Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Memory Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9169GNCJ
Hospital Charge Code	74204079CJ
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Memory Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9169GNCJ
Hospital Charge Code	74204079CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Memory Goal Status CK

Facility

$0.01

Service Code	HCPCS G9169GNCK
Hospital Charge Code	74204079CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Memory Goal Status CK

Facility

$0.01

Service Code	HCPCS G9169GNCK
Hospital Charge Code	74204079CK
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9169GNCL
Hospital Charge Code	74204079CL
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9169GNCL
Hospital Charge Code	74204079CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9169GNCM
Hospital Charge Code	74204079CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9169GNCM
Hospital Charge Code	74204079CM
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9169GNCN
Hospital Charge Code	74204079CN
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9169GNCN
Hospital Charge Code	74204079CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Memory Goal Status M

Facility

$0.01

Hospital Charge Code	74204079M
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Memory Goal Status M

Facility

$0.01

Hospital Charge Code	74204079M
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY SOFT WIRE BASKET

Facility

$191.00

Hospital Charge Code	270325611
Hospital Revenue Code	272
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$72.58
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.30
Rate for Payer: Oxford Commercial	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$38.20
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

MEMORY SOFT WIRE BASKET

Facility

$191.00

Hospital Charge Code	270325611
Hospital Revenue Code	272
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

MEN2/FMTC EXON 10,11,13-16 I

Facility

$2,375.00

Service Code	HCPCS 81404
Hospital Charge Code	39990160A
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$747.54
Rate for Payer: Aetna Medicare Advantage	$890.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$992.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$992.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$274.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$992.05
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$274.83
Rate for Payer: Clover Medicare Advantage	$261.09
Rate for Payer: EmblemHealth Commercial	$824.49
Rate for Payer: Humana Medicare Advantage	$283.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$274.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$219.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$274.83
Rate for Payer: Wellcare Medicare Advantage	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

MEN2/FMTC EXON 10,11,13-16 I

Facility

$2,375.00

Service Code	HCPCS 81404
Hospital Charge Code	39990160A
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

MEN2/FMTC EXON 10,11,13-16 II

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39990160B
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

MEN2/FMTC EXON 10,11,13-16 II

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39990160B
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,087.78
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

MENACTRA

Facility

$706.78

Service Code	HCPCS 90734
Hospital Charge Code	83652581
Hospital Revenue Code	636
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$171.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.04
Rate for Payer: Qualcare PPO/HMO/WC	$106.02

MENACTRA

Facility

$706.78

Service Code	HCPCS 90734
Hospital Charge Code	83652581
Hospital Revenue Code	636
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$353.39
Rate for Payer: Aetna Commercial	$268.58
Rate for Payer: Aetna Medicare Advantage	$212.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.23
Rate for Payer: Cigna Commercial	$353.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.04
Rate for Payer: Qualcare PPO/HMO/WC	$106.02
Rate for Payer: UnitedHealthcare Community & State	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$18.73

MENACTRA(MENINGOCOCCAL) VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	83652579
Hospital Revenue Code	636
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$50.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MENACTRA(MENINGOCOCCAL) VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	83652579
Hospital Revenue Code	636
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

MENADIOL SOD DPH INJ 10MG/ML

Facility

$21.15

Hospital Charge Code	6003453
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

MENADIOL SOD DPH INJ 10MG/ML

Facility

$21.15

Hospital Charge Code	6003453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

MENADIOL SOD DPH INJ 75MG/2ML

Facility

$34.60

Hospital Charge Code	6003446
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

Know your out-of-pocket cost for care.

All Charges