Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HALDOL 50MG/ML VIAL

Facility

$394.45

Service Code	HCPCS J1631
Hospital Charge Code	87504140
Hospital Revenue Code	636
Min. Negotiated Rate	$9.51
Max. Negotiated Rate	$197.22
Rate for Payer: Aetna Commercial	$149.89
Rate for Payer: Aetna Medicare Advantage	$118.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.58
Rate for Payer: Cigna Commercial	$197.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.46
Rate for Payer: Qualcare PPO/HMO/WC	$59.17
Rate for Payer: UnitedHealthcare Community & State	$9.51
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

HALDOL 50MG/ML VIAL

Facility

$394.45

Service Code	HCPCS J1631
Hospital Charge Code	87504140
Hospital Revenue Code	636
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$95.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.46
Rate for Payer: Qualcare PPO/HMO/WC	$59.17

HALDOL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HALDOL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

HALDOL LIQUID

Facility

$52.00

Hospital Charge Code	6008247
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

HALDOL LIQUID

Facility

$52.00

Hospital Charge Code	6008247
Hospital Revenue Code	251
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

HALEY'S MO/30ML

Facility

$1.00

Hospital Charge Code	60634485
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

HALEY'S MO/30ML

Facility

$1.00

Hospital Charge Code	60634485
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

HALF PIN 2.5mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680473
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

HALF PIN 2.5mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680473
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

HALF PIN 3.0mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680476
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

HALF PIN 3.0mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680476
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

HALF PIN 5x150x35 SD 50179150S

Facility

$985.00

Service Code	HCPCS C1776
Hospital Charge Code	270643436
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

HALF PIN 5x150x35 SD 50179150S

Facility

$985.00

Service Code	HCPCS C1776
Hospital Charge Code	270643436
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

HALFPIN BMT 3X20X80 25-383986

Facility

$307.25

Hospital Charge Code	270616767
Hospital Revenue Code	278
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$74.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

HALFPIN BMT 3X20X80 25-383986

Facility

$307.25

Hospital Charge Code	270616767
Hospital Revenue Code	278
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$116.75
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

HALFPIN HMD 3/80 5038-5-080

Facility

$315.25

Hospital Charge Code	270619347
Hospital Revenue Code	272
Min. Negotiated Rate	$47.29
Max. Negotiated Rate	$47.29
Rate for Payer: Qualcare PPO/HMO/WC	$47.29

HALFPIN HMD 3/80 5038-5-080

Facility

$315.25

Hospital Charge Code	270619347
Hospital Revenue Code	272
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$157.62
Rate for Payer: Aetna Commercial	$119.80
Rate for Payer: Aetna Medicare Advantage	$94.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.39
Rate for Payer: Cigna Commercial	$157.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.58
Rate for Payer: Oxford Commercial	$63.05
Rate for Payer: Qualcare PPO/HMO/WC	$47.29
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: UnitedHealthcare Community & State	$7.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8.35

HALF PIN SD 4/5 40MM

Facility

$1,191.80

Service Code	HCPCS C1713
Hospital Charge Code	270700693
Hospital Revenue Code	278
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$595.90
Rate for Payer: Aetna Commercial	$452.88
Rate for Payer: Aetna Medicare Advantage	$357.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.91
Rate for Payer: Cigna Commercial	$595.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$262.20
Rate for Payer: Qualcare PPO/HMO/WC	$178.77
Rate for Payer: UnitedHealthcare Community & State	$28.72
Rate for Payer: Wellpoint Medicaid Managed Care	$31.58

HALF PIN SD 4/5 40MM

Facility

$1,191.80

Service Code	HCPCS C1713
Hospital Charge Code	270700693
Hospital Revenue Code	278
Min. Negotiated Rate	$178.77
Max. Negotiated Rate	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$262.20
Rate for Payer: Qualcare PPO/HMO/WC	$178.77

HALF RING MAXFRAME 180 MM DIA

Facility

$2,603.45

Hospital Charge Code	270683950
Hospital Revenue Code	272
Min. Negotiated Rate	$390.52
Max. Negotiated Rate	$390.52
Rate for Payer: Qualcare PPO/HMO/WC	$390.52

HALF RING MAXFRAME 180 MM DIA

Facility

$2,603.45

Hospital Charge Code	270683950
Hospital Revenue Code	272
Min. Negotiated Rate	$62.74
Max. Negotiated Rate	$1,301.72
Rate for Payer: Aetna Commercial	$989.31
Rate for Payer: Aetna Medicare Advantage	$781.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.88
Rate for Payer: Cigna Commercial	$1,301.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.03
Rate for Payer: Oxford Commercial	$520.69
Rate for Payer: Qualcare PPO/HMO/WC	$390.52
Rate for Payer: UnitedHealthcare Commercial	$520.69
Rate for Payer: UnitedHealthcare Community & State	$62.74
Rate for Payer: Wellpoint Medicaid Managed Care	$68.99

HALOBETASOL PROPIO.05% CRM 50G

Facility

$510.75

Hospital Charge Code	6010409
Hospital Revenue Code	252
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$255.38
Rate for Payer: Aetna Commercial	$194.09
Rate for Payer: Aetna Medicare Advantage	$153.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.24
Rate for Payer: Cigna Commercial	$255.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.22
Rate for Payer: Oxford Commercial	$102.15
Rate for Payer: Qualcare PPO/HMO/WC	$76.61
Rate for Payer: UnitedHealthcare Commercial	$102.15
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: Wellpoint Medicaid Managed Care	$13.53

HALOBETASOL PROPIO.05% CRM 50G

Facility

$510.75

Hospital Charge Code	6010409
Hospital Revenue Code	252
Min. Negotiated Rate	$76.61
Max. Negotiated Rate	$76.61
Rate for Payer: Qualcare PPO/HMO/WC	$76.61

HALOG 0.025%/15GM

Facility

$66.00

Hospital Charge Code	60633074
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

Know your out-of-pocket cost for care.

All Charges