Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJ ANESTH,STELLATE GANGLION

Facility

$3,152.73

Service Code	HCPCS 64510
Hospital Charge Code	16001039
Hospital Revenue Code	360
Min. Negotiated Rate	$75.98
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.82
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$75.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$83.55

INJ ANESTH,STELLATE GANGLION

Facility

$3,152.73

Service Code	HCPCS 64510
Hospital Charge Code	16001039
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ ANSTH,LUMB/THORSYMPATHETIC

Facility

$3,152.73

Service Code	HCPCS 64520
Hospital Charge Code	16000434
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ ANSTH,LUMB/THORSYMPATHETIC

Facility

$3,152.73

Service Code	HCPCS 64520
Hospital Charge Code	16000434
Hospital Revenue Code	360
Min. Negotiated Rate	$75.98
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.82
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$75.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$83.55

INJ ANSTH-PERIPHERL NRV/BRANCH

Facility

$4,414.73

Service Code	HCPCS 64450
Hospital Charge Code	1600000416
Hospital Revenue Code	360
Min. Negotiated Rate	$106.39
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.42
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$662.21
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$106.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$116.99

INJ ANSTH-PERIPHERL NRV/BRANCH

Facility

$4,414.73

Service Code	HCPCS 64450
Hospital Charge Code	1600000416
Hospital Revenue Code	360
Min. Negotiated Rate	$662.21
Max. Negotiated Rate	$662.21
Rate for Payer: Qualcare PPO/HMO/WC	$662.21

INJ ARIPIPRAZOLE ER 300 MG

Facility

$9,554.27

Service Code	HCPCS J0401
Hospital Charge Code	6063943338
Hospital Revenue Code	636
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$2,312.13
Rate for Payer: Aetna Commercial	$19.77
Rate for Payer: Aetna Medicare Advantage	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Medicare Advantage	$7.27
Rate for Payer: Clover Medicare Advantage	$6.91
Rate for Payer: EmblemHealth Commercial	$21.81
Rate for Payer: Humana Medicare Advantage	$7.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,312.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.14
Rate for Payer: UnitedHealthcare Community & State	$230.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.27
Rate for Payer: Wellcare Medicare Advantage	$7.27
Rate for Payer: Wellpoint Medicaid Managed Care	$253.19

INJ ARIPIPRAZOLE ER 300 MG

Facility

$9,554.27

Service Code	HCPCS J0401
Hospital Charge Code	6063943338
Hospital Revenue Code	636
Min. Negotiated Rate	$1,433.14
Max. Negotiated Rate	$2,312.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,312.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.14

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$26.24
Rate for Payer: Aetna Commercial	$19.77
Rate for Payer: Aetna Medicare Advantage	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Medicare Advantage	$7.27
Rate for Payer: Clover Medicare Advantage	$6.91
Rate for Payer: EmblemHealth Commercial	$21.81
Rate for Payer: Humana Medicare Advantage	$7.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.27
Rate for Payer: Wellcare Medicare Advantage	$7.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$229.11
Max. Negotiated Rate	$4,753.38
Rate for Payer: Aetna Commercial	$3,612.57
Rate for Payer: Aetna Medicare Advantage	$2,852.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,424.22
Rate for Payer: Cigna Commercial	$4,753.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01
Rate for Payer: UnitedHealthcare Community & State	$229.11
Rate for Payer: Wellpoint Medicaid Managed Care	$251.93

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$1,426.01
Max. Negotiated Rate	$2,300.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$49.96
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$787.74
Rate for Payer: Aetna Medicare Advantage	$621.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.62
Rate for Payer: Cigna Commercial	$1,036.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.95
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.96

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$310.95
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

INJ BACLOFEN 2000 MCG/ML

Facility

$1,575.70

Hospital Charge Code	6010094
Hospital Revenue Code	636
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$787.85
Rate for Payer: Aetna Commercial	$598.77
Rate for Payer: Aetna Medicare Advantage	$472.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.80
Rate for Payer: Cigna Commercial	$787.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.32
Rate for Payer: Qualcare PPO/HMO/WC	$236.35
Rate for Payer: UnitedHealthcare Community & State	$37.97
Rate for Payer: Wellpoint Medicaid Managed Care	$41.76

INJ BACLOFEN 2000 MCG/ML

Facility

$1,575.70

Hospital Charge Code	6010094
Hospital Revenue Code	636
Min. Negotiated Rate	$236.35
Max. Negotiated Rate	$381.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.32
Rate for Payer: Qualcare PPO/HMO/WC	$236.35

INJ CHLOROTHIAZIDE 500 MG

Facility

$46.25

Hospital Charge Code	6001150
Hospital Revenue Code	636
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$11.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

INJ CHLOROTHIAZIDE 500 MG

Facility

$46.25

Hospital Charge Code	6001150
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

INJDALTEPARIN SODIUM P/2500 IU

Facility

$243.00

Hospital Charge Code	60629252
Hospital Revenue Code	250
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna Commercial	$92.34
Rate for Payer: Aetna Medicare Advantage	$72.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.97
Rate for Payer: Cigna Commercial	$121.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.90
Rate for Payer: Oxford Commercial	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.45
Rate for Payer: UnitedHealthcare Commercial	$48.60
Rate for Payer: UnitedHealthcare Community & State	$5.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.44

INJDALTEPARIN SODIUM P/2500 IU

Facility

$243.00

Hospital Charge Code	60629252
Hospital Revenue Code	250
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$36.45
Rate for Payer: Qualcare PPO/HMO/WC	$36.45

INJ DIPYRIDAMOLE 50MG/10ML

Facility

$401.95

Hospital Charge Code	6009702
Hospital Revenue Code	250
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$60.29

INJ DIPYRIDAMOLE 50MG/10ML

Facility

$401.95

Hospital Charge Code	6009702
Hospital Revenue Code	250
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$200.97
Rate for Payer: Aetna Commercial	$152.74
Rate for Payer: Aetna Medicare Advantage	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.50
Rate for Payer: Cigna Commercial	$200.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.58
Rate for Payer: Oxford Commercial	$80.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.29
Rate for Payer: UnitedHealthcare Commercial	$80.39
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

INJEC LINE HI PRES 48 91001483

Facility

$13.20

Hospital Charge Code	270632531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

INJEC LINE HI PRES 48 91001483

Facility

$13.20

Hospital Charge Code	270632531
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

INJECT,AMPHOTERICIN B LIP 10MG

Facility

$691.85

Hospital Charge Code	6016571
Hospital Revenue Code	636
Min. Negotiated Rate	$103.78
Max. Negotiated Rate	$167.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$103.78

Know your out-of-pocket cost for care.

All Charges