Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FACTOR XIII ASSAY

Facility

$224.00

Service Code	HCPCS 85291
Hospital Charge Code	3004249
Hospital Revenue Code	305
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$29.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.88
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: Cigna Medicare Advantage	$9.11
Rate for Payer: Clover Medicare Advantage	$8.65
Rate for Payer: EmblemHealth Commercial	$27.33
Rate for Payer: Humana Medicare Advantage	$9.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.11
Rate for Payer: Wellcare Medicare Advantage	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

FACTOR XIII ASSAY

Facility

$224.00

Service Code	HCPCS 85291
Hospital Charge Code	3004249
Hospital Revenue Code	305
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

FACTOR X STUART PROWER

Facility

$224.00

Service Code	HCPCS 85260
Hospital Charge Code	3004215
Hospital Revenue Code	305
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

FACTOR X STUART PROWER

Facility

$224.00

Service Code	HCPCS 85260
Hospital Charge Code	3004215
Hospital Revenue Code	305
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.61
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

FAMCICLOVIR 125 MG TAB

Facility

$19.25

Hospital Charge Code	60628817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

FAMCICLOVIR 125 MG TAB

Facility

$19.25

Hospital Charge Code	60628817
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$29.97
Rate for Payer: Aetna Medicare Advantage	$23.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.11
Rate for Payer: Cigna Commercial	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$15.77
Rate for Payer: Qualcare PPO/HMO/WC	$11.83
Rate for Payer: UnitedHealthcare Commercial	$15.77
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.83

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$23.76
Rate for Payer: Qualcare PPO/HMO/WC	$23.76

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$60.19
Rate for Payer: Aetna Medicare Advantage	$47.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.39
Rate for Payer: Cigna Commercial	$79.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.52
Rate for Payer: Oxford Commercial	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$23.76
Rate for Payer: UnitedHealthcare Commercial	$31.68
Rate for Payer: UnitedHealthcare Community & State	$3.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.20

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$115.52
Rate for Payer: Aetna Medicare Advantage	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.52
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.20
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$7.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8.06

FAMILY COUNSEL WITHOUT PATIENT

Facility

$409.00

Service Code	HCPCS 90846
Hospital Charge Code	9310088
Hospital Revenue Code	916
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

FAMILY COUNSEL WITHOUT PATIENT

Facility

$409.00

Service Code	HCPCS 90846
Hospital Charge Code	9310088
Hospital Revenue Code	916
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

FAMILY COUNSEL WITH PATIENT

Facility

$409.00

Service Code	HCPCS 90847
Hospital Charge Code	9310087
Hospital Revenue Code	916
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

FAMILY COUNSEL WITH PATIENT

Facility

$409.00

Service Code	HCPCS 90847
Hospital Charge Code	9310087
Hospital Revenue Code	916
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

FAMILY EDUCATION/CONF 1/4 HR.

Facility

$63.00

Hospital Charge Code	1008400
Hospital Revenue Code	420
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

FAMILY EDUCATION/CONF 1/4 HR.

Facility

$63.00

Hospital Charge Code	1008400
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

FAMILY THERAPY

Facility

$165.80

Service Code	HCPCS 90847
Hospital Charge Code	50005
Hospital Revenue Code	916
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.74
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

FAMILY THERAPY

Facility

$165.80

Service Code	HCPCS 90847
Hospital Charge Code	50005
Hospital Revenue Code	916
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$24.87

FAMILY THERAPY W/O PATIENT 50M

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546772
Hospital Revenue Code	916
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

FAMILY THERAPY W/O PATIENT 50M

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546772
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY THERAPY W/O PT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90846
Hospital Charge Code	4546752
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

Know your out-of-pocket cost for care.

All Charges