Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR LINER 42/43 OD X 22MM

Facility

$1,437.55

Hospital Charge Code	270665069
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$347.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.26
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

BIPOLAR LINER 42/43 OD X 22MM

Facility

$1,437.55

Hospital Charge Code	270665069
Hospital Revenue Code	278
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$718.77
Rate for Payer: Aetna Commercial	$546.27
Rate for Payer: Aetna Medicare Advantage	$431.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.58
Rate for Payer: Cigna Commercial	$718.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.26
Rate for Payer: Qualcare PPO/HMO/WC	$215.63
Rate for Payer: UnitedHealthcare Community & State	$34.64
Rate for Payer: Wellpoint Medicaid Managed Care	$38.10

BIPOLAR MARYLAND SINGLE SITE

Facility

$1,283.33

Hospital Charge Code	270672906
Hospital Revenue Code	272
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$192.50

BIPOLAR MARYLAND SINGLE SITE

Facility

$1,283.33

Hospital Charge Code	270672906
Hospital Revenue Code	272
Min. Negotiated Rate	$30.93
Max. Negotiated Rate	$641.66
Rate for Payer: Aetna Commercial	$487.67
Rate for Payer: Aetna Medicare Advantage	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.25
Rate for Payer: Cigna Commercial	$641.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$385.00
Rate for Payer: Oxford Commercial	$256.67
Rate for Payer: Qualcare PPO/HMO/WC	$192.50
Rate for Payer: UnitedHealthcare Commercial	$256.67
Rate for Payer: UnitedHealthcare Community & State	$30.93
Rate for Payer: Wellpoint Medicaid Managed Care	$34.01

BIPOLAR SHELL 42MM OD

Facility

$2,256.50

Hospital Charge Code	270665068
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$546.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.43
Rate for Payer: Qualcare PPO/HMO/WC	$338.48

BIPOLAR SHELL 42MM OD

Facility

$2,256.50

Hospital Charge Code	270665068
Hospital Revenue Code	278
Min. Negotiated Rate	$54.38
Max. Negotiated Rate	$1,128.25
Rate for Payer: Aetna Commercial	$857.47
Rate for Payer: Aetna Medicare Advantage	$676.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.41
Rate for Payer: Cigna Commercial	$1,128.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.43
Rate for Payer: Qualcare PPO/HMO/WC	$338.48
Rate for Payer: UnitedHealthcare Community & State	$54.38
Rate for Payer: Wellpoint Medicaid Managed Care	$59.80

BIPOLAR TRIGGER FLEA 40 CM PRB

Facility

$3,750.00

Hospital Charge Code	270688728
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

BIPOLAR TRIGGER FLEA 40 CM PRB

Facility

$3,750.00

Hospital Charge Code	270688728
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

BIRCH (T3) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900355
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BIRCH (T3) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900355
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BISACODYL/10MG/EACH

Facility

$1.00

Hospital Charge Code	60632567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BISACODYL/10MG/EACH

Facility

$3.00

Hospital Charge Code	60632568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

BISACODYL/10MG/EACH

Facility

$1.00

Hospital Charge Code	60632567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BISACODYL/10MG/EACH

Facility

$3.00

Hospital Charge Code	60632568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BISACODYL 10 MG SUPP

Facility

$4.00

Service Code	NDC 904505812
Hospital Charge Code	6023048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BISACODYL 10 MG SUPP

Facility

$4.00

Service Code	NDC 904505812
Hospital Charge Code	6023048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISACODYL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BISACODYL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

BISACODYL/5MG/TAB

Facility

$1.00

Hospital Charge Code	60632569
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BISACODYL/5MG/TAB

Facility

$1.00

Hospital Charge Code	60632569
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BISACODYL 5MG TABLETS

Facility

$4.00

Service Code	NDC 52959067430
Hospital Charge Code	60628123
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISACODYL 5MG TABLETS

Facility

$4.00

Service Code	NDC 52959067430
Hospital Charge Code	60628123
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BISACODYL TAB 5MG

Facility

$1.95

Hospital Charge Code	6022206
Hospital Revenue Code	257
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

BISACODYL TAB 5MG

Facility

$1.95

Hospital Charge Code	6022206
Hospital Revenue Code	257
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

BISMUTH MAGMA SSP 8 OZ

Facility

$21.15

Hospital Charge Code	6000707
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

Know your out-of-pocket cost for care.

All Charges