Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

APPLY FINGER SPLINT STATIC

Facility

$348.85

Service Code	HCPCS 29130
Hospital Charge Code	2500373
Hospital Revenue Code	761
Min. Negotiated Rate	$52.33
Max. Negotiated Rate	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$52.33

APPLY FINGER SPLINT STATIC

Facility

$322.82

Service Code	HCPCS 29130
Hospital Charge Code	412329130
Hospital Revenue Code	361
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

APPLY FINGER SPLINT STATIC

Facility

$322.82

Service Code	HCPCS 29130
Hospital Charge Code	412329130
Hospital Revenue Code	361
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

APPLY LONG LEG CAST BRACE

Facility

$1,360.45

Service Code	HCPCS 29358
Hospital Charge Code	412329358
Hospital Revenue Code	361
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

APPLY LONG LEG CAST BRACE

Facility

$1,360.45

Service Code	HCPCS 29358
Hospital Charge Code	412329358
Hospital Revenue Code	361
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

APPLY MULTI-LAYR COMP UPPR LEG

Facility

$1,225.95

Service Code	HCPCS 29582
Hospital Charge Code	9808211
Hospital Revenue Code	510
Min. Negotiated Rate	$183.89
Max. Negotiated Rate	$183.89
Rate for Payer: Qualcare PPO/HMO/WC	$183.89

APPLY MULTI-LAYR COMP UPPR LEG

Facility

$1,225.95

Service Code	HCPCS 29582
Hospital Charge Code	9808211
Hospital Revenue Code	510
Min. Negotiated Rate	$29.55
Max. Negotiated Rate	$612.98
Rate for Payer: Aetna Commercial	$465.86
Rate for Payer: Aetna Medicare Advantage	$367.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.62
Rate for Payer: Cigna Commercial	$612.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.79
Rate for Payer: Qualcare PPO/HMO/WC	$183.89
Rate for Payer: UnitedHealthcare Community & State	$29.55
Rate for Payer: Wellpoint Medicaid Managed Care	$32.49

APPLY MULTLAY COMPRS UPR ARM

Facility

$331.68

Service Code	HCPCS 29583
Hospital Charge Code	9808329
Hospital Revenue Code	510
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$165.84
Rate for Payer: Aetna Commercial	$126.04
Rate for Payer: Aetna Medicare Advantage	$99.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.58
Rate for Payer: Cigna Commercial	$165.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.75
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

APPLY MULTLAY COMPRS UPR ARM

Facility

$331.68

Service Code	HCPCS 29583
Hospital Charge Code	9808329
Hospital Revenue Code	510
Min. Negotiated Rate	$49.75
Max. Negotiated Rate	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$49.75

APPY,DN FR INDICAT PURPS

Facility

$9,108.00

Service Code	HCPCS 44955
Hospital Charge Code	1600000530
Hospital Revenue Code	360
Min. Negotiated Rate	$219.50
Max. Negotiated Rate	$4,554.00
Rate for Payer: Aetna Commercial	$3,461.04
Rate for Payer: Aetna Medicare Advantage	$2,732.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,322.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,322.54
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	$2,322.54
Rate for Payer: Cigna Commercial	$4,554.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,732.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$219.50
Rate for Payer: Wellpoint Medicaid Managed Care	$241.36

APPY,DN FR INDICAT PURPS

Facility

$9,108.00

Service Code	HCPCS 44955
Hospital Charge Code	1600000530
Hospital Revenue Code	360
Min. Negotiated Rate	$1,366.20
Max. Negotiated Rate	$1,366.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.20

APPY,FRR RUPT APNDX W PETONIT

Facility

$10,777.75

Service Code	HCPCS 44960
Hospital Charge Code	16000979
Hospital Revenue Code	360
Min. Negotiated Rate	$1,616.66
Max. Negotiated Rate	$1,616.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.66

