Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$39,733.86

Service Code	MSDRG 121
Min. Negotiated Rate	$12,098.45
Max. Negotiated Rate	$39,733.86
Rate for Payer: Aetna Commercial	$27,559.00
Rate for Payer: Aetna Medicare Advantage	$39,733.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,774.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,774.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,735.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,774.08
Rate for Payer: Cigna Commercial	$21,770.00
Rate for Payer: Cigna Medicare Advantage	$12,735.21
Rate for Payer: Clover Medicare Advantage	$12,098.45
Rate for Payer: EmblemHealth Commercial	$38,205.63
Rate for Payer: Humana Medicare Advantage	$13,117.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,735.21
Rate for Payer: Oxford Commercial	$15,646.39
Rate for Payer: UnitedHealthcare Commercial	$27,436.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,735.21
Rate for Payer: Wellcare Medicare Advantage	$12,735.21

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$27,532.41

Service Code	MSDRG 122
Min. Negotiated Rate	$8,383.27
Max. Negotiated Rate	$27,532.41
Rate for Payer: Aetna Commercial	$19,175.23
Rate for Payer: Aetna Medicare Advantage	$27,532.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,213.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,213.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,824.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,213.14
Rate for Payer: Cigna Commercial	$14,705.46
Rate for Payer: Cigna Medicare Advantage	$8,824.49
Rate for Payer: Clover Medicare Advantage	$8,383.27
Rate for Payer: EmblemHealth Commercial	$26,473.47
Rate for Payer: Humana Medicare Advantage	$9,089.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,824.49
Rate for Payer: Oxford Commercial	$10,569.01
Rate for Payer: UnitedHealthcare Commercial	$18,533.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,824.49
Rate for Payer: Wellcare Medicare Advantage	$8,824.49

ACUTE MYOCARDIAL INFARCTION

Facility

$21,483.16

Service Code	APR-DRG 1904
Min. Negotiated Rate	$21,061.92
Max. Negotiated Rate	$21,483.16
Rate for Payer: UnitedHealthcare Community & State	$21,061.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,483.16
Rate for Payer: Wellpoint Medicaid Managed Care	$21,061.92

ACUTE MYOCARDIAL INFARCTION

Facility

$10,517.50

Service Code	APR-DRG 1902
Min. Negotiated Rate	$10,311.27
Max. Negotiated Rate	$10,517.50
Rate for Payer: UnitedHealthcare Community & State	$10,311.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,517.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10,311.27

ACUTE MYOCARDIAL INFARCTION

Facility

$9,724.68

Service Code	APR-DRG 1901
Min. Negotiated Rate	$9,534.00
Max. Negotiated Rate	$9,724.68
Rate for Payer: UnitedHealthcare Community & State	$9,534.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,724.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9,534.00

ACUTE MYOCARDIAL INFARCTION

Facility

$13,695.24

Service Code	APR-DRG 1903
Min. Negotiated Rate	$13,426.71
Max. Negotiated Rate	$13,695.24
Rate for Payer: UnitedHealthcare Community & State	$13,426.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,695.24
Rate for Payer: Wellpoint Medicaid Managed Care	$13,426.71

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$31,840.88

Service Code	MSDRG 281
Min. Negotiated Rate	$9,695.14
Max. Negotiated Rate	$31,840.88
Rate for Payer: Aetna Commercial	$22,135.65
Rate for Payer: Aetna Medicare Advantage	$31,840.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,205.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$17,200.04
Rate for Payer: Cigna Medicare Advantage	$10,205.41
Rate for Payer: Clover Medicare Advantage	$9,695.14
Rate for Payer: EmblemHealth Commercial	$30,616.23
Rate for Payer: Humana Medicare Advantage	$10,511.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,205.41
Rate for Payer: Oxford Commercial	$12,361.90
Rate for Payer: UnitedHealthcare Commercial	$21,676.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,205.41
Rate for Payer: Wellcare Medicare Advantage	$10,205.41

