Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACT ARTIC HD ARCOM XL 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270681045
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ACT ARTIC HD ARCOM XL 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270681045
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

ACT CUVETTES FOR HC ELITE

Facility

$16.19

Hospital Charge Code	2709002915
Hospital Revenue Code	272
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.43

ACT CUVETTES FOR HC ELITE

Facility

$16.19

Hospital Charge Code	2709002915
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna Commercial	$6.15
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.13
Rate for Payer: Cigna Commercial	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.86
Rate for Payer: Oxford Commercial	$3.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.43
Rate for Payer: UnitedHealthcare Commercial	$3.24
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

ACT DIRECT CHECK ABNORMAL

Facility

$17.81

Hospital Charge Code	2709002914
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.90
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$5.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.54
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.34
Rate for Payer: Oxford Commercial	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.67
Rate for Payer: UnitedHealthcare Commercial	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

ACT DIRECT CHECK ABNORMAL

Facility

$17.81

Hospital Charge Code	2709002914
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.67

ACT DIRECT CHECK NORMAL

Facility

$17.81

Hospital Charge Code	2709002913
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.90
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$5.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.54
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.34
Rate for Payer: Oxford Commercial	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.67
Rate for Payer: UnitedHealthcare Commercial	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

ACT DIRECT CHECK NORMAL

Facility

$17.81

Hospital Charge Code	2709002913
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.67

ACT-EA SUBSEQ DAILY

Facility

$390.00

Service Code	HCPCS 8534791
Hospital Charge Code	7411177
Hospital Revenue Code	305
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACT-EA SUBSEQ DAILY

Facility

$390.00

Service Code	HCPCS 8534791
Hospital Charge Code	7411177
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACT-EA SUBSEQ DAILY

Facility

$390.00

Service Code	HCPCS 8534791
Hospital Charge Code	3668853479
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACT-EA SUBSEQ DAILY

Facility

$390.00

Service Code	HCPCS 8534791
Hospital Charge Code	3668853479
Hospital Revenue Code	305
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACTEMRA 162MG/0.9ML SYRINGE

Facility

$8,399.32

Service Code	HCPCS J3262
Hospital Charge Code	606390312
Hospital Revenue Code	636
Min. Negotiated Rate	$1,259.90
Max. Negotiated Rate	$2,032.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.90

ACTEMRA 162MG/0.9ML SYRINGE

Facility

$8,399.32

Service Code	HCPCS J3262
Hospital Charge Code	606390312
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$2,032.64
Rate for Payer: Aetna Commercial	$15.04
Rate for Payer: Aetna Medicare Advantage	$17.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.96
Rate for Payer: Cigna Medicare Advantage	$5.53
Rate for Payer: Clover Medicare Advantage	$5.25
Rate for Payer: EmblemHealth Commercial	$16.59
Rate for Payer: Humana Medicare Advantage	$5.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.90
Rate for Payer: UnitedHealthcare Community & State	$202.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$222.58

Actemra 80mg/4ml (tocilizumab)

Facility

$1,882.25

Hospital Charge Code	6063943332
Hospital Revenue Code	636
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$941.12
Rate for Payer: Aetna Commercial	$715.25
Rate for Payer: Aetna Medicare Advantage	$564.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.97
Rate for Payer: Cigna Commercial	$941.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.50
Rate for Payer: Qualcare PPO/HMO/WC	$282.34
Rate for Payer: UnitedHealthcare Community & State	$45.36
Rate for Payer: Wellpoint Medicaid Managed Care	$49.88

Actemra 80mg/4ml (tocilizumab)

Facility

$1,882.25

Hospital Charge Code	6063943332
Hospital Revenue Code	636
Min. Negotiated Rate	$282.34
Max. Negotiated Rate	$455.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.50
Rate for Payer: Qualcare PPO/HMO/WC	$282.34

ACTH

Facility

$390.00

Service Code	HCPCS 82533
Hospital Charge Code	39708049A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTH

Facility

$390.00

Service Code	HCPCS 82533
Hospital Charge Code	39708049A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACTH ADRENOCORTICOTROPIC HORM

Facility

$402.45

Service Code	HCPCS 82024
Hospital Charge Code	3003092
Hospital Revenue Code	309
Min. Negotiated Rate	$60.37
Max. Negotiated Rate	$60.37
Rate for Payer: Qualcare PPO/HMO/WC	$60.37

ACTH ADRENOCORTICOTROPIC HORM

Facility

$402.45

Service Code	HCPCS 82024
Hospital Charge Code	3003092
Hospital Revenue Code	309
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$201.22
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare Advantage	$125.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.41
Rate for Payer: Cigna Commercial	$201.22
Rate for Payer: Cigna Medicare Advantage	$38.62
Rate for Payer: Clover Medicare Advantage	$36.69
Rate for Payer: EmblemHealth Commercial	$115.86
Rate for Payer: Humana Medicare Advantage	$39.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.62
Rate for Payer: Wellcare Medicare Advantage	$38.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.66

ACTHAR/40U

Facility

$155.00

Hospital Charge Code	60632392
Hospital Revenue Code	636
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

ACTHAR/40U

Facility

$155.00

Hospital Charge Code	60632392
Hospital Revenue Code	636
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

ACTH,PLASMA

Facility

$667.59

Service Code	HCPCS 82024
Hospital Charge Code	39900032
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ACTH,PLASMA

Facility

$667.59

Service Code	HCPCS 82024
Hospital Charge Code	39900032
Hospital Revenue Code	309
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare Advantage	$125.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.41
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$38.62
Rate for Payer: Clover Medicare Advantage	$36.69
Rate for Payer: EmblemHealth Commercial	$115.86
Rate for Payer: Humana Medicare Advantage	$39.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.62
Rate for Payer: Wellcare Medicare Advantage	$38.62
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ACTIDOSE AQUA 120ML

Facility

$111.89

Service Code	NDC 574012174
Hospital Charge Code	6063943305
Hospital Revenue Code	250
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$16.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.78

Know your out-of-pocket cost for care.

All Charges