APPY,FRR RUPT APNDX W PETONIT

Facility

$10,777.75

Service Code	HCPCS 44960
Hospital Charge Code	16000979
Hospital Revenue Code	360
Min. Negotiated Rate	$259.74
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$4,095.55
Rate for Payer: Aetna Medicare Advantage	$3,233.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,748.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,748.33
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	$2,748.33
Rate for Payer: Cigna Commercial	$5,388.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,233.32
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.66
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$259.74
Rate for Payer: Wellpoint Medicaid Managed Care	$285.61

APRACLONIDINE 0.5% OPSOL 10ML

Facility

$518.52

Hospital Charge Code	606350913
Hospital Revenue Code	250
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$259.26
Rate for Payer: Aetna Commercial	$197.04
Rate for Payer: Aetna Medicare Advantage	$155.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.22
Rate for Payer: Cigna Commercial	$259.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.56
Rate for Payer: Oxford Commercial	$103.70
Rate for Payer: Qualcare PPO/HMO/WC	$77.78
Rate for Payer: UnitedHealthcare Commercial	$103.70
Rate for Payer: UnitedHealthcare Community & State	$12.50
Rate for Payer: Wellpoint Medicaid Managed Care	$13.74

APRACLONIDINE 0.5% OPSOL 10ML

Facility

$518.52

Hospital Charge Code	606350913
Hospital Revenue Code	250
Min. Negotiated Rate	$77.78
Max. Negotiated Rate	$77.78
Rate for Payer: Qualcare PPO/HMO/WC	$77.78

APRACLONIDINE OPH SOL 0.5%

Facility

$46.75

Hospital Charge Code	6011076
Hospital Revenue Code	252
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

APRACLONIDINE OPH SOL 0.5%

Facility

$46.75

Hospital Charge Code	6011076
Hospital Revenue Code	252
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$9.35
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

APREPITANT 125MG CAP

Facility

$1,756.94

Service Code	HCPCS J8501
Hospital Charge Code	6063943056
Hospital Revenue Code	636
Min. Negotiated Rate	$42.34
Max. Negotiated Rate	$878.47
Rate for Payer: Aetna Commercial	$667.64
Rate for Payer: Aetna Medicare Advantage	$527.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.02
Rate for Payer: Cigna Commercial	$878.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.18
Rate for Payer: Qualcare PPO/HMO/WC	$263.54
Rate for Payer: UnitedHealthcare Community & State	$42.34
Rate for Payer: Wellpoint Medicaid Managed Care	$46.56

APREPITANT 125MG CAP

Facility

$1,756.94

Service Code	HCPCS J8501
Hospital Charge Code	6063943056
Hospital Revenue Code	636
Min. Negotiated Rate	$263.54
Max. Negotiated Rate	$425.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.18
Rate for Payer: Qualcare PPO/HMO/WC	$263.54

APREPITANT 80MG CAP

Facility

$1,124.53

Service Code	HCPCS J8501
Hospital Charge Code	6063943057
Hospital Revenue Code	636
Min. Negotiated Rate	$27.10
Max. Negotiated Rate	$562.26
Rate for Payer: Aetna Commercial	$427.32
Rate for Payer: Aetna Medicare Advantage	$337.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.76
Rate for Payer: Cigna Commercial	$562.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.14
Rate for Payer: Qualcare PPO/HMO/WC	$168.68
Rate for Payer: UnitedHealthcare Community & State	$27.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.80

APREPITANT 80MG CAP

Facility

$1,124.53

Service Code	HCPCS J8501
Hospital Charge Code	6063943057
Hospital Revenue Code	636
Min. Negotiated Rate	$168.68
Max. Negotiated Rate	$272.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.14
Rate for Payer: Qualcare PPO/HMO/WC	$168.68

APRESAZIDE 25/25/CAP

Facility

$6.00

Hospital Charge Code	60632475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

APRESAZIDE 25/25/CAP

Facility

$6.00

Hospital Charge Code	60632475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

APRESOLINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60632476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

APRESOLINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60632476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges