Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJECTION IM/SUBQ

Facility

$320.48

Service Code	HCPCS 96372
Hospital Charge Code	2011448
Hospital Revenue Code	260
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$48.07
Rate for Payer: Qualcare PPO/HMO/WC	$48.07

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	84206300
Hospital Revenue Code	510
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	93500051
Hospital Revenue Code	260
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.90
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$8.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.09

INJECTION IM/SUBQ

Facility

$320.48

Service Code	HCPCS 96372
Hospital Charge Code	5000000
Hospital Revenue Code	260
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.07
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$7.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4818524
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	93500055
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECTION IM/SUBQ

Facility

$206.86

Service Code	HCPCS 96372
Hospital Charge Code	83653145
Hospital Revenue Code	260
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$31.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.03

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	84310135
Hospital Revenue Code	510
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$308.77
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.52
Rate for Payer: Qualcare PPO/HMO/WC	$51.76
Rate for Payer: UnitedHealthcare Community & State	$8.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4822524
Hospital Revenue Code	260
Min. Negotiated Rate	$22.71
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	1600505
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4832524
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	9800520
Hospital Revenue Code	510
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4832524
Hospital Revenue Code	260
Min. Negotiated Rate	$22.71
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	73050935
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	87502250
Hospital Revenue Code	510
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$320.48

Service Code	HCPCS 96372
Hospital Charge Code	1500103
Hospital Revenue Code	260
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$48.07
Rate for Payer: Qualcare PPO/HMO/WC	$48.07

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4824524
Hospital Revenue Code	260
Min. Negotiated Rate	$22.71
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	83652387
Hospital Revenue Code	510
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$308.77
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.52
Rate for Payer: Qualcare PPO/HMO/WC	$51.76
Rate for Payer: UnitedHealthcare Community & State	$8.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	93950121
Hospital Revenue Code	260
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	73050975
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	2300903
Hospital Revenue Code	260
Min. Negotiated Rate	$22.71
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	73050975
Hospital Revenue Code	260
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.90
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$8.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.09

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	83652387
Hospital Revenue Code	510
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	73050935
Hospital Revenue Code	260
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.90
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$8.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.09

INJECTION IM/SUBQ

Facility

$201.60

Service Code	HCPCS 96372
Hospital Charge Code	3400256M
Hospital Revenue Code	260
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$30.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.24

Know your out-of-pocket cost for care.

All Charges