Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARTRIDE FRONT LOADING****

Facility

$66.00

Hospital Charge Code	1601624
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CARTRIDE FRONT LOADING****

Facility

$66.00

Hospital Charge Code	1601624
Hospital Revenue Code	272
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

CARTRIDGE CURTEK 22m XL 906758

Facility

$2,430.45

Hospital Charge Code	270631759
Hospital Revenue Code	272
Min. Negotiated Rate	$364.57
Max. Negotiated Rate	$364.57
Rate for Payer: Qualcare PPO/HMO/WC	$364.57

CARTRIDGE CURTEK 22m XL 906758

Facility

$2,430.45

Hospital Charge Code	270631759
Hospital Revenue Code	272
Min. Negotiated Rate	$58.57
Max. Negotiated Rate	$1,215.22
Rate for Payer: Aetna Commercial	$923.57
Rate for Payer: Aetna Medicare Advantage	$729.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$619.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$619.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$619.76
Rate for Payer: Cigna Commercial	$1,215.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.13
Rate for Payer: Oxford Commercial	$486.09
Rate for Payer: Qualcare PPO/HMO/WC	$364.57
Rate for Payer: UnitedHealthcare Commercial	$486.09
Rate for Payer: UnitedHealthcare Community & State	$58.57
Rate for Payer: Wellpoint Medicaid Managed Care	$64.41

CARTRIDGE CURVTEK LG 40-0203

Facility

$3,681.65

Hospital Charge Code	270613470
Hospital Revenue Code	272
Min. Negotiated Rate	$552.25
Max. Negotiated Rate	$552.25
Rate for Payer: Qualcare PPO/HMO/WC	$552.25

CARTRIDGE CURVTEK LG 40-0203

Facility

$3,681.65

Hospital Charge Code	270613470
Hospital Revenue Code	272
Min. Negotiated Rate	$88.73
Max. Negotiated Rate	$1,840.83
Rate for Payer: Aetna Commercial	$1,399.03
Rate for Payer: Aetna Medicare Advantage	$1,104.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$938.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$938.82
Rate for Payer: Cigna Commercial	$1,840.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.49
Rate for Payer: Oxford Commercial	$736.33
Rate for Payer: Qualcare PPO/HMO/WC	$552.25
Rate for Payer: UnitedHealthcare Commercial	$736.33
Rate for Payer: UnitedHealthcare Community & State	$88.73
Rate for Payer: Wellpoint Medicaid Managed Care	$97.56

CARTRIDGE CURVTEK MED 906750

Facility

$3,578.45

Hospital Charge Code	270615868
Hospital Revenue Code	272
Min. Negotiated Rate	$536.77
Max. Negotiated Rate	$536.77
Rate for Payer: Qualcare PPO/HMO/WC	$536.77

CARTRIDGE CURVTEK MED 906750

Facility

$3,578.45

Hospital Charge Code	270615868
Hospital Revenue Code	272
Min. Negotiated Rate	$86.24
Max. Negotiated Rate	$1,789.22
Rate for Payer: Aetna Commercial	$1,359.81
Rate for Payer: Aetna Medicare Advantage	$1,073.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.50
Rate for Payer: Cigna Commercial	$1,789.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.54
Rate for Payer: Oxford Commercial	$715.69
Rate for Payer: Qualcare PPO/HMO/WC	$536.77
Rate for Payer: UnitedHealthcare Commercial	$715.69
Rate for Payer: UnitedHealthcare Community & State	$86.24
Rate for Payer: Wellpoint Medicaid Managed Care	$94.83

CARTRIDGE HI-SORB 641208000

Facility

$343.25

Hospital Charge Code	270606197
Hospital Revenue Code	270
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$171.62
Rate for Payer: Aetna Commercial	$130.44
Rate for Payer: Aetna Medicare Advantage	$102.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.53
Rate for Payer: Cigna Commercial	$171.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.97
Rate for Payer: Oxford Commercial	$68.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.49
Rate for Payer: UnitedHealthcare Commercial	$68.65
Rate for Payer: UnitedHealthcare Community & State	$8.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9.10

