Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACTIDOSE AQUA 120ML

Facility

$111.89

Service Code	NDC 574012174
Hospital Charge Code	6063943305
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$55.95
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare Advantage	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.53
Rate for Payer: Cigna Commercial	$55.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.57
Rate for Payer: Oxford Commercial	$22.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.78
Rate for Payer: UnitedHealthcare Commercial	$22.38
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

ACTIDOSE W/ SORBITOL 120ML

Facility

$111.89

Service Code	NDC 574012074
Hospital Charge Code	6063943307
Hospital Revenue Code	250
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$16.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.78

ACTIDOSE W/ SORBITOL 120ML

Facility

$111.89

Service Code	NDC 574012074
Hospital Charge Code	6063943307
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$55.95
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare Advantage	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.53
Rate for Payer: Cigna Commercial	$55.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.57
Rate for Payer: Oxford Commercial	$22.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.78
Rate for Payer: UnitedHealthcare Commercial	$22.38
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

ACTIFED/TAB

Facility

$1.00

Hospital Charge Code	60632395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

ACTIFED/TAB

Facility

$1.00

Hospital Charge Code	60632395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

ACTIFED W/CODEINE/480ML

Facility

$38.00

Hospital Charge Code	60632396
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

ACTIFED W/CODEINE/480ML

Facility

$38.00

Hospital Charge Code	60632396
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

ACTIFUSE BN GRAFT REFILL 7.5ML

Facility

$7,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694719
Hospital Revenue Code	278
Min. Negotiated Rate	$177.74
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$177.74
Rate for Payer: Wellpoint Medicaid Managed Care	$195.44

ACTIFUSE BN GRAFT REFILL 7.5ML

Facility

$7,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

ACTIFUSE BONE GRAFT SUB 7.5ML

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694718
Hospital Revenue Code	278
Min. Negotiated Rate	$274.14
Max. Negotiated Rate	$5,687.50
Rate for Payer: Aetna Commercial	$4,322.50
Rate for Payer: Aetna Medicare Advantage	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,900.62
Rate for Payer: Cigna Commercial	$5,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,502.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25
Rate for Payer: UnitedHealthcare Community & State	$274.14
Rate for Payer: Wellpoint Medicaid Managed Care	$301.44

ACTIFUSE BONE GRAFT SUB 7.5ML

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694718
Hospital Revenue Code	278
Min. Negotiated Rate	$1,706.25
Max. Negotiated Rate	$2,752.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,502.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25

ACTIFUSE SHAPE LG CYL 15x45MM

Facility

$7,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270672053
Hospital Revenue Code	278
Min. Negotiated Rate	$175.57
Max. Negotiated Rate	$3,642.50
Rate for Payer: Aetna Commercial	$2,768.30
Rate for Payer: Aetna Medicare Advantage	$2,185.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,857.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,857.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,457.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,857.67
Rate for Payer: Cigna Commercial	$3,642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,762.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,602.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.75
Rate for Payer: UnitedHealthcare Community & State	$175.57
Rate for Payer: Wellpoint Medicaid Managed Care	$193.05

ACTIFUSE SHAPE LG CYL 15x45MM

Facility

$7,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270672053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,092.75
Max. Negotiated Rate	$1,762.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,457.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,762.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,602.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.75

ACTIGAL

Facility

$9.00

Hospital Charge Code	60634496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

ACTIGAL

Facility

$9.00

Hospital Charge Code	60634496
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

ACTIGRAPHY TESTING

Facility

$497.00

Service Code	HCPCS 95803
Hospital Charge Code	90000010
Hospital Revenue Code	920
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$74.55
Rate for Payer: Qualcare PPO/HMO/WC	$74.55

ACTIGRAPHY TESTING

Facility

$497.00

Service Code	HCPCS 95803
Hospital Charge Code	90000010
Hospital Revenue Code	920
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.55
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$11.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$13.17

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	366885347
Hospital Revenue Code	305
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.28
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.28
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Medicare Advantage	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	366885347
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	7411175
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	7411175
Hospital Revenue Code	305
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.28
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.28
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Medicare Advantage	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACTIN(SMOOTH MUSCLE) AB IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900524
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
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	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACTIN(SMOOTH MUSCLE) AB IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900524
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTISHD AMN BARRIER MEM 4X8CM

Facility

$31,545.00

Service Code	HCPCS C1734
Hospital Charge Code	270693700
Hospital Revenue Code	278
Min. Negotiated Rate	$760.23
Max. Negotiated Rate	$15,772.50
Rate for Payer: Aetna Commercial	$11,987.10
Rate for Payer: Aetna Medicare Advantage	$9,463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,043.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,043.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,043.98
Rate for Payer: Cigna Commercial	$15,772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,633.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,939.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.75
Rate for Payer: UnitedHealthcare Community & State	$760.23
Rate for Payer: Wellpoint Medicaid Managed Care	$835.94

ACTISHD AMN BARRIER MEM 4X8CM

Facility

$31,545.00

Service Code	HCPCS C1734
Hospital Charge Code	270693700
Hospital Revenue Code	278
Min. Negotiated Rate	$4,731.75
Max. Negotiated Rate	$7,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,633.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,939.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.75

Know your out-of-pocket cost for care.

All Charges