Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GADOXETATE 181.43MG/ML 10ML

Facility

$109.75

Service Code	NDC 50419032005
Hospital Charge Code	606390437
Hospital Revenue Code	255
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$16.46
Rate for Payer: Qualcare PPO/HMO/WC	$16.46

GADOXETATE 181.43MG/ML 10ML

Facility

$109.75

Service Code	NDC 50419032005
Hospital Charge Code	606390437
Hospital Revenue Code	255
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.88
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$32.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$54.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.92
Rate for Payer: Oxford Commercial	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.46
Rate for Payer: UnitedHealthcare Commercial	$21.95
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$26.70

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.59
Rate for Payer: Aetna Medicare Advantage	$44.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.89
Rate for Payer: Cigna Commercial	$89.00
Rate for Payer: Cigna Medicare Advantage	$13.82
Rate for Payer: Clover Medicare Advantage	$13.13
Rate for Payer: EmblemHealth Commercial	$41.46
Rate for Payer: Humana Medicare Advantage	$14.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.82
Rate for Payer: Wellcare Medicare Advantage	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$156.79
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
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	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

GALACTOMAN

Facility

$110.55

Service Code	HCPCS 87305
Hospital Charge Code	3036010
Hospital Revenue Code	300
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$16.58
Rate for Payer: Qualcare PPO/HMO/WC	$16.58

GALACTOMAN

Facility

$110.55

Service Code	HCPCS 87305
Hospital Charge Code	3036010
Hospital Revenue Code	300
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$55.27
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.58
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$6.98
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.51
Rate for Payer: Oxford Commercial	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$3.67
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.46
Rate for Payer: Aetna Medicare Advantage	$36.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.43
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: Cigna Medicare Advantage	$11.20
Rate for Payer: Clover Medicare Advantage	$10.64
Rate for Payer: EmblemHealth Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$11.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.20
Rate for Payer: Wellcare Medicare Advantage	$11.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

GALLIUM GA-67 CITRATE

Facility

$750.00

Hospital Charge Code	270653758
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GALLIUM GA-67 CITRATE

Facility

$750.00

Hospital Charge Code	270653758
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$179.15
Rate for Payer: Aetna Commercial	$134.99
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$49.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.15
Rate for Payer: Cigna Medicare Advantage	$34.74
Rate for Payer: Clover Medicare Advantage	$47.15
Rate for Payer: EmblemHealth Commercial	$148.89
Rate for Payer: Humana Medicare Advantage	$51.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$49.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.33
Rate for Payer: Qualcare PPO/HMO/WC	$41.67
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.63
Rate for Payer: Wellcare Medicare Advantage	$49.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.36

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$41.67
Max. Negotiated Rate	$41.67
Rate for Payer: Qualcare PPO/HMO/WC	$41.67

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$113.58
Max. Negotiated Rate	$1,727.31
Rate for Payer: Aetna Commercial	$1,301.57
Rate for Payer: Aetna Medicare Advantage	$1,550.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,727.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,727.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$478.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,727.31
Rate for Payer: Cigna Medicare Advantage	$334.96
Rate for Payer: Clover Medicare Advantage	$454.59
Rate for Payer: EmblemHealth Commercial	$1,435.56
Rate for Payer: Humana Medicare Advantage	$492.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$478.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,413.86
Rate for Payer: Qualcare PPO/HMO/WC	$706.93
Rate for Payer: UnitedHealthcare Community & State	$113.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$478.52
Rate for Payer: Wellcare Medicare Advantage	$478.52
Rate for Payer: Wellpoint Medicaid Managed Care	$124.89

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$706.93
Max. Negotiated Rate	$706.93
Rate for Payer: Qualcare PPO/HMO/WC	$706.93

GALLIUM NITRATE INJ 500MG/20ML

Facility

$965.15

Hospital Charge Code	6009625
Hospital Revenue Code	250
Min. Negotiated Rate	$23.26
Max. Negotiated Rate	$482.57
Rate for Payer: Aetna Commercial	$366.76
Rate for Payer: Aetna Medicare Advantage	$289.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.11
Rate for Payer: Cigna Commercial	$482.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.55
Rate for Payer: Oxford Commercial	$193.03
Rate for Payer: Qualcare PPO/HMO/WC	$144.77
Rate for Payer: UnitedHealthcare Commercial	$193.03
Rate for Payer: UnitedHealthcare Community & State	$23.26
Rate for Payer: Wellpoint Medicaid Managed Care	$25.58

GALLIUM NITRATE INJ 500MG/20ML

Facility

$965.15

Hospital Charge Code	6009625
Hospital Revenue Code	250
Min. Negotiated Rate	$144.77
Max. Negotiated Rate	$144.77
Rate for Payer: Qualcare PPO/HMO/WC	$144.77

GAMAR/2ML

Facility

$75.00

Hospital Charge Code	60634238
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GAMAR/2ML

Facility

$75.00

Hospital Charge Code	60634238
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

GAMASTAN/10ML

Facility

$324.00

Hospital Charge Code	60635881
Hospital Revenue Code	259
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$64.80
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

Know your out-of-pocket cost for care.

All Charges