Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Y-PLATE 1.5MM 3HOLE/8HOLE

Facility

$967.15

Service Code	HCPCS C1713
Hospital Charge Code	270654817
Hospital Revenue Code	278
Min. Negotiated Rate	$145.07
Max. Negotiated Rate	$234.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$212.77
Rate for Payer: Qualcare PPO/HMO/WC	$145.07

Y-PLATE 2.0MM 3 HOLE/8HOLE

Facility

$1,096.95

Service Code	HCPCS C1713
Hospital Charge Code	270654830
Hospital Revenue Code	278
Min. Negotiated Rate	$164.54
Max. Negotiated Rate	$265.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.33
Rate for Payer: Qualcare PPO/HMO/WC	$164.54

Y-PLATE 2.0MM 3 HOLE/8HOLE

Facility

$1,096.95

Service Code	HCPCS C1713
Hospital Charge Code	270654830
Hospital Revenue Code	278
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$548.48
Rate for Payer: Aetna Commercial	$416.84
Rate for Payer: Aetna Medicare Advantage	$329.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.72
Rate for Payer: Cigna Commercial	$548.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.33
Rate for Payer: Qualcare PPO/HMO/WC	$164.54
Rate for Payer: UnitedHealthcare Community & State	$26.44
Rate for Payer: Wellpoint Medicaid Managed Care	$29.07

Y-PLATE 2.4MM 3HOLE/8HOLE

Facility

$1,164.95

Service Code	HCPCS C1713
Hospital Charge Code	270654863
Hospital Revenue Code	278
Min. Negotiated Rate	$174.74
Max. Negotiated Rate	$281.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$256.29
Rate for Payer: Qualcare PPO/HMO/WC	$174.74

Y-PLATE 2.4MM 3HOLE/8HOLE

Facility

$1,164.95

Service Code	HCPCS C1713
Hospital Charge Code	270654863
Hospital Revenue Code	278
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$582.48
Rate for Payer: Aetna Commercial	$442.68
Rate for Payer: Aetna Medicare Advantage	$349.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$297.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$297.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$297.06
Rate for Payer: Cigna Commercial	$582.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$256.29
Rate for Payer: Qualcare PPO/HMO/WC	$174.74
Rate for Payer: UnitedHealthcare Community & State	$28.08
Rate for Payer: Wellpoint Medicaid Managed Care	$30.87

Y-PLATE LCP 3/HEAD 7H 2.4x60MM

Facility

$2,970.00

Hospital Charge Code	270659767
Hospital Revenue Code	278
Min. Negotiated Rate	$445.50
Max. Negotiated Rate	$718.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$594.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$445.50

Y-PLATE LCP 3/HEAD 7H 2.4x60MM

Facility

$2,970.00

Hospital Charge Code	270659767
Hospital Revenue Code	278
Min. Negotiated Rate	$71.58
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna Commercial	$1,128.60
Rate for Payer: Aetna Medicare Advantage	$891.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$757.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$757.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$594.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$757.35
Rate for Payer: Cigna Commercial	$1,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$445.50
Rate for Payer: UnitedHealthcare Community & State	$71.58
Rate for Payer: Wellpoint Medicaid Managed Care	$78.70

YUTOPAR/10MG/1ML

Facility

$414.00

Hospital Charge Code	60634186
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

YUTOPAR/10MG/1ML

Facility

$414.00

Hospital Charge Code	60634186
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

YUTOPAR/TAB

Facility

$13.00

Hospital Charge Code	60634693
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

YUTOPAR/TAB

Facility

$13.00

Hospital Charge Code	60634693
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

ZA10 PTA FEMORAL-POPLITEAL AR

Facility

$5,000.00

Service Code	HCPCS 37224
Hospital Charge Code	1600000375
Hospital Revenue Code	360
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

ZA10 PTA FEMORAL-POPLITEAL AR

Facility

$5,000.00

Service Code	HCPCS 37224
Hospital Charge Code	1600000375
Hospital Revenue Code	360
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

ZALCITABINE 0.375 MG TAB

Facility

$19.25

Hospital Charge Code	60627339
Hospital Revenue Code	252
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

ZALCITABINE 0.375 MG TAB

Facility

$19.25

Hospital Charge Code	60627339
Hospital Revenue Code	252
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

ZANOSAR PER 1GM INJ

Facility

$1,999.01

Hospital Charge Code	606394262
Hospital Revenue Code	636
Min. Negotiated Rate	$299.85
Max. Negotiated Rate	$483.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.76
Rate for Payer: Qualcare PPO/HMO/WC	$299.85

ZANOSAR PER 1GM INJ

Facility

$1,999.01

Hospital Charge Code	606394262
Hospital Revenue Code	636
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$999.50
Rate for Payer: Aetna Commercial	$759.62
Rate for Payer: Aetna Medicare Advantage	$599.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$509.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$509.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$509.75
Rate for Payer: Cigna Commercial	$999.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.76
Rate for Payer: Qualcare PPO/HMO/WC	$299.85
Rate for Payer: UnitedHealthcare Community & State	$48.18
Rate for Payer: Wellpoint Medicaid Managed Care	$52.97

ZANTAC 150MG GELDOSE

Facility

$7.00

Hospital Charge Code	60635056
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

ZANTAC 150MG GELDOSE

Facility

$7.00

Hospital Charge Code	60635056
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

ZANTAC 150MG GELDOSE UD

Facility

$15.00

Hospital Charge Code	60635057
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

ZANTAC 150MG GELDOSE UD

Facility

$15.00

Hospital Charge Code	60635057
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

ZANTAC/150MG/TAB

Facility

$12.00

Hospital Charge Code	60634188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

ZANTAC/150MG/TAB

Facility

$12.00

Hospital Charge Code	60634188
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

ZANTAC/25MG/1ML

Facility

$24.00

Hospital Charge Code	60634189
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

ZANTAC/25MG/1ML

Facility

$24.00

Hospital Charge Code	60634189
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

Know your out-of-pocket cost for care.

All Charges