Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJ THIETHYLPRAZINE 5MG/ML 2M

Facility

$34.60

Hospital Charge Code	6005300
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

INJ TRIGGER POINT 1/2 MUSCL

Facility

$1,147.71

Service Code	HCPCS 20552
Hospital Charge Code	1600000599
Hospital Revenue Code	360
Min. Negotiated Rate	$27.66
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.16
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$27.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$30.41

INJ TRIGGER POINT 1/2 MUSCL

Facility

$1,147.71

Service Code	HCPCS 20552
Hospital Charge Code	1600000599
Hospital Revenue Code	360
Min. Negotiated Rate	$172.16
Max. Negotiated Rate	$172.16
Rate for Payer: Qualcare PPO/HMO/WC	$172.16

INJ-TRIGGER POINT, 1/2 MUSCLE

Facility

$1,091.00

Service Code	HCPCS 20552
Hospital Charge Code	75190120
Hospital Revenue Code	361
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

INJ-TRIGGER POINT, 1/2 MUSCLE

Facility

$1,091.00

Service Code	HCPCS 20552
Hospital Charge Code	75190120
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

INK CARTRIDGE

Facility

$214.75

Hospital Charge Code	270656361
Hospital Revenue Code	271
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$32.21
Rate for Payer: Qualcare PPO/HMO/WC	$32.21

INK CARTRIDGE

Facility

$214.75

Hospital Charge Code	270656361
Hospital Revenue Code	271
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.38
Rate for Payer: Aetna Commercial	$81.61
Rate for Payer: Aetna Medicare Advantage	$64.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.76
Rate for Payer: Cigna Commercial	$107.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.42
Rate for Payer: Oxford Commercial	$42.95
Rate for Payer: Qualcare PPO/HMO/WC	$32.21
Rate for Payer: UnitedHealthcare Commercial	$42.95
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

INK INDIA VL 10ML 500200IN

Facility

$158.45

Hospital Charge Code	270622581
Hospital Revenue Code	270
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$23.77
Rate for Payer: Qualcare PPO/HMO/WC	$23.77

INK INDIA VL 10ML 500200IN

Facility

$158.45

Hospital Charge Code	270622581
Hospital Revenue Code	270
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$79.22
Rate for Payer: Aetna Commercial	$60.21
Rate for Payer: Aetna Medicare Advantage	$47.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.40
Rate for Payer: Cigna Commercial	$79.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.53
Rate for Payer: Oxford Commercial	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$23.77
Rate for Payer: UnitedHealthcare Commercial	$31.69
Rate for Payer: UnitedHealthcare Community & State	$3.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.20

INNERBODY 14X12X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703906
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

INNERBODY 14X12X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703906
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

INNERBODY 15X13X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704157
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

INNERBODY 15X13X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704157
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

INOCOR INJ/5MG/1ML

Facility

$2,367.00

Hospital Charge Code	60634261
Hospital Revenue Code	250
Min. Negotiated Rate	$355.05
Max. Negotiated Rate	$355.05
Rate for Payer: Qualcare PPO/HMO/WC	$355.05

INOCOR INJ/5MG/1ML

Facility

$2,367.00

Hospital Charge Code	60634261
Hospital Revenue Code	250
Min. Negotiated Rate	$57.04
Max. Negotiated Rate	$1,183.50
Rate for Payer: Aetna Commercial	$899.46
Rate for Payer: Aetna Medicare Advantage	$710.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.59
Rate for Payer: Cigna Commercial	$1,183.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$710.10
Rate for Payer: Oxford Commercial	$473.40
Rate for Payer: Qualcare PPO/HMO/WC	$355.05
Rate for Payer: UnitedHealthcare Commercial	$473.40
Rate for Payer: UnitedHealthcare Community & State	$57.04
Rate for Payer: Wellpoint Medicaid Managed Care	$62.73

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953N
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954N
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

Know your out-of-pocket cost for care.

All Charges