Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEALON 5 0.6ML SYRINGE

Facility

$414.00

Hospital Charge Code	60635577
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

HEALON .85

Facility

$929.00

Hospital Charge Code	270332572
Hospital Revenue Code	272
Min. Negotiated Rate	$22.39
Max. Negotiated Rate	$464.50
Rate for Payer: Aetna Commercial	$353.02
Rate for Payer: Aetna Medicare Advantage	$278.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.90
Rate for Payer: Cigna Commercial	$464.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.70
Rate for Payer: Oxford Commercial	$185.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.35
Rate for Payer: UnitedHealthcare Commercial	$185.80
Rate for Payer: UnitedHealthcare Community & State	$22.39
Rate for Payer: Wellpoint Medicaid Managed Care	$24.62

HEALON .85

Facility

$929.00

Hospital Charge Code	270332572
Hospital Revenue Code	272
Min. Negotiated Rate	$139.35
Max. Negotiated Rate	$139.35
Rate for Payer: Qualcare PPO/HMO/WC	$139.35

HEALON ACD+GEL REF:HDPRP15

Facility

$575.00

Hospital Charge Code	270703451
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

HEALON ACD+GEL REF:HDPRP15

Facility

$575.00

Hospital Charge Code	270703451
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

HEALON GV PRO 0.85ML

Facility

$955.22

Service Code	NDC 50474065165
Hospital Charge Code	606390481
Hospital Revenue Code	272
Min. Negotiated Rate	$143.28
Max. Negotiated Rate	$143.28
Rate for Payer: Qualcare PPO/HMO/WC	$143.28

HEALON GV PRO 0.85ML

Facility

$955.22

Service Code	NDC 50474065165
Hospital Charge Code	606390481
Hospital Revenue Code	272
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.61
Rate for Payer: Aetna Commercial	$362.98
Rate for Payer: Aetna Medicare Advantage	$286.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.58
Rate for Payer: Cigna Commercial	$477.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.57
Rate for Payer: Oxford Commercial	$191.04
Rate for Payer: Qualcare PPO/HMO/WC	$143.28
Rate for Payer: UnitedHealthcare Commercial	$191.04
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

HEALON OPTH/10G/1ML

Facility

$671.00

Hospital Charge Code	60633079
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$335.50
Rate for Payer: Aetna Commercial	$254.98
Rate for Payer: Aetna Medicare Advantage	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.10
Rate for Payer: Cigna Commercial	$335.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.30
Rate for Payer: Oxford Commercial	$134.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.65
Rate for Payer: UnitedHealthcare Commercial	$134.20
Rate for Payer: UnitedHealthcare Community & State	$16.17
Rate for Payer: Wellpoint Medicaid Managed Care	$17.78

HEALON OPTH/10G/1ML

Facility

$671.00

Hospital Charge Code	60633079
Hospital Revenue Code	250
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

HEALOS 10cc

Facility

$8,505.00

Hospital Charge Code	270657919
Hospital Revenue Code	278
Min. Negotiated Rate	$204.97
Max. Negotiated Rate	$4,252.50
Rate for Payer: Aetna Commercial	$3,231.90
Rate for Payer: Aetna Medicare Advantage	$2,551.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,168.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,168.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,168.78
Rate for Payer: Cigna Commercial	$4,252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,871.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.75
Rate for Payer: UnitedHealthcare Community & State	$204.97
Rate for Payer: Wellpoint Medicaid Managed Care	$225.38

HEALOS 10cc

Facility

$8,505.00

Hospital Charge Code	270657919
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.75
Max. Negotiated Rate	$2,058.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,701.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,871.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.75

HEALTH RISK ASSESEMENT

Facility

$442.00

Service Code	HCPCS 99420
Hospital Charge Code	9200090
Hospital Revenue Code	520
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

HEALTH RISK ASSESEMENT

Facility

$442.00

Service Code	HCPCS 99420
Hospital Charge Code	9200090
Hospital Revenue Code	520
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna Medicare Advantage	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.71
Rate for Payer: Cigna Commercial	$221.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
Rate for Payer: UnitedHealthcare Community & State	$10.65
Rate for Payer: Wellpoint Medicaid Managed Care	$11.71

