Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTUBATION,ENDOTRACH EMERG****

Facility

$672.00

Service Code	HCPCS 31500
Hospital Charge Code	5700035
Hospital Revenue Code	361
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

INTUBATION,ENDOTRACH EMERG****

Facility

$672.00

Service Code	HCPCS 31500
Hospital Charge Code	5700035
Hospital Revenue Code	361
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

INTUBATION ET EMERGENT

Facility

$1,991.00

Service Code	HCPCS 31500
Hospital Charge Code	1600000667
Hospital Revenue Code	360
Min. Negotiated Rate	$298.65
Max. Negotiated Rate	$298.65
Rate for Payer: Qualcare PPO/HMO/WC	$298.65

INTUBATION ET EMERGENT

Facility

$1,991.00

Service Code	HCPCS 31500
Hospital Charge Code	1600000667
Hospital Revenue Code	360
Min. Negotiated Rate	$47.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$298.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$47.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

INTUBATION ET EMERGENT

Facility

$1,991.01

Service Code	HCPCS 31500
Hospital Charge Code	T
Hospital Revenue Code	360
Min. Negotiated Rate	$298.65
Max. Negotiated Rate	$298.65
Rate for Payer: Qualcare PPO/HMO/WC	$298.65

INTUBATION ET EMERGENT

Facility

$1,991.01

Service Code	HCPCS 31500
Hospital Charge Code	T
Hospital Revenue Code	360
Min. Negotiated Rate	$47.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$597.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$298.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$47.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

INVEGA HSP 3MG TAB

Facility

$54.00

Hospital Charge Code	60635648
Hospital Revenue Code	250
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

INVEGA HSP 3MG TAB

Facility

$54.00

Hospital Charge Code	60635648
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

INVEGA HSP 6MG TAB

Facility

$58.00

Hospital Charge Code	60635671
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$22.04
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.40
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

INVEGA HSP 6MG TAB

Facility

$58.00

Hospital Charge Code	60635671
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

INVEGA SUSTENA 117 MG

Facility

$7,774.95

Service Code	NDC 50458056201
Hospital Charge Code	60634951
Hospital Revenue Code	250
Min. Negotiated Rate	$1,166.24
Max. Negotiated Rate	$1,166.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.24

INVEGA SUSTENA 117 MG

Facility

$7,774.95

Service Code	NDC 50458056201
Hospital Charge Code	60634951
Hospital Revenue Code	250
Min. Negotiated Rate	$187.38
Max. Negotiated Rate	$3,887.47
Rate for Payer: Aetna Commercial	$2,954.48
Rate for Payer: Aetna Medicare Advantage	$2,332.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,982.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,982.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,982.61
Rate for Payer: Cigna Commercial	$3,887.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,332.49
Rate for Payer: Oxford Commercial	$1,554.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.24
Rate for Payer: UnitedHealthcare Commercial	$1,554.99
Rate for Payer: UnitedHealthcare Community & State	$187.38
Rate for Payer: Wellpoint Medicaid Managed Care	$206.04

INVEGA SUSTENNA 156 MG INJ

Facility

$10,366.91

Service Code	HCPCS J2426
Hospital Charge Code	606350946
Hospital Revenue Code	636
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$2,508.79
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,508.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,555.04
Rate for Payer: UnitedHealthcare Community & State	$249.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$274.72

INVEGA SUSTENNA 156 MG INJ

Facility

$10,366.91

Service Code	HCPCS J2426
Hospital Charge Code	606350946
Hospital Revenue Code	636
Min. Negotiated Rate	$1,555.04
Max. Negotiated Rate	$2,508.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,508.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,555.04

INVEGA SUSTENNA 234MG

Facility

$15,550.10

Service Code	HCPCS J2426
Hospital Charge Code	6063943348
Hospital Revenue Code	636
Min. Negotiated Rate	$2,332.51
Max. Negotiated Rate	$3,763.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.51

INVEGA SUSTENNA 234MG

Facility

$15,550.10

Service Code	HCPCS J2426
Hospital Charge Code	6063943348
Hospital Revenue Code	636
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$3,763.12
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.51
Rate for Payer: UnitedHealthcare Community & State	$374.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$412.08

INVIA CONNECTOR DBL LUM

Facility

$67.90

Hospital Charge Code	270687289
Hospital Revenue Code	271
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$10.19
Rate for Payer: Qualcare PPO/HMO/WC	$10.19

INVIA CONNECTOR DBL LUM

Facility

$67.90

Hospital Charge Code	270687289
Hospital Revenue Code	271
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$33.95
Rate for Payer: Aetna Commercial	$25.80
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.31
Rate for Payer: Cigna Commercial	$33.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.37
Rate for Payer: Oxford Commercial	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.19
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

INVIA FITPAD WHITE

Facility

$52.50

Hospital Charge Code	270687295
Hospital Revenue Code	271
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

INVIA FITPAD WHITE

Facility

$52.50

Hospital Charge Code	270687295
Hospital Revenue Code	271
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

INVIA FOAM DRESSING KIT FITPAD

Facility

$175.00

Hospital Charge Code	270687290
Hospital Revenue Code	271
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

INVIA FOAM DRESSING KIT FITPAD

Facility

$175.00

Hospital Charge Code	270687290
Hospital Revenue Code	271
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

INVIA WHITE FOAM SMALL NPWT

Facility

$49.00

Hospital Charge Code	270687292
Hospital Revenue Code	271
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

INVIA WHITE FOAM SMALL NPWT

Facility

$49.00

Hospital Charge Code	270687292
Hospital Revenue Code	271
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

INVICTUS GUIDEWIRE

Facility

$400.00

Hospital Charge Code	270703549
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

Know your out-of-pocket cost for care.

All Charges