Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJ ESTROGEN SUB CNJGTD 5MG/ML

Facility

$234.25

Hospital Charge Code	6002323
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$56.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

INJ ESTROGEN SUB CNJGTD 5MG/ML

Facility

$234.25

Hospital Charge Code	6002323
Hospital Revenue Code	636
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Community & State	$5.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.21

INJETAK ADJUSTABLE NEEDLE 70CM

Facility

$1,196.00

Hospital Charge Code	270702238
Hospital Revenue Code	279
Min. Negotiated Rate	$28.82
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$454.48
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.80
Rate for Payer: Oxford Commercial	$239.20
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$239.20
Rate for Payer: UnitedHealthcare Community & State	$28.82
Rate for Payer: Wellpoint Medicaid Managed Care	$31.69

INJETAK ADJUSTABLE NEEDLE 70CM

Facility

$1,196.00

Hospital Charge Code	270702238
Hospital Revenue Code	279
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

INJ FORAMEN EPIDURAL ADD-ON

Facility

$3,152.73

Service Code	HCPCS 64484
Hospital Charge Code	1600000459
Hospital Revenue Code	360
Min. Negotiated Rate	$75.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,198.04
Rate for Payer: Aetna Medicare Advantage	$945.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.95
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	$803.95
Rate for Payer: Cigna Commercial	$1,576.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.82
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$75.98

INJ FORAMEN EPIDURAL ADD-ON

Facility

$3,152.73

Service Code	HCPCS 64484
Hospital Charge Code	1600000459
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$191.76
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	$2,387.04
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$191.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$72.18
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,138.07
Rate for Payer: Aetna Medicare Advantage	$898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.70
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	$763.70
Rate for Payer: Cigna Commercial	$1,497.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$898.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$72.18
Rate for Payer: Wellpoint Medicaid Managed Care	$79.37

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$449.24
Max. Negotiated Rate	$449.24
Rate for Payer: Qualcare PPO/HMO/WC	$449.24

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

INJ GENTAMICIN IM 80MG/2ML

Facility

$5.80

Hospital Charge Code	60627237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

INJ GENTAMICIN IM 80MG/2ML

Facility

$5.80

Hospital Charge Code	60627237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

INJGRANISETRN HYDROCHLO 100MCG

Facility

$3,098.25

Hospital Charge Code	60629359
Hospital Revenue Code	636
Min. Negotiated Rate	$74.67
Max. Negotiated Rate	$1,549.12
Rate for Payer: Aetna Commercial	$1,177.34
Rate for Payer: Aetna Medicare Advantage	$929.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$790.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$790.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$790.05
Rate for Payer: Cigna Commercial	$1,549.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.78
Rate for Payer: Qualcare PPO/HMO/WC	$464.74
Rate for Payer: UnitedHealthcare Community & State	$74.67
Rate for Payer: Wellpoint Medicaid Managed Care	$82.10

INJGRANISETRN HYDROCHLO 100MCG

Facility

$3,098.25

Hospital Charge Code	60629359
Hospital Revenue Code	636
Min. Negotiated Rate	$464.74
Max. Negotiated Rate	$749.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.78
Rate for Payer: Qualcare PPO/HMO/WC	$464.74

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$27.77
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$437.93
Rate for Payer: Aetna Medicare Advantage	$345.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.87
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	$293.87
Rate for Payer: Cigna Commercial	$576.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.73
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.87
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$27.77

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$172.87
Max. Negotiated Rate	$172.87
Rate for Payer: Qualcare PPO/HMO/WC	$172.87

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$149.18
Rate for Payer: Qualcare PPO/HMO/WC	$149.18

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.35
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.18
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$26.35

INJ METARMINL BITARTRTE1% 10ML

Facility

$159.00

Hospital Charge Code	6003552
Hospital Revenue Code	636
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

INJ METARMINL BITARTRTE1% 10ML

Facility

$159.00

Hospital Charge Code	6003552
Hospital Revenue Code	636
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$38.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

INJ METOCLOPRAMIDE 50MG/10MG

Facility

$64.00

Hospital Charge Code	6007074
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

INJ METOCLOPRAMIDE 50MG/10MG

Facility

$64.00

Hospital Charge Code	6007074
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

INJ METOCLOPRAMIDE 5MG/ML

Facility

$21.15

Hospital Charge Code	6003677
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

Know your out-of-pocket cost for care.

All Charges