Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	3039022
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	3039022
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	39990222
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	38430022
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	39990222
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	39990223
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	39990223
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	38430023
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	3039023
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	3039023
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	38430023
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	38430024
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	39990224
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	3039024
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	38430024
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	3039024
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	39990224
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTI-RETICULIN AB SCREEN (SER)

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3007127
Hospital Revenue Code	302
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

ANTI-RETICULIN AB SCREEN (SER)

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3007127
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

ANTI RI ANTOBODIES

Facility

$98.00

Service Code	HCPCS 86256
Hospital Charge Code	3038071
Hospital Revenue Code	300
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

ANTI RI ANTOBODIES

Facility

$98.00

Service Code	HCPCS 86256
Hospital Charge Code	3038071
Hospital Revenue Code	300
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

ANTIROTATION SCREW 85MM

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270687017
Hospital Revenue Code	278
Min. Negotiated Rate	$275.25
Max. Negotiated Rate	$444.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$403.70
Rate for Payer: Qualcare PPO/HMO/WC	$275.25

ANTIROTATION SCREW 85MM

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270687017
Hospital Revenue Code	278
Min. Negotiated Rate	$44.22
Max. Negotiated Rate	$917.50
Rate for Payer: Aetna Commercial	$697.30
Rate for Payer: Aetna Medicare Advantage	$550.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$467.93
Rate for Payer: Cigna Commercial	$917.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$403.70
Rate for Payer: Qualcare PPO/HMO/WC	$275.25
Rate for Payer: UnitedHealthcare Community & State	$44.22
Rate for Payer: Wellpoint Medicaid Managed Care	$48.63

ANTIROT SCR FEM NECK 90MMSTER

Facility

$1,077.10

Service Code	HCPCS C1713
Hospital Charge Code	270686944
Hospital Revenue Code	278
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$538.55
Rate for Payer: Aetna Commercial	$409.30
Rate for Payer: Aetna Medicare Advantage	$323.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.66
Rate for Payer: Cigna Commercial	$538.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.96
Rate for Payer: Qualcare PPO/HMO/WC	$161.56
Rate for Payer: UnitedHealthcare Community & State	$25.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

ANTIROT SCR FEM NECK 90MMSTER

Facility

$1,077.10

Service Code	HCPCS C1713
Hospital Charge Code	270686944
Hospital Revenue Code	278
Min. Negotiated Rate	$161.56
Max. Negotiated Rate	$260.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.96
Rate for Payer: Qualcare PPO/HMO/WC	$161.56

Know your out-of-pocket cost for care.

All Charges