Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

UROKINASE INJ 5000 IU/ML 1.8ML

Facility

$654.10

Hospital Charge Code	6010219
Hospital Revenue Code	250
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$327.05
Rate for Payer: Aetna Commercial	$248.56
Rate for Payer: Aetna Medicare Advantage	$196.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.80
Rate for Payer: Cigna Commercial	$327.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.23
Rate for Payer: Oxford Commercial	$130.82
Rate for Payer: Qualcare PPO/HMO/WC	$98.11
Rate for Payer: UnitedHealthcare Commercial	$130.82
Rate for Payer: UnitedHealthcare Community & State	$15.76
Rate for Payer: Wellpoint Medicaid Managed Care	$17.33

UROKINASE INJ 5000 IU/ML 1.8ML

Facility

$654.10

Hospital Charge Code	6010219
Hospital Revenue Code	250
Min. Negotiated Rate	$98.11
Max. Negotiated Rate	$98.11
Rate for Payer: Qualcare PPO/HMO/WC	$98.11

UROKINASE INJ 9,000U/1.8ML

Facility

$519.55

Hospital Charge Code	60627542
Hospital Revenue Code	250
Min. Negotiated Rate	$77.93
Max. Negotiated Rate	$77.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.93

UROKINASE INJ 9,000U/1.8ML

Facility

$519.55

Hospital Charge Code	60627542
Hospital Revenue Code	250
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$259.77
Rate for Payer: Aetna Commercial	$197.43
Rate for Payer: Aetna Medicare Advantage	$155.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.49
Rate for Payer: Cigna Commercial	$259.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.87
Rate for Payer: Oxford Commercial	$103.91
Rate for Payer: Qualcare PPO/HMO/WC	$77.93
Rate for Payer: UnitedHealthcare Commercial	$103.91
Rate for Payer: UnitedHealthcare Community & State	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$13.77

UROLIFT 2 IMPLANT CARTRIDGE

Facility

$23,000.00

Hospital Charge Code	270702038
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

UROLIFT 2 IMPLANT CARTRIDGE

Facility

$23,000.00

Hospital Charge Code	270702038
Hospital Revenue Code	278
Min. Negotiated Rate	$554.30
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$8,740.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00
Rate for Payer: UnitedHealthcare Community & State	$554.30
Rate for Payer: Wellpoint Medicaid Managed Care	$609.50

UROLIFT CARTRIDGE HANDLE KIT

Facility

$5,750.00

Hospital Charge Code	270702039
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

UROLIFT CARTRIDGE HANDLE KIT

Facility

$5,750.00

Hospital Charge Code	270702039
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

UROLIFT CARTRIDGE HANDLE KIT

Facility

$5,750.00

Hospital Charge Code	270702309
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

UROLIFT CARTRIDGE HANDLE KIT

Facility

$5,750.00

Hospital Charge Code	270702309
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

UROLOME LOANER KIT LK0022

Facility

$11,408.00

Hospital Charge Code	270634331
Hospital Revenue Code	272
Min. Negotiated Rate	$274.93
Max. Negotiated Rate	$5,704.00
Rate for Payer: Aetna Commercial	$4,335.04
Rate for Payer: Aetna Medicare Advantage	$3,422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,909.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,909.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,909.04
Rate for Payer: Cigna Commercial	$5,704.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,422.40
Rate for Payer: Oxford Commercial	$2,281.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.20
Rate for Payer: UnitedHealthcare Commercial	$2,281.60
Rate for Payer: UnitedHealthcare Community & State	$274.93
Rate for Payer: Wellpoint Medicaid Managed Care	$302.31

UROLOME LOANER KIT LK0022

Facility

$11,408.00

Hospital Charge Code	270634331
Hospital Revenue Code	272
Min. Negotiated Rate	$1,711.20
Max. Negotiated Rate	$1,711.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.20

URO MAX ULTRA 21FR 75CM ASCEND

Facility

$1,038.70

Hospital Charge Code	270658598
Hospital Revenue Code	278
Min. Negotiated Rate	$155.81
Max. Negotiated Rate	$251.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$228.51
Rate for Payer: Qualcare PPO/HMO/WC	$155.81

URO MAX ULTRA 21FR 75CM ASCEND

Facility

$1,038.70

Hospital Charge Code	270658598
Hospital Revenue Code	278
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$519.35
Rate for Payer: Aetna Commercial	$394.71
Rate for Payer: Aetna Medicare Advantage	$311.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.87
Rate for Payer: Cigna Commercial	$519.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$228.51
Rate for Payer: Qualcare PPO/HMO/WC	$155.81
Rate for Payer: UnitedHealthcare Community & State	$25.03
Rate for Payer: Wellpoint Medicaid Managed Care	$27.53

URO MAX ULTRA BALLOON CATHETER

Facility

$1,741.15

Service Code	HCPCS C1726
Hospital Charge Code	270656990
Hospital Revenue Code	278
Min. Negotiated Rate	$261.17
Max. Negotiated Rate	$421.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$383.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.17

URO MAX ULTRA BALLOON CATHETER

Facility

$1,741.15

Service Code	HCPCS C1726
Hospital Charge Code	270656990
Hospital Revenue Code	278
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$870.58
Rate for Payer: Aetna Commercial	$661.64
Rate for Payer: Aetna Medicare Advantage	$522.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.99
Rate for Payer: Cigna Commercial	$870.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$383.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.17
Rate for Payer: UnitedHealthcare Community & State	$41.96
Rate for Payer: Wellpoint Medicaid Managed Care	$46.14

UROMAX ULTRA BALLOON DILATION

Facility

$1,741.15

Hospital Charge Code	270657032
Hospital Revenue Code	278
Min. Negotiated Rate	$261.17
Max. Negotiated Rate	$421.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$383.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.17

UROMAX ULTRA BALLOON DILATION

Facility

$1,741.15

Hospital Charge Code	270657032
Hospital Revenue Code	278
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$870.58
Rate for Payer: Aetna Commercial	$661.64
Rate for Payer: Aetna Medicare Advantage	$522.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.99
Rate for Payer: Cigna Commercial	$870.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$383.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.17
Rate for Payer: UnitedHealthcare Community & State	$41.96
Rate for Payer: Wellpoint Medicaid Managed Care	$46.14

UROVAC BLADDER EVACUATOR

Facility

$148.00

Hospital Charge Code	270332412
Hospital Revenue Code	272
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$74.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$29.60
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$29.60
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

UROVAC BLADDER EVACUATOR

Facility

$148.00

Hospital Charge Code	270332412
Hospital Revenue Code	272
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

URR

Facility

$5.56

Service Code	HCPCS 84520CE
Hospital Charge Code	8200335RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

URR

Facility

$5.56

Service Code	HCPCS 84520CE
Hospital Charge Code	8200335RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

URSODIOL 300 MG CAP

Facility

$49.25

Service Code	NDC 591315901
Hospital Charge Code	60628733
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$7.39
Rate for Payer: Qualcare PPO/HMO/WC	$7.39

URSODIOL 300 MG CAP

Facility

$49.25

Service Code	NDC 591315901
Hospital Charge Code	60628733
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$24.62
Rate for Payer: Aetna Commercial	$18.71
Rate for Payer: Aetna Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$24.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.78
Rate for Payer: Oxford Commercial	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$7.39
Rate for Payer: UnitedHealthcare Commercial	$9.85
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

URTERINE MANIPULATOR 4.5MM

Facility

$583.00

Hospital Charge Code	270332489
Hospital Revenue Code	272
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

Know your out-of-pocket cost for care.

All Charges