CARTRIDGE HI-SORB 641208000

Facility

$343.25

Hospital Charge Code	270606197
Hospital Revenue Code	270
Min. Negotiated Rate	$51.49
Max. Negotiated Rate	$51.49
Rate for Payer: Qualcare PPO/HMO/WC	$51.49

CARTRIDGE, MONARCH II IOL

Facility

$1,000.00

Hospital Charge Code	270655285
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CARTRIDGE, MONARCH II IOL

Facility

$1,000.00

Hospital Charge Code	270655285
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CARTRIDGE PAPER & INK ENDOSCOP

Facility

$6,583.50

Hospital Charge Code	270655839
Hospital Revenue Code	278
Min. Negotiated Rate	$987.52
Max. Negotiated Rate	$1,593.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,316.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,448.37
Rate for Payer: Qualcare PPO/HMO/WC	$987.52

CARTRIDGE PAPER & INK ENDOSCOP

Facility

$6,583.50

Hospital Charge Code	270655839
Hospital Revenue Code	278
Min. Negotiated Rate	$158.66
Max. Negotiated Rate	$3,291.75
Rate for Payer: Aetna Commercial	$2,501.73
Rate for Payer: Aetna Medicare Advantage	$1,975.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,678.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,678.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,316.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,678.79
Rate for Payer: Cigna Commercial	$3,291.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,448.37
Rate for Payer: Qualcare PPO/HMO/WC	$987.52
Rate for Payer: UnitedHealthcare Community & State	$158.66
Rate for Payer: Wellpoint Medicaid Managed Care	$174.46

CARTRIDGE RELOAD THICK TISSUE

Facility

$599.00

Hospital Charge Code	270334714
Hospital Revenue Code	272
Min. Negotiated Rate	$14.44
Max. Negotiated Rate	$299.50
Rate for Payer: Aetna Commercial	$227.62
Rate for Payer: Aetna Medicare Advantage	$179.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.75
Rate for Payer: Cigna Commercial	$299.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.70
Rate for Payer: Oxford Commercial	$119.80
Rate for Payer: Qualcare PPO/HMO/WC	$89.85
Rate for Payer: UnitedHealthcare Commercial	$119.80
Rate for Payer: UnitedHealthcare Community & State	$14.44
Rate for Payer: Wellpoint Medicaid Managed Care	$15.87

CARTRIDGE RELOAD THICK TISSUE

Facility

$599.00

Hospital Charge Code	270334714
Hospital Revenue Code	272
Min. Negotiated Rate	$89.85
Max. Negotiated Rate	$89.85
Rate for Payer: Qualcare PPO/HMO/WC	$89.85

CARTRIDGE TVX

Facility

$107.33

Hospital Charge Code	270656296
Hospital Revenue Code	271
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.66
Rate for Payer: Aetna Commercial	$40.79
Rate for Payer: Aetna Medicare Advantage	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.37
Rate for Payer: Cigna Commercial	$53.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.20
Rate for Payer: Oxford Commercial	$21.47
Rate for Payer: Qualcare PPO/HMO/WC	$16.10
Rate for Payer: UnitedHealthcare Commercial	$21.47
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

CARTRIDGE TVX

Facility

$107.33

Hospital Charge Code	270656296
Hospital Revenue Code	271
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$16.10
Rate for Payer: Qualcare PPO/HMO/WC	$16.10

CARVEDILOL 12.5 MG TAB

Facility

$126.03

Service Code	NDC 80725014120
Hospital Charge Code	60628811
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 12.5 MG TAB

Facility

$126.03

Service Code	NDC 80725014120
Hospital Charge Code	60628811
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

CARVEDILOL 25 MG TAB

Facility

$126.03

Service Code	NDC 80725014220
Hospital Charge Code	60628812
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 25 MG TAB

Facility

$126.03

Service Code	NDC 80725014220
Hospital Charge Code	60628812
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

CARVEDILOL 3.125 MG TAB

Facility

$126.03

Service Code	NDC 80725013920
Hospital Charge Code	60627623
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 3.125 MG TAB

Facility

$126.03

Service Code	NDC 80725013920
Hospital Charge Code	60627623
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

CARVEDILOL 6.25 MG TAB

Facility

$126.03

Service Code	NDC 80725014020
Hospital Charge Code	60628586
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

Know your out-of-pocket cost for care.

All Charges