Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73237026
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73050955
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	93500069
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	395096375
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73050955
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	7411253
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73050950
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	5100781
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	93500077
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	2400614
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	8200514
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	5700258
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	8200514
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	100116
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	411096376
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	3400260
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$633.74

Service Code	HCPCS 96376
Hospital Charge Code	5700444
Hospital Revenue Code	450
Min. Negotiated Rate	$95.06
Max. Negotiated Rate	$95.06
Rate for Payer: Qualcare PPO/HMO/WC	$95.06

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	5700258
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	2011451
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$633.74

Service Code	HCPCS 96376
Hospital Charge Code	5700444
Hospital Revenue Code	450
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$240.82
Rate for Payer: Aetna Medicare Advantage	$190.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.60
Rate for Payer: Cigna Commercial	$316.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.06
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$16.79

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	2011451
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	395096376
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	395096376
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	73190113
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	73050960
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

Know your out-of-pocket cost for care.

All Charges