Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$5,508.75
Max. Negotiated Rate	$8,887.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
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

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$227.14
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$3,581.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75
Rate for Payer: UnitedHealthcare Community & State	$227.14
Rate for Payer: Wellpoint Medicaid Managed Care	$249.76

XELODA 500MG

Facility

$80.00

Hospital Charge Code	60635625
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

XELODA 500MG

Facility

$80.00

Hospital Charge Code	60635625
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$8.06
Rate for Payer: Qualcare PPO/HMO/WC	$8.06

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$26.86
Rate for Payer: Aetna Commercial	$20.42
Rate for Payer: Aetna Medicare Advantage	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.70
Rate for Payer: Cigna Commercial	$26.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.06
Rate for Payer: UnitedHealthcare Commercial	$10.75
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,761.71
Max. Negotiated Rate	$36,550.00
Rate for Payer: Aetna Commercial	$27,778.00
Rate for Payer: Aetna Medicare Advantage	$21,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,640.50
Rate for Payer: Cigna Commercial	$36,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16,082.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00
Rate for Payer: UnitedHealthcare Community & State	$1,761.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1,937.15

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$17,690.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16,082.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$47.34
Rate for Payer: Qualcare PPO/HMO/WC	$47.34

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$225.21
Rate for Payer: Aetna Commercial	$119.92
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.67
Rate for Payer: Qualcare PPO/HMO/WC	$47.34
Rate for Payer: UnitedHealthcare Community & State	$7.61
Rate for Payer: Wellpoint Medicaid Managed Care	$8.36

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.00
Rate for Payer: Oxford Commercial	$96.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$96.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

XIENCE SKYPOINT DES 3.00 x 38

Facility

$3,500.00

Hospital Charge Code	270704383
Hospital Revenue Code	279
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

XIENCE SKYPOINT DES 3.00 x 38

Facility

$3,500.00

Hospital Charge Code	270704383
Hospital Revenue Code	279
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

XIENCE SKYPOINT DES 4.00 x 28

Facility

$3,500.00

Hospital Charge Code	270704408
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

XIENCE SKYPOINT DES 4.00 x 28

Facility

$3,500.00

Hospital Charge Code	270704408
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

XIGRIS 5MG VIAL

Facility

$462.00

Hospital Charge Code	60635377
Hospital Revenue Code	250
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$175.56
Rate for Payer: Aetna Medicare Advantage	$138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.81
Rate for Payer: Cigna Commercial	$231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.60
Rate for Payer: Oxford Commercial	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$69.30
Rate for Payer: UnitedHealthcare Commercial	$92.40
Rate for Payer: UnitedHealthcare Community & State	$11.13
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

XIGRIS 5MG VIAL

Facility

$462.00

Hospital Charge Code	60635377
Hospital Revenue Code	250
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.30

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$897.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$144.12
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$2,272.40
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.00
Rate for Payer: Oxford Commercial	$1,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00
Rate for Payer: UnitedHealthcare Commercial	$1,196.00
Rate for Payer: UnitedHealthcare Community & State	$144.12
Rate for Payer: Wellpoint Medicaid Managed Care	$158.47

Know your out-of-pocket cost for care.

All Charges