Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MANUAL THRPY EACH 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008105
Hospital Revenue Code	420
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

MAPPING OF SENTINEL LYMPH NODE

Facility

$3,482.00

Service Code	HCPCS 38900
Hospital Charge Code	16000431
Hospital Revenue Code	360
Min. Negotiated Rate	$83.92
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,323.16
Rate for Payer: Aetna Medicare Advantage	$1,044.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.91
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	$887.91
Rate for Payer: Cigna Commercial	$1,741.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,044.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$522.30
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$83.92
Rate for Payer: Wellpoint Medicaid Managed Care	$92.27

MAPPING OF SENTINEL LYMPH NODE

Facility

$3,482.00

Service Code	HCPCS 38900
Hospital Charge Code	16000431
Hospital Revenue Code	360
Min. Negotiated Rate	$522.30
Max. Negotiated Rate	$522.30
Rate for Payer: Qualcare PPO/HMO/WC	$522.30

MAPROTILINE #S06***

Facility

$116.00

Hospital Charge Code	3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.08
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

MAPROTILINE #S06***

Facility

$116.00

Hospital Charge Code	3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

MAPROTILINE TAB 25MG

Facility

$4.50

Hospital Charge Code	60628641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

MAPROTILINE TAB 25MG

Facility

$4.50

Hospital Charge Code	60628641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

MAPROTILINE/VAPROTILINE (HPLC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3000783
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

MAPROTILINE/VAPROTILINE (HPLC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3000783
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

MAQUET QUADROX OXYGENATOR

Facility

$7,962.45

Hospital Charge Code	2703110A
Hospital Revenue Code	272
Min. Negotiated Rate	$1,194.37
Max. Negotiated Rate	$1,194.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.37

MAQUET QUADROX OXYGENATOR

Facility

$7,962.45

Hospital Charge Code	2703110A
Hospital Revenue Code	272
Min. Negotiated Rate	$191.90
Max. Negotiated Rate	$3,981.22
Rate for Payer: Aetna Commercial	$3,025.73
Rate for Payer: Aetna Medicare Advantage	$2,388.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,030.42
Rate for Payer: Cigna Commercial	$3,981.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,388.74
Rate for Payer: Oxford Commercial	$1,592.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.37
Rate for Payer: UnitedHealthcare Commercial	$1,592.49
Rate for Payer: UnitedHealthcare Community & State	$191.90
Rate for Payer: Wellpoint Medicaid Managed Care	$211.00

MARCAINE 0.25% 10ML

Facility

$12.93

Service Code	NDC 409115901
Hospital Charge Code	606350928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.88
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

MARCAINE 0.25% 10ML

Facility

$12.93

Service Code	NDC 409115901
Hospital Charge Code	606350928
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

MARCAINE 0.25% W/EPI/50ML

Facility

$48.00

Hospital Charge Code	60633354
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

MARCAINE 0.25% W/EPI/50ML

Facility

$48.00

Hospital Charge Code	60633354
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

MARCAINE 0.5% 10ML VIAL

Facility

$25.19

Service Code	NDC 409156010
Hospital Charge Code	606350953
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

MARCAINE 0.5% 10ML VIAL

Facility

$25.19

Service Code	NDC 409156010
Hospital Charge Code	606350953
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$9.57
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.56
Rate for Payer: Oxford Commercial	$5.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$5.04
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

MARCAINE 0.5% 50ML

Facility

$33.77

Service Code	NDC 409161050
Hospital Charge Code	6063943295
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.07

MARCAINE 0.5% 50ML

Facility

$33.77

Service Code	NDC 409161050
Hospital Charge Code	6063943295
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.89
Rate for Payer: Aetna Commercial	$12.83
Rate for Payer: Aetna Medicare Advantage	$10.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.61
Rate for Payer: Cigna Commercial	$16.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.13
Rate for Payer: Oxford Commercial	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.07
Rate for Payer: UnitedHealthcare Commercial	$6.75
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

MARCAINE.25%W EPI1:200000 50ML

Facility

$53.27

Service Code	NDC 409381201
Hospital Charge Code	606390545
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.64
Rate for Payer: Aetna Commercial	$20.24
Rate for Payer: Aetna Medicare Advantage	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.58
Rate for Payer: Cigna Commercial	$26.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.98
Rate for Payer: Oxford Commercial	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.99
Rate for Payer: UnitedHealthcare Commercial	$10.65
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

MARCAINE.25%W EPI1:200000 50ML

Facility

$53.27

Service Code	NDC 409381201
Hospital Charge Code	606390545
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$7.99

MARCAINE/DEXTROSE

Facility

$8.64

Hospital Charge Code	60635813
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

MARCAINE/DEXTROSE

Facility

$8.64

Hospital Charge Code	60635813
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

MARCAINE W EPI 0.5% 1 200000

Facility

$25.46

Service Code	NDC 409174910
Hospital Charge Code	606380002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.82

MARCAINE W EPI 0.5% 1 200000

Facility

$25.46

Service Code	NDC 409174910
Hospital Charge Code	606380002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$9.67
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.49
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.64
Rate for Payer: Oxford Commercial	$5.09
Rate for Payer: Qualcare PPO/HMO/WC	$3.82
Rate for Payer: UnitedHealthcare Commercial	$5.09
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

Know your out-of-pocket cost for care.

All Charges