Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETABULAR REAMER BASKETS 60MM

Facility

$1,345.00

Hospital Charge Code	270668108
Hospital Revenue Code	272
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.50
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$32.41
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

ACETABULAR REAMER BASKETS 62MM

Facility

$1,345.00

Hospital Charge Code	270668109
Hospital Revenue Code	272
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.50
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$32.41
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

ACETABULAR REAMER BASKETS 62MM

Facility

$1,345.00

Hospital Charge Code	270668109
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

ACETABULAR REAMER BASKETS 64MM

Facility

$1,345.00

Hospital Charge Code	270668110
Hospital Revenue Code	272
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.50
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$32.41
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

ACETABULAR REAMER BASKETS 64MM

Facility

$1,345.00

Hospital Charge Code	270668110
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

ACETABULAR SHELL 48 C PPS G7

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690496
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

ACETABULAR SHELL 48 C PPS G7

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690496
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ACETABULAR SHELL 58MM TRI PSI

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270692256
Hospital Revenue Code	278
Min. Negotiated Rate	$114.11
Max. Negotiated Rate	$2,367.38
Rate for Payer: Aetna Commercial	$1,799.20
Rate for Payer: Aetna Medicare Advantage	$1,420.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.36
Rate for Payer: Cigna Commercial	$2,367.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.64
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$114.11
Rate for Payer: Wellpoint Medicaid Managed Care	$125.47

ACETABULAR SHELL 58MM TRI PSI

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270692256
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.64
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

ACETABULAR SHELL G7 OSS 4 62MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270698037
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

ACETABULAR SHELL G7 OSS 4 62MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270698037
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

ACETABULAR SHELL SIZE 22MM

Facility

$7,965.00

Hospital Charge Code	270663598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.75
Max. Negotiated Rate	$1,927.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75

ACETABULAR SHELL SIZE 22MM

Facility

$7,965.00

Hospital Charge Code	270663598
Hospital Revenue Code	278
Min. Negotiated Rate	$191.96
Max. Negotiated Rate	$3,982.50
Rate for Payer: Aetna Commercial	$3,026.70
Rate for Payer: Aetna Medicare Advantage	$2,389.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,031.08
Rate for Payer: Cigna Commercial	$3,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75
Rate for Payer: UnitedHealthcare Community & State	$191.96
Rate for Payer: Wellpoint Medicaid Managed Care	$211.07

ACETABULAR SHELL SIZE 24MM

Facility

$7,965.00

Hospital Charge Code	270663289
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.75
Max. Negotiated Rate	$1,927.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75

ACETABULAR SHELL SIZE 24MM

Facility

$7,965.00

Hospital Charge Code	270663289
Hospital Revenue Code	278
Min. Negotiated Rate	$191.96
Max. Negotiated Rate	$3,982.50
Rate for Payer: Aetna Commercial	$3,026.70
Rate for Payer: Aetna Medicare Advantage	$2,389.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,031.08
Rate for Payer: Cigna Commercial	$3,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75
Rate for Payer: UnitedHealthcare Community & State	$191.96
Rate for Payer: Wellpoint Medicaid Managed Care	$211.07

ACETAMINOPHE COD300MG/30MG/5ML

Facility

$3.85

Hospital Charge Code	6014070
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

ACETAMINOPHE COD300MG/30MG/5ML

Facility

$3.85

Hospital Charge Code	6014070
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

ACETAMINOPHEN 10MG/ML IV SOL

Facility

$284.62

Service Code	HCPCS J0131
Hospital Charge Code	60630066
Hospital Revenue Code	636
Min. Negotiated Rate	$42.69
Max. Negotiated Rate	$68.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.88
Rate for Payer: Qualcare PPO/HMO/WC	$42.69

ACETAMINOPHEN 10MG/ML IV SOL

Facility

$284.62

Service Code	HCPCS J0131
Hospital Charge Code	60630066
Hospital Revenue Code	636
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$142.31
Rate for Payer: Aetna Commercial	$108.16
Rate for Payer: Aetna Medicare Advantage	$85.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.58
Rate for Payer: Cigna Commercial	$142.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.88
Rate for Payer: Qualcare PPO/HMO/WC	$42.69
Rate for Payer: UnitedHealthcare Community & State	$6.86
Rate for Payer: Wellpoint Medicaid Managed Care	$7.54

ACETAMINOPHEN 120 MG SUPP

Facility

$4.00

Service Code	NDC 45802073233
Hospital Charge Code	60627725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ACETAMINOPHEN 120 MG SUPP

Facility

$4.00

Service Code	NDC 45802073233
Hospital Charge Code	60627725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 160MG/5ML UD CUP

Facility

$4.00

Hospital Charge Code	83652543
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 160MG/5ML UD CUP

Facility

$4.00

Hospital Charge Code	83652543
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ACETAMINOPHEN #2 TAB

Facility

$4.00

Service Code	NDC 93005001
Hospital Charge Code	6063943046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN #2 TAB

Facility

$4.00

Service Code	NDC 93005001
Hospital Charge Code	6063943046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges