Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XYLOCAINE 5%/35GM

Facility

$56.00

Hospital Charge Code	60634185
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

XYLOCAINE MPF 0.5% VIAL

Facility

$24.92

Service Code	NDC 409427801
Hospital Charge Code	60634763
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.46
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.35
Rate for Payer: Cigna Commercial	$12.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Oxford Commercial	$4.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.74
Rate for Payer: UnitedHealthcare Commercial	$4.98
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

XYLOCAINE MPF 0.5% VIAL

Facility

$24.92

Service Code	NDC 409427801
Hospital Charge Code	60634763
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.74

XYLOCAINE MPF 1% 10MG/ML 10 ML

Facility

$41.54

Service Code	NDC 63323049297
Hospital Charge Code	606390183
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.77
Rate for Payer: Aetna Commercial	$15.79
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.59
Rate for Payer: Cigna Commercial	$20.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.46
Rate for Payer: Oxford Commercial	$8.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.23
Rate for Payer: UnitedHealthcare Commercial	$8.31
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

XYLOCAINE MPF 1% 10MG/ML 10 ML

Facility

$41.54

Service Code	NDC 63323049297
Hospital Charge Code	606390183
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$6.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.23

XYLOCAINE MPF 1% AMP

Facility

$82.41

Service Code	NDC 63323049237
Hospital Charge Code	60634762
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.32
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.72
Rate for Payer: Oxford Commercial	$16.48
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Commercial	$16.48
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

XYLOCAINE MPF 1% AMP

Facility

$82.41

Service Code	NDC 63323049237
Hospital Charge Code	60634762
Hospital Revenue Code	250
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.36

XYLOCAINE, MPF 2%

Facility

$15.00

Hospital Charge Code	60635444
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

XYLOCAINE, MPF 2%

Facility

$15.00

Hospital Charge Code	60635444
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

XYLOCAINE-MPF 2% 10MLPLYM

Facility

$24.52

Service Code	NDC 409428202
Hospital Charge Code	60635347
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$3.68
Rate for Payer: Qualcare PPO/HMO/WC	$3.68

XYLOCAINE-MPF 2% 10MLPLYM

Facility

$24.52

Service Code	NDC 409428202
Hospital Charge Code	60635347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.26
Rate for Payer: Aetna Commercial	$9.32
Rate for Payer: Aetna Medicare Advantage	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.25
Rate for Payer: Cigna Commercial	$12.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.36
Rate for Payer: Oxford Commercial	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.68
Rate for Payer: UnitedHealthcare Commercial	$4.90
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

XYLOCAINE MPF 4% 5ML

Facility

$21.00

Hospital Charge Code	60635354
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

XYLOCAINE MPF 4% 5ML

Facility

$21.00

Hospital Charge Code	60635354
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

XYLOCAINE ORAL 10%/30ML

Facility

$190.00

Hospital Charge Code	60634181
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Oxford Commercial	$38.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

XYLOCAINE ORAL 10%/30ML

Facility

$190.00

Hospital Charge Code	60634181
Hospital Revenue Code	250
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

XYLOCAINE TOPICAL 4%/50ML

Facility

$66.00

Hospital Charge Code	60634182
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

XYLOCAINE TOPICAL 4%/50ML

Facility

$66.00

Hospital Charge Code	60634182
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

XYLOSE ABSORPTION

Facility

$103.25

Service Code	HCPCS 84620
Hospital Charge Code	3002813
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

XYLOSE ABSORPTION

Facility

$103.25

Service Code	HCPCS 84620
Hospital Charge Code	3002813
Hospital Revenue Code	301
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.60
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$12.91
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

XYLOSE ABSORPTION TEST

Facility

$180.00

Service Code	HCPCS 84620
Hospital Charge Code	38472704
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

XYLOSE ABSORPTION TEST

Facility

$180.00

Service Code	HCPCS 84620
Hospital Charge Code	38472704
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.60
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$12.91
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

Y-ADAPTER

Facility

$209.00

Hospital Charge Code	2008170
Hospital Revenue Code	272
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$79.42
Rate for Payer: Aetna Medicare Advantage	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.30
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.70
Rate for Payer: Oxford Commercial	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

Y-ADAPTER

Facility

$209.00

Hospital Charge Code	2008170
Hospital Revenue Code	272
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

YAG LASER*****

Facility

$765.00

Service Code	HCPCS 66821
Hospital Charge Code	5600010
Hospital Revenue Code	369
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$1,777.28
Rate for Payer: Aetna Medicare Advantage	$2,117.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$653.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.61
Rate for Payer: Cigna Commercial	$1,309.76
Rate for Payer: Cigna Medicare Advantage	$653.41
Rate for Payer: Clover Medicare Advantage	$620.74
Rate for Payer: EmblemHealth Commercial	$1,960.23
Rate for Payer: Humana Medicare Advantage	$673.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$653.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.50
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$653.41
Rate for Payer: Wellcare Medicare Advantage	$653.41
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

YAG LASER*****

Facility

$765.00

Service Code	HCPCS 66821
Hospital Charge Code	5600010
Hospital Revenue Code	369
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

Know your out-of-pocket cost for care.

All Charges