Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HALOPERIDOL DECAN INJ 50MG/ML

Facility

$192.96

Service Code	HCPCS J1631
Hospital Charge Code	60627804
Hospital Revenue Code	636
Min. Negotiated Rate	$28.94
Max. Negotiated Rate	$46.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.94

HALOPERIDOL DECAN INJ 50MG/ML

Facility

$192.96

Service Code	HCPCS J1631
Hospital Charge Code	60627804
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.48
Rate for Payer: Aetna Commercial	$73.32
Rate for Payer: Aetna Medicare Advantage	$57.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.20
Rate for Payer: Cigna Commercial	$96.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.94
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

HALOPERIDOL (HALDOL)

Facility

$324.00

Service Code	HCPCS 80173
Hospital Charge Code	38473128
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

HALOPERIDOL (HALDOL)

Facility

$324.00

Service Code	HCPCS 80173
Hospital Charge Code	38473128
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.96
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$15.78
Rate for Payer: Clover Medicare Advantage	$14.99
Rate for Payer: EmblemHealth Commercial	$47.34
Rate for Payer: Humana Medicare Advantage	$16.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.78
Rate for Payer: Wellcare Medicare Advantage	$15.78
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

HALOPERIDOL INTENSOL ORAL120ML

Facility

$131.85

Hospital Charge Code	6016190
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

HALOPERIDOL INTENSOL ORAL120ML

Facility

$131.85

Hospital Charge Code	6016190
Hospital Revenue Code	251
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.55
Rate for Payer: Oxford Commercial	$26.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$26.37
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

HALOPERIDOL (QUANT SERUM)

Facility

$244.85

Service Code	HCPCS 80173
Hospital Charge Code	3007424
Hospital Revenue Code	301
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$36.73

HALOPERIDOL (QUANT SERUM)

Facility

$244.85

Service Code	HCPCS 80173
Hospital Charge Code	3007424
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.96
Rate for Payer: Cigna Commercial	$122.42
Rate for Payer: Cigna Medicare Advantage	$15.78
Rate for Payer: Clover Medicare Advantage	$14.99
Rate for Payer: EmblemHealth Commercial	$47.34
Rate for Payer: Humana Medicare Advantage	$16.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.78
Rate for Payer: Wellcare Medicare Advantage	$15.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

HALOPERIDOL TAB 2MG

Facility

$1.95

Hospital Charge Code	6022511
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

HALOPERIDOL TAB 2MG

Facility

$1.95

Hospital Charge Code	6022511
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

HALOPERIDOL VIAL 5MG

Facility

$37.80

Hospital Charge Code	6012587
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

HALOPERIDOL VIAL 5MG

Facility

$37.80

Hospital Charge Code	6012587
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

HALOTESTIN/10MG/TAB

Facility

$8.00

Hospital Charge Code	60633078
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

HALOTESTIN/10MG/TAB

Facility

$8.00

Hospital Charge Code	60633078
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

HALOTHANE 100% GAS

Facility

$446.45

Hospital Charge Code	60627668
Hospital Revenue Code	250
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$66.97
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

HALOTHANE 100% GAS

Facility

$446.45

Hospital Charge Code	60627668
Hospital Revenue Code	250
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$223.22
Rate for Payer: Aetna Commercial	$169.65
Rate for Payer: Aetna Medicare Advantage	$133.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.84
Rate for Payer: Cigna Commercial	$223.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.94
Rate for Payer: Oxford Commercial	$89.29
Rate for Payer: Qualcare PPO/HMO/WC	$66.97
Rate for Payer: UnitedHealthcare Commercial	$89.29
Rate for Payer: UnitedHealthcare Community & State	$10.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.83

HALOTHANE/125ML

Facility

$122.00

Hospital Charge Code	60634824
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

HALOTHANE/125ML

Facility

$122.00

Hospital Charge Code	60634824
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

HALOTHANE GAS INTERMED 3-6HRS

Facility

$268.20

Hospital Charge Code	6010425
Hospital Revenue Code	250
Min. Negotiated Rate	$40.23
Max. Negotiated Rate	$40.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.23

HALOTHANE GAS INTERMED 3-6HRS

Facility

$268.20

Hospital Charge Code	6010425
Hospital Revenue Code	250
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna Commercial	$101.92
Rate for Payer: Aetna Medicare Advantage	$80.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.39
Rate for Payer: Cigna Commercial	$134.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.46
Rate for Payer: Oxford Commercial	$53.64
Rate for Payer: Qualcare PPO/HMO/WC	$40.23
Rate for Payer: UnitedHealthcare Commercial	$53.64
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: Wellpoint Medicaid Managed Care	$7.11

HALOTHANE GAS LONG 250ML 6+HRS

Facility

$718.10

Hospital Charge Code	6009385
Hospital Revenue Code	250
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$359.05
Rate for Payer: Aetna Commercial	$272.88
Rate for Payer: Aetna Medicare Advantage	$215.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.12
Rate for Payer: Cigna Commercial	$359.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.43
Rate for Payer: Oxford Commercial	$143.62
Rate for Payer: Qualcare PPO/HMO/WC	$107.72
Rate for Payer: UnitedHealthcare Commercial	$143.62
Rate for Payer: UnitedHealthcare Community & State	$17.31
Rate for Payer: Wellpoint Medicaid Managed Care	$19.03

HALOTHANE GAS LONG 250ML 6+HRS

Facility

$718.10

Hospital Charge Code	6009385
Hospital Revenue Code	250
Min. Negotiated Rate	$107.72
Max. Negotiated Rate	$107.72
Rate for Payer: Qualcare PPO/HMO/WC	$107.72

HALOTHANE GAS SHORT 0-3 HOURS

Facility

$136.35

Hospital Charge Code	6010433
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

HALOTHANE GAS SHORT 0-3 HOURS

Facility

$136.35

Hospital Charge Code	6010433
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

HALOTHANE INJ 125MG

Facility

$141.00

Hospital Charge Code	60635256
Hospital Revenue Code	250
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

Know your out-of-pocket cost for care.

All Charges