Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

X3 INS MDM LINER 22.2X38MM D

Facility

$3,623.35

Service Code	HCPCS C1776
Hospital Charge Code	270695717
Hospital Revenue Code	278
Min. Negotiated Rate	$543.50
Max. Negotiated Rate	$876.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.14
Rate for Payer: Qualcare PPO/HMO/WC	$543.50

X3 INS MDM LINER 22.2X38MM D

Facility

$3,623.35

Service Code	HCPCS C1776
Hospital Charge Code	270695717
Hospital Revenue Code	278
Min. Negotiated Rate	$87.32
Max. Negotiated Rate	$1,811.67
Rate for Payer: Aetna Commercial	$1,376.87
Rate for Payer: Aetna Medicare Advantage	$1,087.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.95
Rate for Payer: Cigna Commercial	$1,811.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.14
Rate for Payer: Qualcare PPO/HMO/WC	$543.50
Rate for Payer: UnitedHealthcare Community & State	$87.32
Rate for Payer: Wellpoint Medicaid Managed Care	$96.02

XANAX/0.25MG/TAB

Facility

$6.00

Hospital Charge Code	60634178
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

XANAX/0.25MG/TAB

Facility

$6.00

Hospital Charge Code	60634178
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

XANAX/0.5MG/TAB

Facility

$7.00

Hospital Charge Code	60634179
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

XANAX/0.5MG/TAB

Facility

$7.00

Hospital Charge Code	60634179
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

XANAX/0.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

XANAX/0.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.51
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.40
Rate for Payer: Cigna Commercial	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.70
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$5.80
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

XANAX/1MG/TAB

Facility

$6.00

Hospital Charge Code	60634180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

XANAX/1MG/TAB

Facility

$6.00

Hospital Charge Code	60634180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.30
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.30
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.30
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.75
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$885.07
Max. Negotiated Rate	$18,362.50
Rate for Payer: Aetna Commercial	$13,955.50
Rate for Payer: Aetna Medicare Advantage	$11,017.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,364.88
Rate for Payer: Cigna Commercial	$18,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,887.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,079.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,508.75
Rate for Payer: UnitedHealthcare Community & State	$885.07
Rate for Payer: Wellpoint Medicaid Managed Care	$973.21

Know your out-of-pocket cost for care.

All Charges