Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COMPAZINE/5MG/5ML

Facility

$4.00

Service Code	NDC 440819012
Hospital Charge Code	60632732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

COMPAZINE/5MG/5ML

Facility

$4.00

Service Code	NDC 440819012
Hospital Charge Code	60632732
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

COMPAZINE/5MG/EACH

Facility

$9.00

Hospital Charge Code	60632736
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

COMPAZINE/5MG/EACH

Facility

$9.00

Hospital Charge Code	60632736
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

COMPAZINE SUPP ADULT

Facility

$21.15

Hospital Charge Code	6008312
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

COMPAZINE SUPP ADULT

Facility

$21.15

Hospital Charge Code	6008312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

COMP DX MAMMO ADD ON-GL

Facility

$62.65

Service Code	HCPCS 77051
Hospital Charge Code	85000065
Hospital Revenue Code	401
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$23.81
Rate for Payer: Aetna Medicare Advantage	$18.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.98
Rate for Payer: Cigna Commercial	$31.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.80
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.40
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

COMP DX MAMMO ADD ON-GL

Facility

$62.65

Service Code	HCPCS 77051
Hospital Charge Code	85000065
Hospital Revenue Code	401
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.40

COMP DX MAMMO ADD ON-PC

Facility

$16.50

Service Code	HCPCS 7705126
Hospital Charge Code	85000075
Hospital Revenue Code	401
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$6.27
Rate for Payer: Aetna Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.21
Rate for Payer: Cigna Commercial	$8.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.95
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.48
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

COMP DX MAMMO ADD ON-PC

Facility

$16.50

Service Code	HCPCS 7705126
Hospital Charge Code	85000075
Hospital Revenue Code	401
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

COMP DX MAMMO ADD ON-TC

Facility

$46.20

Service Code	HCPCS 77051TC
Hospital Charge Code	85000070
Hospital Revenue Code	401
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

COMP DX MAMMO ADD ON-TC

Facility

$46.20

Service Code	HCPCS 77051TC
Hospital Charge Code	85000070
Hospital Revenue Code	401
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$17.56
Rate for Payer: Aetna Medicare Advantage	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.78
Rate for Payer: Cigna Commercial	$23.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.86
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

COMP FEMORAL 62.5mm 183126

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270638691
Hospital Revenue Code	278
Min. Negotiated Rate	$415.24
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$415.24
Rate for Payer: Wellpoint Medicaid Managed Care	$456.60

COMP FEMORAL 62.5mm 183126

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270638691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

COMP FEMORAL 65mm 183128

Facility

$15,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270638609
Hospital Revenue Code	278
Min. Negotiated Rate	$371.98
Max. Negotiated Rate	$7,717.50
Rate for Payer: Aetna Commercial	$5,865.30
Rate for Payer: Aetna Medicare Advantage	$4,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,935.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,935.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,935.93
Rate for Payer: Cigna Commercial	$7,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,735.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,395.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,315.25
Rate for Payer: UnitedHealthcare Community & State	$371.98
Rate for Payer: Wellpoint Medicaid Managed Care	$409.03

COMP FEMORAL 65mm 183128

Facility

$15,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270638609
Hospital Revenue Code	278
Min. Negotiated Rate	$2,315.25
Max. Negotiated Rate	$3,735.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,735.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,395.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,315.25

COMP FEMORAL OXFORD MED 154601

Facility

$11,420.00

Hospital Charge Code	270639274
Hospital Revenue Code	278
Min. Negotiated Rate	$275.22
Max. Negotiated Rate	$5,710.00
Rate for Payer: Aetna Commercial	$4,339.60
Rate for Payer: Aetna Medicare Advantage	$3,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,912.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,912.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,912.10
Rate for Payer: Cigna Commercial	$5,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,763.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,512.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,713.00
Rate for Payer: UnitedHealthcare Community & State	$275.22
Rate for Payer: Wellpoint Medicaid Managed Care	$302.63

COMP FEMORAL OXFORD MED 154601

Facility

$11,420.00

Hospital Charge Code	270639274
Hospital Revenue Code	278
Min. Negotiated Rate	$1,713.00
Max. Negotiated Rate	$2,763.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,763.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,512.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,713.00

COMPLEMENT ANTIGEN

Facility

$120.00

Service Code	HCPCS 86160
Hospital Charge Code	401386160C
Hospital Revenue Code	302
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

COMPLEMENT ANTIGEN

Facility

$120.00

Service Code	HCPCS 86160
Hospital Charge Code	401386160C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
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	$43.32
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

COMPLEMENT C1 PANEL A

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
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	$43.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COMPLEMENT C1 PANEL A

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C1 PANEL B

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C1 PANEL B

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
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	$43.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COMPLEMENT C1 PANEL C

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
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	$43.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges