Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BREVITAL SODIUM/500MG

Facility

$45.00

Hospital Charge Code	60632582
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

BREVITAL SODIUM/500MG

Facility

$45.00

Hospital Charge Code	60632582
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$422.95
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,861.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$422.95
Rate for Payer: Wellpoint Medicaid Managed Care	$465.07

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,861.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	671263
Hospital Revenue Code	278
Min. Negotiated Rate	$250.25
Max. Negotiated Rate	$5,191.88
Rate for Payer: Aetna Commercial	$3,945.82
Rate for Payer: Aetna Medicare Advantage	$3,115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.86
Rate for Payer: Cigna Commercial	$5,191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56
Rate for Payer: UnitedHealthcare Community & State	$250.25
Rate for Payer: Wellpoint Medicaid Managed Care	$275.17

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	270671263
Hospital Revenue Code	278
Min. Negotiated Rate	$250.25
Max. Negotiated Rate	$5,191.88
Rate for Payer: Aetna Commercial	$3,945.82
Rate for Payer: Aetna Medicare Advantage	$3,115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.86
Rate for Payer: Cigna Commercial	$5,191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56
Rate for Payer: UnitedHealthcare Community & State	$250.25
Rate for Payer: Wellpoint Medicaid Managed Care	$275.17

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	270671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$2,512.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$2,512.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

BRIDGE 24CC

Facility

$12,487.50

Hospital Charge Code	270671264
Hospital Revenue Code	278
Min. Negotiated Rate	$300.95
Max. Negotiated Rate	$6,243.75
Rate for Payer: Aetna Commercial	$4,745.25
Rate for Payer: Aetna Medicare Advantage	$3,746.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,184.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,184.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,497.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,184.31
Rate for Payer: Cigna Commercial	$6,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,021.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,747.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,873.12
Rate for Payer: UnitedHealthcare Community & State	$300.95
Rate for Payer: Wellpoint Medicaid Managed Care	$330.92

BRIDGE 24CC

Facility

$12,487.50

Hospital Charge Code	270671264
Hospital Revenue Code	278
Min. Negotiated Rate	$1,873.12
Max. Negotiated Rate	$3,021.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,021.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,747.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,873.12

BRIDGE 46CC

Facility

$17,850.00

Hospital Charge Code	270671265
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$4,319.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,319.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,927.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,677.50

BRIDGE 46CC

Facility

$17,850.00

Hospital Charge Code	270671265
Hospital Revenue Code	278
Min. Negotiated Rate	$430.19
Max. Negotiated Rate	$8,925.00
Rate for Payer: Aetna Commercial	$6,783.00
Rate for Payer: Aetna Medicare Advantage	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,551.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,551.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,551.75
Rate for Payer: Cigna Commercial	$8,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,319.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,927.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,677.50
Rate for Payer: UnitedHealthcare Community & State	$430.19
Rate for Payer: Wellpoint Medicaid Managed Care	$473.02

BRIDGE LOOPOSTOMY

Facility

$29.65

Hospital Charge Code	270303152
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BRIDGE LOOPOSTOMY

Facility

$29.65

Hospital Charge Code	270303152
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

BRIDGE LOOPOSTOMY 7767*****

Facility

$34.00

Hospital Charge Code	8001356
Hospital Revenue Code	279
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

BRIDGE LOOPOSTOMY 7767*****

Facility

$34.00

Hospital Charge Code	8001356
Hospital Revenue Code	279
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

BRIDGE PLATE STR 2.0MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690770
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

BRIDGE PLATE STR 2.0MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690770
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

BRIEF EMOTIONAL/BEHAV ASSMT

Facility

$232.00

Service Code	HCPCS 96127
Hospital Charge Code	412396127
Hospital Revenue Code	510
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

BRIEF EMOTIONAL/BEHAV ASSMT

Facility

$232.00

Service Code	HCPCS 96127
Hospital Charge Code	412396127
Hospital Revenue Code	510
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$160.16
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

BRIEF MEDICATION VISIT***

Facility

$174.00

Service Code	HCPCS 90862
Hospital Charge Code	50007
Hospital Revenue Code	914
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

BRIEF MEDICATION VISIT***

Facility

$174.00

Service Code	HCPCS 90862
Hospital Charge Code	50007
Hospital Revenue Code	914
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

BRIEF VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99211WF
Hospital Charge Code	9600016
Hospital Revenue Code	519
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$9.61
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

BRIEF VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99211WF
Hospital Charge Code	9600016
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

BRILINTA 60 MG (TICAGRELOR)

Facility

$36.45

Service Code	NDC 186077660
Hospital Charge Code	606390095
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.94
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$7.29
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

Know your out-of-pocket cost for care.

All Charges