Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BTB TIGHTROPE WITH SUTURE

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270678335
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

BTB TIGHTROPE WITH SUTURE

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270678335
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$538.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

BTL SPRAY FILM BARRIER 28ML

Facility

$35.61

Hospital Charge Code	270649950
Hospital Revenue Code	270
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

BTL SPRAY FILM BARRIER 28ML

Facility

$35.61

Hospital Charge Code	2706499950
Hospital Revenue Code	270
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

BTL SPRAY FILM BARRIER 28ML

Facility

$35.61

Hospital Charge Code	270649950
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare Advantage	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.08
Rate for Payer: Cigna Commercial	$17.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.68
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

BTL SPRAY FILM BARRIER 28ML

Facility

$35.61

Hospital Charge Code	2706499950
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare Advantage	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.08
Rate for Payer: Cigna Commercial	$17.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.68
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

B-TYPE NATRIURETIC PEPTIDE

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3009045
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

B-TYPE NATRIURETIC PEPTIDE

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3009045
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

BUCELLA ABORTUS IGG, EIA

Facility

$71.25

Service Code	HCPCS 86622
Hospital Charge Code	3006550
Hospital Revenue Code	302
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.29
Rate for Payer: Aetna Medicare Advantage	$28.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.23
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: Cigna Medicare Advantage	$8.93
Rate for Payer: Clover Medicare Advantage	$8.48
Rate for Payer: EmblemHealth Commercial	$26.79
Rate for Payer: Humana Medicare Advantage	$9.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.93
Rate for Payer: Wellcare Medicare Advantage	$8.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

BUCELLA ABORTUS IGG, EIA

Facility

$71.25

Service Code	HCPCS 86622
Hospital Charge Code	3006550
Hospital Revenue Code	302
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

BUCKET HANDLE RICHARDS 4.25mm

Facility

$1,171.65

Hospital Charge Code	270639952
Hospital Revenue Code	272
Min. Negotiated Rate	$175.75
Max. Negotiated Rate	$175.75
Rate for Payer: Qualcare PPO/HMO/WC	$175.75

BUCKET HANDLE RICHARDS 4.25mm

Facility

$1,171.65

Hospital Charge Code	270639952
Hospital Revenue Code	272
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$585.83
Rate for Payer: Aetna Commercial	$445.23
Rate for Payer: Aetna Medicare Advantage	$351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.77
Rate for Payer: Cigna Commercial	$585.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.50
Rate for Payer: Oxford Commercial	$234.33
Rate for Payer: Qualcare PPO/HMO/WC	$175.75
Rate for Payer: UnitedHealthcare Commercial	$234.33
Rate for Payer: UnitedHealthcare Community & State	$28.24
Rate for Payer: Wellpoint Medicaid Managed Care	$31.05

BUCKET RCHDS HANDLE 1MM 142044

Facility

$897.65

Hospital Charge Code	270620115
Hospital Revenue Code	272
Min. Negotiated Rate	$134.65
Max. Negotiated Rate	$134.65
Rate for Payer: Qualcare PPO/HMO/WC	$134.65

BUCKET RCHDS HANDLE 1MM 142044

Facility

$897.65

Hospital Charge Code	270620115
Hospital Revenue Code	272
Min. Negotiated Rate	$21.63
Max. Negotiated Rate	$448.82
Rate for Payer: Aetna Commercial	$341.11
Rate for Payer: Aetna Medicare Advantage	$269.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.90
Rate for Payer: Cigna Commercial	$448.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.30
Rate for Payer: Oxford Commercial	$179.53
Rate for Payer: Qualcare PPO/HMO/WC	$134.65
Rate for Payer: UnitedHealthcare Commercial	$179.53
Rate for Payer: UnitedHealthcare Community & State	$21.63
Rate for Payer: Wellpoint Medicaid Managed Care	$23.79

BUCKS BRACKET *******

Facility

$168.00

Hospital Charge Code	8001851
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

BUCKS BRACKET *******

Facility

$168.00

Hospital Charge Code	8001851
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

BUDESONIDE 3 MG ER

Facility

$126.30

Service Code	NDC 378715501
Hospital Charge Code	60629914
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.15
Rate for Payer: Aetna Commercial	$47.99
Rate for Payer: Aetna Medicare Advantage	$37.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.21
Rate for Payer: Cigna Commercial	$63.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.89
Rate for Payer: Oxford Commercial	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$18.95
Rate for Payer: UnitedHealthcare Commercial	$25.26
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

BUDESONIDE 3 MG ER

Facility

$126.30

Service Code	NDC 378715501
Hospital Charge Code	60629914
Hospital Revenue Code	250
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$18.95
Rate for Payer: Qualcare PPO/HMO/WC	$18.95

BUDESONIDE90 MCG/INH POW

Facility

$885.10

Hospital Charge Code	60629874
Hospital Revenue Code	250
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$442.55
Rate for Payer: Aetna Commercial	$336.34
Rate for Payer: Aetna Medicare Advantage	$265.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.70
Rate for Payer: Cigna Commercial	$442.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.53
Rate for Payer: Oxford Commercial	$177.02
Rate for Payer: Qualcare PPO/HMO/WC	$132.76
Rate for Payer: UnitedHealthcare Commercial	$177.02
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$23.46

BUDESONIDE90 MCG/INH POW

Facility

$885.10

Hospital Charge Code	60629874
Hospital Revenue Code	250
Min. Negotiated Rate	$132.76
Max. Negotiated Rate	$132.76
Rate for Payer: Qualcare PPO/HMO/WC	$132.76

BUDESONIDE INH 0.25MG/2ML

Facility

$70.08

Service Code	NDC 186198804
Hospital Charge Code	60629103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.04
Rate for Payer: Aetna Commercial	$26.63
Rate for Payer: Aetna Medicare Advantage	$21.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$35.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.02
Rate for Payer: Oxford Commercial	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$10.51
Rate for Payer: UnitedHealthcare Commercial	$14.02
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

BUDESONIDE INH 0.25MG/2ML

Facility

$70.08

Service Code	NDC 186198804
Hospital Charge Code	60629103
Hospital Revenue Code	250
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$10.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.51

BUDESONIDE INH 0.5MG/30ML

Facility

$82.48

Service Code	NDC 186198904
Hospital Charge Code	60629104
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.24
Rate for Payer: Aetna Commercial	$31.34
Rate for Payer: Aetna Medicare Advantage	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.03
Rate for Payer: Cigna Commercial	$41.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.74
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.37
Rate for Payer: UnitedHealthcare Commercial	$16.50
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

BUDESONIDE INH 0.5MG/30ML

Facility

$82.48

Service Code	NDC 186198904
Hospital Charge Code	60629104
Hospital Revenue Code	250
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$12.37
Rate for Payer: Qualcare PPO/HMO/WC	$12.37

BUFFERED OPHTH IRRIG 118ML

Facility

$48.00

Hospital Charge Code	6000756
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

Know your out-of-pocket cost for care.

All Charges