Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GYNE-LOTRIMIN 1%/45GM

Facility

$15.00

Hospital Charge Code	60633062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

GYNE-LOTRIMIN 1%/45GM

Facility

$15.00

Hospital Charge Code	60633062
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

H470080A VASCULAR GRAFT

Facility

$10,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270656770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

H470080A VASCULAR GRAFT

Facility

$10,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270656770
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

HABITROL/14MG/24H

Facility

$23.00

Hospital Charge Code	60634728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

HABITROL/14MG/24H

Facility

$23.00

Hospital Charge Code	60634728
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

HABITROL 14 PATCH

Facility

$5.00

Hospital Charge Code	60635181
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HABITROL 14 PATCH

Facility

$5.00

Hospital Charge Code	60635181
Hospital Revenue Code	250
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	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

HABITROL/21MG/24H

Facility

$23.00

Hospital Charge Code	60634729
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

HABITROL/21MG/24H

Facility

$23.00

Hospital Charge Code	60634729
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

HABITROL 21 PATCH

Facility

$5.00

Hospital Charge Code	60635182
Hospital Revenue Code	250
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	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

HABITROL 21 PATCH

Facility

$5.00

Hospital Charge Code	60635182
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HABITROL/7MG/24H

Facility

$23.00

Hospital Charge Code	60634730
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

HABITROL/7MG/24H

Facility

$23.00

Hospital Charge Code	60634730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

HABITROL 7 PATCH

Facility

$5.00

Hospital Charge Code	60635180
Hospital Revenue Code	250
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	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

HABITROL 7 PATCH

Facility

$5.00

Hospital Charge Code	60635180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HAEMOP FLUB PRP-T CONJ VAC 4DS

Facility

$72.03

Service Code	HCPCS 90648
Hospital Charge Code	606390467
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$17.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

HAEMOP FLUB PRP-T CONJ VAC 4DS

Facility

$72.03

Service Code	HCPCS 90648
Hospital Charge Code	606390467
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$52.27
Rate for Payer: Aetna Commercial	$27.37
Rate for Payer: Aetna Medicare Advantage	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.37
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	$18.37
Rate for Payer: Cigna Commercial	$36.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

HAEMOPHILS INFL-TYPE B 0.5ML**

Facility

$64.00

Service Code	HCPCS 90721
Hospital Charge Code	6017727
Hospital Revenue Code	259
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

HAEMOPHILS INFL-TYPE B 0.5ML**

Facility

$64.00

Service Code	HCPCS 90721
Hospital Charge Code	6017727
Hospital Revenue Code	259
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

HAEMOPHILUS B CONJUGATE VACCIN

Facility

$714.10

Service Code	HCPCS 90645
Hospital Charge Code	60630032
Hospital Revenue Code	636
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$357.05
Rate for Payer: Aetna Commercial	$271.36
Rate for Payer: Aetna Medicare Advantage	$214.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.10
Rate for Payer: Cigna Commercial	$357.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.81
Rate for Payer: Qualcare PPO/HMO/WC	$107.11
Rate for Payer: UnitedHealthcare Community & State	$17.21
Rate for Payer: Wellpoint Medicaid Managed Care	$18.92

HAEMOPHILUS B CONJUGATE VACCIN

Facility

$714.10

Service Code	HCPCS 90645
Hospital Charge Code	60630032
Hospital Revenue Code	636
Min. Negotiated Rate	$107.11
Max. Negotiated Rate	$172.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.81
Rate for Payer: Qualcare PPO/HMO/WC	$107.11

HAEMOPHILUS B (PEDVAXHIB) 7.5

Facility

$105.36

Service Code	HCPCS 90647
Hospital Charge Code	60630158
Hospital Revenue Code	636
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$52.68
Rate for Payer: Aetna Commercial	$40.04
Rate for Payer: Aetna Medicare Advantage	$31.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.87
Rate for Payer: Cigna Commercial	$52.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

HAEMOPHILUS B (PEDVAXHIB) 7.5

Facility

$105.36

Service Code	HCPCS 90647
Hospital Charge Code	60630158
Hospital Revenue Code	636
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.80

HAEMOPHILUS B VACCINE

Facility

$273.00

Service Code	HCPCS 90737
Hospital Charge Code	60628302
Hospital Revenue Code	259
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

Know your out-of-pocket cost for care.

All Charges