Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CAPOTEN/50MG/TAB

Facility

$5.00

Hospital Charge Code	60632612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CAPOTEN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60632613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CAPOTEN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60632613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CAPOTEN/50MG/TAB

Facility

$5.00

Hospital Charge Code	60632612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

CAPOZIDE/TAB

Facility

$6.00

Hospital Charge Code	60632617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CAPOZIDE/TAB

Facility

$6.00

Hospital Charge Code	60632616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CAPOZIDE/TAB

Facility

$6.00

Hospital Charge Code	60632617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CAPOZIDE/TAB

Facility

$6.00

Hospital Charge Code	60632616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CAPOZIDE/TAB

Facility

$5.00

Hospital Charge Code	60632615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CAPOZIDE/TAB

Facility

$5.00

Hospital Charge Code	60632615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

CAP PLEURX REPL VALVE 507235

Facility

$24.85

Hospital Charge Code	270635260
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

CAP PLEURX REPL VALVE 507235

Facility

$24.85

Hospital Charge Code	270635260
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

CAP PROTECT F/4 FX PINS 393.40

Facility

$17.50

Hospital Charge Code	270638401
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.75
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.25
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CAP PROTECT F/4 FX PINS 393.40

Facility

$17.50

Hospital Charge Code	270638401
Hospital Revenue Code	272
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

CAP PROTECTIVE F/4.0MM CARBON

Facility

$13.83

Hospital Charge Code	270633008
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.92
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: Aetna Medicare Advantage	$4.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.53
Rate for Payer: Cigna Commercial	$6.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

CAP PROTECTIVE F/4.0MM CARBON

Facility

$13.83

Hospital Charge Code	270633008
Hospital Revenue Code	278
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

CAP PROTECTIVE F/4.5mm FIX PIN

Facility

$17.15

Hospital Charge Code	270639893
Hospital Revenue Code	278
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$4.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.57

CAP PROTECTIVE F/4.5mm FIX PIN

Facility

$17.15

Hospital Charge Code	270639893
Hospital Revenue Code	278
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.57
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare Advantage	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.37
Rate for Payer: Cigna Commercial	$8.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

CAP PSN ASF 14 MM 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690744
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CAP PSN ASF 14 MM 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690744
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

CAP REVEAL DIS ATT O.D. 11.35

Facility

$90.00

Hospital Charge Code	270685846
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CAP REVEAL DIS ATT O.D. 11.35

Facility

$90.00

Hospital Charge Code	270685846
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

Know your out-of-pocket cost for care.

All Charges