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$53,981.27

Service Code	MSDRG 280
Min. Negotiated Rate	$16,436.61
Max. Negotiated Rate	$53,981.27
Rate for Payer: Aetna Commercial	$37,348.62
Rate for Payer: Aetna Medicare Advantage	$53,981.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,984.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,984.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,301.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,984.99
Rate for Payer: Cigna Commercial	$30,019.13
Rate for Payer: Cigna Medicare Advantage	$17,301.69
Rate for Payer: Clover Medicare Advantage	$16,436.61
Rate for Payer: EmblemHealth Commercial	$51,905.07
Rate for Payer: Humana Medicare Advantage	$17,820.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,301.69
Rate for Payer: Oxford Commercial	$21,575.15
Rate for Payer: UnitedHealthcare Commercial	$37,832.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,301.69
Rate for Payer: Wellcare Medicare Advantage	$17,301.69

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$25,505.91

Service Code	MSDRG 282
Min. Negotiated Rate	$7,766.22
Max. Negotiated Rate	$25,505.91
Rate for Payer: Aetna Commercial	$17,782.81
Rate for Payer: Aetna Medicare Advantage	$25,505.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,747.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,747.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,747.92
Rate for Payer: Cigna Commercial	$13,532.09
Rate for Payer: Cigna Medicare Advantage	$8,174.97
Rate for Payer: Clover Medicare Advantage	$7,766.22
Rate for Payer: EmblemHealth Commercial	$24,524.91
Rate for Payer: Humana Medicare Advantage	$8,420.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,174.97
Rate for Payer: Oxford Commercial	$9,725.69
Rate for Payer: UnitedHealthcare Commercial	$17,054.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,174.97
Rate for Payer: Wellcare Medicare Advantage	$8,174.97

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$24,507.16

Service Code	MSDRG 284
Min. Negotiated Rate	$7,462.12
Max. Negotiated Rate	$24,507.16
Rate for Payer: Aetna Commercial	$17,096.54
Rate for Payer: Aetna Medicare Advantage	$24,507.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,213.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,213.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,854.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,213.14
Rate for Payer: Cigna Commercial	$12,953.83
Rate for Payer: Cigna Medicare Advantage	$7,854.86
Rate for Payer: Clover Medicare Advantage	$7,462.12
Rate for Payer: EmblemHealth Commercial	$23,564.58
Rate for Payer: Humana Medicare Advantage	$8,090.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,854.86
Rate for Payer: Oxford Commercial	$9,310.09
Rate for Payer: UnitedHealthcare Commercial	$16,325.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,854.86
Rate for Payer: Wellcare Medicare Advantage	$7,854.86

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$66,156.79

Service Code	MSDRG 283
Min. Negotiated Rate	$20,143.90
Max. Negotiated Rate	$66,156.79
Rate for Payer: Aetna Commercial	$45,714.59
Rate for Payer: Aetna Medicare Advantage	$66,156.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,824.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,824.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,204.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,824.17
Rate for Payer: Cigna Commercial	$37,068.69
Rate for Payer: Cigna Medicare Advantage	$21,204.10
Rate for Payer: Clover Medicare Advantage	$20,143.90
Rate for Payer: EmblemHealth Commercial	$63,612.30
Rate for Payer: Humana Medicare Advantage	$21,840.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,204.10
Rate for Payer: Oxford Commercial	$26,641.76
Rate for Payer: UnitedHealthcare Commercial	$46,717.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,204.10
Rate for Payer: Wellcare Medicare Advantage	$21,204.10

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$21,491.50

Service Code	MSDRG 285
Min. Negotiated Rate	$6,543.89
Max. Negotiated Rate	$21,491.50
Rate for Payer: Aetna Commercial	$15,024.44
Rate for Payer: Aetna Medicare Advantage	$21,491.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,397.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,397.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,888.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,397.89
Rate for Payer: Cigna Commercial	$11,207.81
Rate for Payer: Cigna Medicare Advantage	$6,888.30
Rate for Payer: Clover Medicare Advantage	$6,543.89
Rate for Payer: EmblemHealth Commercial	$20,664.90
Rate for Payer: Humana Medicare Advantage	$7,094.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,888.30
Rate for Payer: Oxford Commercial	$8,055.20
Rate for Payer: UnitedHealthcare Commercial	$14,125.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,888.30
Rate for Payer: Wellcare Medicare Advantage	$6,888.30

