Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

M/L TAPER 9 STD

Facility

$15,359.40

Hospital Charge Code	270665070
Hospital Revenue Code	270
Min. Negotiated Rate	$2,303.91
Max. Negotiated Rate	$2,303.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91

M/L TAPER 9 STD

Facility

$15,359.40

Hospital Charge Code	270665070
Hospital Revenue Code	270
Min. Negotiated Rate	$370.16
Max. Negotiated Rate	$7,679.70
Rate for Payer: Aetna Commercial	$5,836.57
Rate for Payer: Aetna Medicare Advantage	$4,607.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,916.65
Rate for Payer: Cigna Commercial	$7,679.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,607.82
Rate for Payer: Oxford Commercial	$3,071.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91
Rate for Payer: UnitedHealthcare Commercial	$3,071.88
Rate for Payer: UnitedHealthcare Community & State	$370.16
Rate for Payer: Wellpoint Medicaid Managed Care	$407.02

M/L TAPR12.5STD RDCD NECK LGTH

Facility

$15,359.40

Hospital Charge Code	270663138
Hospital Revenue Code	278
Min. Negotiated Rate	$370.16
Max. Negotiated Rate	$7,679.70
Rate for Payer: Aetna Commercial	$5,836.57
Rate for Payer: Aetna Medicare Advantage	$4,607.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,916.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,916.65
Rate for Payer: Cigna Commercial	$7,679.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,716.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,379.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91
Rate for Payer: UnitedHealthcare Community & State	$370.16
Rate for Payer: Wellpoint Medicaid Managed Care	$407.02

M/L TAPR12.5STD RDCD NECK LGTH

Facility

$15,359.40

Hospital Charge Code	270663138
Hospital Revenue Code	278
Min. Negotiated Rate	$2,303.91
Max. Negotiated Rate	$3,716.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,071.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,716.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,379.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,303.91

MLTPLE ELIXIR 50ML-INFANT DRPS

Facility

$94.45

Hospital Charge Code	60628977
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$47.23
Rate for Payer: Aetna Commercial	$35.89
Rate for Payer: Aetna Medicare Advantage	$28.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.08
Rate for Payer: Cigna Commercial	$47.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$18.89
Rate for Payer: Qualcare PPO/HMO/WC	$14.17
Rate for Payer: UnitedHealthcare Commercial	$18.89
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

MLTPLE ELIXIR 50ML-INFANT DRPS

Facility

$94.45

Hospital Charge Code	60628977
Hospital Revenue Code	250
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$14.17

MMR/VZV PROFILE,EIA I

Facility

$390.00

Service Code	HCPCS 86735
Hospital Charge Code	39990121A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.50
Rate for Payer: Aetna Medicare Advantage	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.11
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.05
Rate for Payer: Clover Medicare Advantage	$12.40
Rate for Payer: EmblemHealth Commercial	$39.15
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.05
Rate for Payer: Wellcare Medicare Advantage	$13.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MMR/VZV PROFILE,EIA I

Facility

$390.00

Service Code	HCPCS 86735
Hospital Charge Code	39990121A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA II

Facility

$390.00

Service Code	HCPCS 86762
Hospital Charge Code	39990121B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MMR/VZV PROFILE,EIA II

Facility

$390.00

Service Code	HCPCS 86762
Hospital Charge Code	39990121B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.38
Rate for Payer: Aetna Commercial	$89.20
Rate for Payer: Aetna Medicare Advantage	$70.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.86
Rate for Payer: Cigna Commercial	$117.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.22

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$35.21
Max. Negotiated Rate	$56.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$30.21

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: Aetna Medicare Advantage	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.35
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	$51.35
Rate for Payer: Cigna Commercial	$100.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.41
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.21
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$4.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5.34

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$2,802.99
Rate for Payer: Aetna Commercial	$2,130.28
Rate for Payer: Aetna Medicare Advantage	$1,681.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,429.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,429.53
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	$1,429.53
Rate for Payer: Cigna Commercial	$2,802.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$135.10
Rate for Payer: Wellpoint Medicaid Managed Care	$148.56

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$840.90
Max. Negotiated Rate	$840.90
Rate for Payer: Qualcare PPO/HMO/WC	$840.90

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$233.46
Max. Negotiated Rate	$4,843.47
Rate for Payer: Aetna Commercial	$3,681.03
Rate for Payer: Aetna Medicare Advantage	$2,906.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.17
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	$2,470.17
Rate for Payer: Cigna Commercial	$4,843.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,906.08
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$233.46
Rate for Payer: Wellpoint Medicaid Managed Care	$256.70

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,453.04
Max. Negotiated Rate	$1,453.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04

MNTREAS2NDREF IND EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS G0270
Hospital Charge Code	3016G0270
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

MNTREAS2NDREF IND EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS G0270
Hospital Charge Code	3016G0270
Hospital Revenue Code	942
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

MNTREASS2NDREF GROUP 30MIN

Facility

$2,700.00

Service Code	HCPCS G0271
Hospital Charge Code	3016G0271
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

Know your out-of-pocket cost for care.

All Charges