer: Aetna Commercial	$1,394.56
Rate for Payer: Aetna Medicare Advantage	$1,100.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$935.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$935.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$935.82
Rate for Payer: Cigna Commercial	$1,834.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$807.38
Rate for Payer: Qualcare PPO/HMO/WC	$550.49
Rate for Payer: UnitedHealthcare Community & State	$88.44
Rate for Payer: Wellpoint Medicaid Managed Care	$97.25

ULNAR PRECOAT REG RI32-8105-12

Facility

$11,006.45

Hospital Charge Code	270609043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.97
Max. Negotiated Rate	$2,663.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,201.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,663.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,421.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.97

ULNAR PRECOAT REG RI32-8105-12

Facility

$11,006.45

Hospital Charge Code	270609043
Hospital Revenue Code	278
Min. Negotiated Rate	$265.26
Max. Negotiated Rate	$5,503.23
Rate for Payer: Aetna Commercial	$4,182.45
Rate for Payer: Aetna Medicare Advantage	$3,301.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,806.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,806.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,201.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,806.64
Rate for Payer: Cigna Commercial	$5,503.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,663.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,421.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.97
Rate for Payer: UnitedHealthcare Community & State	$265.26
Rate for Payer: Wellpoint Medicaid Managed Care	$291.67

ULS CORTICAL SCREW 3.5MM X 22M

Facility

$12.15

Hospital Charge Code	270657744
Hospital Revenue Code	278
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

ULS CORTICAL SCREW 3.5MM X 22M

Facility

$12.15

Hospital Charge Code	270657744
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.08
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$3.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.10
Rate for Payer: Cigna Commercial	$6.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.82
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

ULTANE SEVOFLURANE 250ML

Facility

$1,043.00

Hospital Charge Code	60635038
Hospital Revenue Code	250
Min. Negotiated Rate	$25.14
Max. Negotiated Rate	$521.50
Rate for Payer: Aetna Commercial	$396.34
Rate for Payer: Aetna Medicare Advantage	$312.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.96
Rate for Payer: Cigna Commercial	$521.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.90
Rate for Payer: Oxford Commercial	$208.60
Rate for Payer: Qualcare PPO/HMO/WC	$156.45
Rate for Payer: UnitedHealthcare Commercial	$208.60
Rate for Payer: UnitedHealthcare Community & State	$25.14
Rate for Payer: Wellpoint Medicaid Managed Care	$27.64

ULTANE SEVOFLURANE 250ML

Facility

$1,043.00

Hospital Charge Code	60635038
Hospital Revenue Code	250
Min. Negotiated Rate	$156.45
Max. Negotiated Rate	$156.45
Rate for Payer: Qualcare PPO/HMO/WC	$156.45

ULTIPOR ******

Facility

$42.00

Hospital Charge Code	7000409
Hospital Revenue Code	279
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

ULTIPOR ******

Facility

$42.00

Hospital Charge Code	7000409
Hospital Revenue Code	279
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

ULTIVA 2MG VIAL

Facility

$610.64

Service Code	NDC 72078003502
Hospital Charge Code	6063943298
Hospital Revenue Code	250
Min. Negotiated Rate	$91.60
Max. Negotiated Rate	$91.60
Rate for Payer: Qualcare PPO/HMO/WC	$91.60

ULTIVA 2MG VIAL

Facility

$610.64

Service Code	NDC 72078003502
Hospital Charge Code	6063943298
Hospital Revenue Code	250
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$305.32
Rate for Payer: Aetna Commercial	$232.04
Rate for Payer: Aetna Medicare Advantage	$183.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.71
Rate for Payer: Cigna Commercial	$305.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.19
Rate for Payer: Oxford Commercial	$122.13
Rate for Payer: Qualcare PPO/HMO/WC	$91.60
Rate for Payer: UnitedHealthcare Commercial	$122.13
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: Wellpoint Medicaid Managed Care	$16.18

ULTRABRAID II2 BLUE SUTURE 38

Facility

$102.05

Hospital Charge Code	270681095
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$38.78
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.61
Rate for Payer: Oxford Commercial	$20.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$20.41
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

ULTRABRAID II2 BLUE SUTURE 38

Facility

$102.05

Hospital Charge Code	270681095
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

ULTRA-COAT KERRISON MEDIUM 40D

Facility

$4,102.95

Hospital Charge Code	270691414
Hospital Revenue Code	272
Min. Negotiated Rate	$615.44
Max. Negotiated Rate	$615.44
Rate for Payer: Qualcare PPO/HMO/WC	$615.44

Know your out-of-pocket cost for care.

All Charges