ACYCLOVIR 200 MG CAP

Facility

$8.78

Service Code	HCPCS J8499
Hospital Charge Code	60627335
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.39
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna Medicare Advantage	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.24
Rate for Payer: Cigna Commercial	$4.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

ACYCLOVIR 200 MG CAP

Facility

$8.78

Service Code	HCPCS J8499
Hospital Charge Code	60627335
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$2.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

ACYCLOVIR 500 MG INJ

Facility

$36.18

Service Code	HCPCS J0133
Hospital Charge Code	6007652
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$13.75
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

ACYCLOVIR 500 MG INJ

Facility

$36.18

Service Code	HCPCS J0133
Hospital Charge Code	6007652
Hospital Revenue Code	636
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$8.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

ACYCLOVIR 5% 3GM

Facility

$468.85

Hospital Charge Code	60628332
Hospital Revenue Code	250
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$234.43
Rate for Payer: Aetna Commercial	$178.16
Rate for Payer: Aetna Medicare Advantage	$140.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.56
Rate for Payer: Cigna Commercial	$234.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.66
Rate for Payer: Oxford Commercial	$93.77
Rate for Payer: Qualcare PPO/HMO/WC	$70.33
Rate for Payer: UnitedHealthcare Commercial	$93.77
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

ACYCLOVIR 5% 3GM

Facility

$468.85

Hospital Charge Code	60628332
Hospital Revenue Code	250
Min. Negotiated Rate	$70.33
Max. Negotiated Rate	$70.33
Rate for Payer: Qualcare PPO/HMO/WC	$70.33

ACYCLOVIR 5% OINT 15GM

Facility

$2,671.96

Service Code	NDC 51079055067
Hospital Charge Code	6005854
Hospital Revenue Code	250
Min. Negotiated Rate	$400.79
Max. Negotiated Rate	$400.79
Rate for Payer: Qualcare PPO/HMO/WC	$400.79

ACYCLOVIR 5% OINT 15GM

Facility

$2,671.96

Service Code	NDC 51079055067
Hospital Charge Code	6005854
Hospital Revenue Code	250
Min. Negotiated Rate	$64.39
Max. Negotiated Rate	$1,335.98
Rate for Payer: Aetna Commercial	$1,015.34
Rate for Payer: Aetna Medicare Advantage	$801.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$681.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$681.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$681.35
Rate for Payer: Cigna Commercial	$1,335.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.59
Rate for Payer: Oxford Commercial	$534.39
Rate for Payer: Qualcare PPO/HMO/WC	$400.79
Rate for Payer: UnitedHealthcare Commercial	$534.39
Rate for Payer: UnitedHealthcare Community & State	$64.39
Rate for Payer: Wellpoint Medicaid Managed Care	$70.81

ACYCLOVIR 800 MG TAB

Facility

$28.27

Service Code	NDC 63304050501
Hospital Charge Code	6010631
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.13
Rate for Payer: Aetna Commercial	$10.74
Rate for Payer: Aetna Medicare Advantage	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.21
Rate for Payer: Cigna Commercial	$14.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.48
Rate for Payer: Oxford Commercial	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.24
Rate for Payer: UnitedHealthcare Commercial	$5.65
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

ACYCLOVIR 800 MG TAB

Facility

$28.27

Service Code	NDC 63304050501
Hospital Charge Code	6010631
Hospital Revenue Code	251
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.24
Rate for Payer: Qualcare PPO/HMO/WC	$4.24

ACYCLOVIR BY HPLC QUANTIT ASSA

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035121
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

ACYCLOVIR BY HPLC QUANTIT ASSA

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035121
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

ACYCLOVIR ODD DOSE IVPB

Facility

$301.45

Hospital Charge Code	60627336
Hospital Revenue Code	250
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$150.72
Rate for Payer: Aetna Commercial	$114.55
Rate for Payer: Aetna Medicare Advantage	$90.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.87
Rate for Payer: Cigna Commercial	$150.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.44
Rate for Payer: Oxford Commercial	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$45.22
Rate for Payer: UnitedHealthcare Commercial	$60.29
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.99

Know your out-of-pocket cost for care.

All Charges