Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPID FLRSCNT ANTI TITERS 2

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476311
Hospital Revenue Code	302
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

EPID FLRSCNT ANTI TITERS 2

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476311
Hospital Revenue Code	302
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

EPIDURAL, CERV/THORACIC (SEP)

Facility

$3,107.20

Service Code	HCPCS 62310
Hospital Charge Code	84506025
Hospital Revenue Code	361
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$1,553.60
Rate for Payer: Aetna Commercial	$1,180.74
Rate for Payer: Aetna Medicare Advantage	$932.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$792.34
Rate for Payer: Cigna Commercial	$1,553.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$932.16
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Community & State	$74.88
Rate for Payer: Wellpoint Medicaid Managed Care	$82.34

EPIDURAL, CERV/THORACIC (SEP)

Facility

$3,107.20

Service Code	HCPCS 62310
Hospital Charge Code	84506025
Hospital Revenue Code	361
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

EPIDURAL, LUMBAR/CAUDAL (SEP)

Facility

$3,107.20

Service Code	HCPCS 62311
Hospital Charge Code	84506030
Hospital Revenue Code	361
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

EPIDURAL, LUMBAR/CAUDAL (SEP)

Facility

$3,107.20

Service Code	HCPCS 62311
Hospital Charge Code	84506030
Hospital Revenue Code	361
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$1,553.60
Rate for Payer: Aetna Commercial	$1,180.74
Rate for Payer: Aetna Medicare Advantage	$932.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$792.34
Rate for Payer: Cigna Commercial	$1,553.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$932.16
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Community & State	$74.88
Rate for Payer: Wellpoint Medicaid Managed Care	$82.34

EPIDURAL SET PERIFIX

Facility

$88.25

Hospital Charge Code	270684453
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$44.12
Rate for Payer: Aetna Commercial	$33.53
Rate for Payer: Aetna Medicare Advantage	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.50
Rate for Payer: Cigna Commercial	$44.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.48
Rate for Payer: Oxford Commercial	$17.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.24
Rate for Payer: UnitedHealthcare Commercial	$17.65
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

EPIDURAL SET PERIFIX

Facility

$88.25

Hospital Charge Code	270684453
Hospital Revenue Code	272
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$13.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.24

EPIDURAL TRAY CONT. W/NDLE 17G

Facility

$429.00

Hospital Charge Code	270331780
Hospital Revenue Code	272
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$214.50
Rate for Payer: Aetna Commercial	$163.02
Rate for Payer: Aetna Medicare Advantage	$128.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.39
Rate for Payer: Cigna Commercial	$214.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.70
Rate for Payer: Oxford Commercial	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.35
Rate for Payer: UnitedHealthcare Commercial	$85.80
Rate for Payer: UnitedHealthcare Community & State	$10.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.37

EPIDURAL TRAY CONT. W/NDLE 17G

Facility

$429.00

Hospital Charge Code	270331780
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.35

EPIDURAL TRAYS COMBINED SPINAL

Facility

$306.55

Hospital Charge Code	270702891
Hospital Revenue Code	272
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$153.28
Rate for Payer: Aetna Commercial	$116.49
Rate for Payer: Aetna Medicare Advantage	$91.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.17
Rate for Payer: Cigna Commercial	$153.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.97
Rate for Payer: Oxford Commercial	$61.31
Rate for Payer: Qualcare PPO/HMO/WC	$45.98
Rate for Payer: UnitedHealthcare Commercial	$61.31
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

EPIDURAL TRAYS COMBINED SPINAL

Facility

$306.55

Hospital Charge Code	270702891
Hospital Revenue Code	272
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$45.98

EPIFIX PER SQ CM

Facility

$827.50

Service Code	HCPCS Q4186
Hospital Charge Code	9808328
Hospital Revenue Code	636
Min. Negotiated Rate	$124.12
Max. Negotiated Rate	$200.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.25
Rate for Payer: Qualcare PPO/HMO/WC	$124.12

EPIFIX PER SQ CM

Facility

$827.50

Service Code	HCPCS Q4186
Hospital Charge Code	9808328
Hospital Revenue Code	636
Min. Negotiated Rate	$19.94
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.25
Rate for Payer: Qualcare PPO/HMO/WC	$124.12
Rate for Payer: UnitedHealthcare Community & State	$19.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$21.93

EPIFIX PER SQ CM JW

Facility

$827.50

Service Code	HCPCS Q4131JW
Hospital Charge Code	9808328W
Hospital Revenue Code	636
Min. Negotiated Rate	$124.12
Max. Negotiated Rate	$200.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.25
Rate for Payer: Qualcare PPO/HMO/WC	$124.12

EPIFIX PER SQ CM JW

Facility

$827.50

Service Code	HCPCS Q4131JW
Hospital Charge Code	9808328W
Hospital Revenue Code	636
Min. Negotiated Rate	$19.94
Max. Negotiated Rate	$413.75
Rate for Payer: Aetna Commercial	$314.45
Rate for Payer: Aetna Medicare Advantage	$248.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.01
Rate for Payer: Cigna Commercial	$413.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.25
Rate for Payer: Qualcare PPO/HMO/WC	$124.12
Rate for Payer: UnitedHealthcare Community & State	$19.94
Rate for Payer: Wellpoint Medicaid Managed Care	$21.93

EPINEPHINE

Facility

$47.35

Hospital Charge Code	270656755
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

EPINEPHINE

Facility

$47.35

Hospital Charge Code	270656755
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

EPINEPHRINE

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3035135
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

EPINEPHRINE

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3035135
Hospital Revenue Code	301
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.78

EPINEPHRINE 0.1MG/ML LIFE

Facility

$18.00

Hospital Charge Code	60635245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

EPINEPHRINE 0.1MG/ML LIFE

Facility

$18.00

Hospital Charge Code	60635245
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

EPINEPHRINE 0.4ML

Facility

$5.00

Hospital Charge Code	60635607
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

EPINEPHRINE 0.4ML

Facility

$5.00

Hospital Charge Code	60635607
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

EPINEPHRINE 0.5% OPHTH SOLN

Facility

$319.25

Hospital Charge Code	60628069
Hospital Revenue Code	250
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$47.89
Rate for Payer: Qualcare PPO/HMO/WC	$47.89

Know your out-of-pocket cost for care.

All Charges