Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$15.40

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

GERI PSYCH PRIVATE

Facility

$18,000.00

Hospital Charge Code	100824
Hospital Revenue Code	114
Min. Negotiated Rate	$1,115.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

GERI PSYCH SEMI-PRIVATE

Facility

$18,000.00

Hospital Charge Code	100826
Hospital Revenue Code	124
Min. Negotiated Rate	$1,115.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

GERITOL PER ML

Facility

$4.00

Service Code	NDC 46017001112
Hospital Charge Code	606390439
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

GERITOL PER ML

Facility

$4.00

Service Code	NDC 46017001112
Hospital Charge Code	606390439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GERM CELL I

Facility

$164.00

Service Code	HCPCS 84702
Hospital Charge Code	3038091A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

GERM CELL I

Facility

$164.00

Service Code	HCPCS 84702
Hospital Charge Code	3038091A
Hospital Revenue Code	301
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

GERM CELL II

Facility

$121.25

Service Code	HCPCS 82105
Hospital Charge Code	3038091B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$60.62
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

GERM CELL II

Facility

$121.25

Service Code	HCPCS 82105
Hospital Charge Code	3038091B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.19
Max. Negotiated Rate	$18.19
Rate for Payer: Qualcare PPO/HMO/WC	$18.19

GEWIRE 035D 260x7cm TFE 256899

Facility

$312.50

Hospital Charge Code	270633916
Hospital Revenue Code	272
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$156.25
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare Advantage	$93.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.69
Rate for Payer: Cigna Commercial	$156.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.75
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.88
Rate for Payer: UnitedHealthcare Commercial	$62.50
Rate for Payer: UnitedHealthcare Community & State	$7.53
Rate for Payer: Wellpoint Medicaid Managed Care	$8.28

GEWIRE 035D 260x7cm TFE 256899

Facility

$312.50

Hospital Charge Code	270633916
Hospital Revenue Code	272
Min. Negotiated Rate	$46.88
Max. Negotiated Rate	$46.88
Rate for Payer: Qualcare PPO/HMO/WC	$46.88

GFRAFT GOR 14MMX40CM SBT1401

Facility

$4,310.25

Hospital Charge Code	270634308
Hospital Revenue Code	278
Min. Negotiated Rate	$103.88
Max. Negotiated Rate	$2,155.12
Rate for Payer: Aetna Commercial	$1,637.89
Rate for Payer: Aetna Medicare Advantage	$1,293.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,099.11
Rate for Payer: Cigna Commercial	$2,155.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$948.25
Rate for Payer: Qualcare PPO/HMO/WC	$646.54
Rate for Payer: UnitedHealthcare Community & State	$103.88
Rate for Payer: Wellpoint Medicaid Managed Care	$114.22

GFRAFT GOR 14MMX40CM SBT1401

Facility

$4,310.25

Hospital Charge Code	270634308
Hospital Revenue Code	278
Min. Negotiated Rate	$646.54
Max. Negotiated Rate	$1,043.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$948.25
Rate for Payer: Qualcare PPO/HMO/WC	$646.54

GFRG AUTOL FAT LIPO EA ADDL

Facility

$8,265.00

Service Code	HCPCS 15774
Hospital Charge Code	1600000627
Hospital Revenue Code	360
Min. Negotiated Rate	$199.19
Max. Negotiated Rate	$4,132.50
Rate for Payer: Aetna Commercial	$3,140.70
Rate for Payer: Aetna Medicare Advantage	$2,479.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,107.57
Rate for Payer: Cigna Commercial	$4,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,479.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$199.19
Rate for Payer: Wellpoint Medicaid Managed Care	$219.02

GFRG AUTOL FAT LIPO EA ADDL

Facility

$8,265.00

Service Code	HCPCS 15774
Hospital Charge Code	1600000627
Hospital Revenue Code	360
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$1,239.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

GGTP GAMMA GLUTAMYLTRANSFERAS

Facility

$667.59

Service Code	HCPCS 82977
Hospital Charge Code	3030293
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$19.58
Rate for Payer: Aetna Medicare Advantage	$23.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.99
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$6.84
Rate for Payer: EmblemHealth Commercial	$21.60
Rate for Payer: Humana Medicare Advantage	$7.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20
Rate for Payer: Wellcare Medicare Advantage	$7.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

GGTP GAMMA GLUTAMYLTRANSFERAS

Facility

$667.59

Service Code	HCPCS 82977
Hospital Charge Code	3030293
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

G,H 10MM, 7-10, POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657028
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

G,H 10MM, 7-10, POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657028
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

GIA-50 LOAD UNIT****

Facility

$158.00

Hospital Charge Code	1601038
Hospital Revenue Code	272
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

GIA-50 LOAD UNIT****

Facility

$158.00

Hospital Charge Code	1601038
Hospital Revenue Code	272
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$60.04
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$31.60
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

GIA-50 STAPLE****

Facility

$321.00

Hospital Charge Code	1601020
Hospital Revenue Code	272
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$160.50
Rate for Payer: Aetna Commercial	$121.98
Rate for Payer: Aetna Medicare Advantage	$96.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.86
Rate for Payer: Cigna Commercial	$160.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.30
Rate for Payer: Oxford Commercial	$64.20
Rate for Payer: Qualcare PPO/HMO/WC	$48.15
Rate for Payer: UnitedHealthcare Commercial	$64.20
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.51

GIA-50 STAPLE****

Facility

$321.00

Hospital Charge Code	1601020
Hospital Revenue Code	272
Min. Negotiated Rate	$48.15
Max. Negotiated Rate	$48.15
Rate for Payer: Qualcare PPO/HMO/WC	$48.15

Know your out-of-pocket cost for care.

All Charges