HEALTH SHAKES

Facility

$12.00

Hospital Charge Code	60634847
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

HEALTH SHAKES

Facility

$12.00

Hospital Charge Code	60634847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

HEALTH START ENROLLMENT

Facility

$174.55

Service Code	HCPCS 9924152HD
Hospital Charge Code	83652500
Hospital Revenue Code	514
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$26.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.18

HEALTH START ENROLLMENT

Facility

$174.55

Service Code	HCPCS 9924152HD
Hospital Charge Code	83652500
Hospital Revenue Code	514
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.28
Rate for Payer: Aetna Commercial	$66.33
Rate for Payer: Aetna Medicare Advantage	$52.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.51
Rate for Payer: Cigna Commercial	$87.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.37
Rate for Payer: Qualcare PPO/HMO/WC	$26.18
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

HEALTHSTART INIT ANTE VISIT

Facility

$140.80

Service Code	HCPCS 99201SB
Hospital Charge Code	83652506
Hospital Revenue Code	514
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$70.40
Rate for Payer: Aetna Commercial	$53.50
Rate for Payer: Aetna Medicare Advantage	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.90
Rate for Payer: Cigna Commercial	$70.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.24
Rate for Payer: Qualcare PPO/HMO/WC	$21.12
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

HEALTHSTART INIT ANTE VISIT

Facility

$140.80

Service Code	HCPCS 99201SB
Hospital Charge Code	83652506
Hospital Revenue Code	514
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.12

HEALTH START PRENATAL DEVELOP

Facility

$174.55

Service Code	HCPCS 9924122HD
Hospital Charge Code	83652502
Hospital Revenue Code	514
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.28
Rate for Payer: Aetna Commercial	$66.33
Rate for Payer: Aetna Medicare Advantage	$52.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.51
Rate for Payer: Cigna Commercial	$87.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.37
Rate for Payer: Qualcare PPO/HMO/WC	$26.18
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

HEALTH START PRENATAL DEVELOP

Facility

$174.55

Service Code	HCPCS 9924122HD
Hospital Charge Code	83652502
Hospital Revenue Code	514
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$26.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.18

HEALTHSTART SUBANTE 4-6 VISITS

Facility

$1,974.70

Service Code	HCPCS 59425SB
Hospital Charge Code	83652508
Hospital Revenue Code	514
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$987.35
Rate for Payer: Aetna Commercial	$750.39
Rate for Payer: Aetna Medicare Advantage	$592.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.55
Rate for Payer: Cigna Commercial	$987.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.41
Rate for Payer: Qualcare PPO/HMO/WC	$296.20
Rate for Payer: UnitedHealthcare Community & State	$47.59
Rate for Payer: Wellpoint Medicaid Managed Care	$52.33

HEALTHSTART SUBANTE 4-6 VISITS

Facility

$1,974.70

Service Code	HCPCS 59425SB
Hospital Charge Code	83652508
Hospital Revenue Code	514
Min. Negotiated Rate	$296.20
Max. Negotiated Rate	$296.20
Rate for Payer: Qualcare PPO/HMO/WC	$296.20

HEALTH START SUB PLAN 2ND TRI

Facility

$174.55

Service Code	HCPCS 99241
Hospital Charge Code	83652504
Hospital Revenue Code	514
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$26.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.18

HEALTH START SUB PLAN 2ND TRI

Facility

$174.55

Service Code	HCPCS 99241
Hospital Charge Code	83652504
Hospital Revenue Code	514
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.28
Rate for Payer: Aetna Commercial	$66.33
Rate for Payer: Aetna Medicare Advantage	$52.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.51
Rate for Payer: Cigna Commercial	$87.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.37
Rate for Payer: Qualcare PPO/HMO/WC	$26.18
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

Know your out-of-pocket cost for care.

All Charges