Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$18,076.90

Service Code	APR-DRG 9303
Min. Negotiated Rate	$17,722.45
Max. Negotiated Rate	$18,076.90
Rate for Payer: UnitedHealthcare Community & State	$17,722.45
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,076.90
Rate for Payer: Wellpoint Medicaid Managed Care	$17,722.45

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$9,631.50

Service Code	APR-DRG 9301
Min. Negotiated Rate	$9,442.65
Max. Negotiated Rate	$9,631.50
Rate for Payer: UnitedHealthcare Community & State	$9,442.65
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,631.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9,442.65

MULTIPLE SLEEP LATENCY - MSLT

Facility

$1,915.25

Service Code	HCPCS 95805
Hospital Charge Code	9501280
Hospital Revenue Code	920
Min. Negotiated Rate	$46.16
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,373.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.58
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$287.29
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$46.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$50.75

MULTIPLE SLEEP LATENCY - MSLT

Facility

$1,915.25

Service Code	HCPCS 95805
Hospital Charge Code	9501280
Hospital Revenue Code	920
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$287.29
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

MULTIPLE VITAMINS INJ 10 ML

Facility

$59.09

Service Code	NDC 54643564901
Hospital Charge Code	6012876
Hospital Revenue Code	250
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$8.86
Rate for Payer: Qualcare PPO/HMO/WC	$8.86

MULTIPLE VITAMINS INJ 10 ML

Facility

$59.09

Service Code	NDC 54643564901
Hospital Charge Code	6012876
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.55
Rate for Payer: Aetna Commercial	$22.45
Rate for Payer: Aetna Medicare Advantage	$17.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.07
Rate for Payer: Cigna Commercial	$29.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.73
Rate for Payer: Oxford Commercial	$11.82
Rate for Payer: Qualcare PPO/HMO/WC	$8.86
Rate for Payer: UnitedHealthcare Commercial	$11.82
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.57

MULTIPLE VITAMINS LIQ

Facility

$241.20

Service Code	NDC 54838000870
Hospital Charge Code	60628501
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna Commercial	$91.66
Rate for Payer: Aetna Medicare Advantage	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.51
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$48.24
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$48.24
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

MULTIPLE VITAMINS LIQ

Facility

$241.20

Service Code	NDC 54838000870
Hospital Charge Code	60628501
Hospital Revenue Code	250
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

MULTIPODUS BOOT L

Facility

$530.95

Hospital Charge Code	270665976
Hospital Revenue Code	270
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$265.48
Rate for Payer: Aetna Commercial	$201.76
Rate for Payer: Aetna Medicare Advantage	$159.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.39
Rate for Payer: Cigna Commercial	$265.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.28
Rate for Payer: Oxford Commercial	$106.19
Rate for Payer: Qualcare PPO/HMO/WC	$79.64
Rate for Payer: UnitedHealthcare Commercial	$106.19
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.07

MULTIPODUS BOOT L

Facility

$530.95

Hospital Charge Code	270665976
Hospital Revenue Code	270
Min. Negotiated Rate	$79.64
Max. Negotiated Rate	$79.64
Rate for Payer: Qualcare PPO/HMO/WC	$79.64

MULTIPODUS BOOT MED.

Facility

$598.80

Hospital Charge Code	270669589
Hospital Revenue Code	274
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$299.40
Rate for Payer: Aetna Commercial	$227.54
Rate for Payer: Aetna Medicare Advantage	$179.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.69
Rate for Payer: Cigna Commercial	$299.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$131.74
Rate for Payer: Qualcare PPO/HMO/WC	$89.82
Rate for Payer: UnitedHealthcare Community & State	$14.43
Rate for Payer: Wellpoint Medicaid Managed Care	$15.87

MULTIPODUS BOOT MED.

Facility

$598.80

Hospital Charge Code	270669589
Hospital Revenue Code	274
Min. Negotiated Rate	$89.82
Max. Negotiated Rate	$144.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$131.74
Rate for Payer: Qualcare PPO/HMO/WC	$89.82

MULTIPOLAR BIPOLAR CUP SHELL

Facility

$2,256.50

Hospital Charge Code	270657038
Hospital Revenue Code	278
Min. Negotiated Rate	$54.38
Max. Negotiated Rate	$1,128.25
Rate for Payer: Aetna Commercial	$857.47
Rate for Payer: Aetna Medicare Advantage	$676.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.41
Rate for Payer: Cigna Commercial	$1,128.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.43
Rate for Payer: Qualcare PPO/HMO/WC	$338.48
Rate for Payer: UnitedHealthcare Community & State	$54.38
Rate for Payer: Wellpoint Medicaid Managed Care	$59.80

MULTIPOLAR BIPOLAR CUP SHELL

Facility

$2,256.50

Hospital Charge Code	270657038
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$546.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.43
Rate for Payer: Qualcare PPO/HMO/WC	$338.48

MULTIVITAMIN10 1 VIAL

Facility

$84.00

Hospital Charge Code	60628500
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

MULTIVITAMIN10 1 VIAL

Facility

$84.00

Hospital Charge Code	60628500
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

MULTIVITAMIN AND IRON DROPS

Facility

$4.00

Service Code	NDC 536853080
Hospital Charge Code	6063943217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MULTIVITAMIN AND IRON DROPS

Facility

$4.00

Service Code	NDC 536853080
Hospital Charge Code	6063943217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MULTIVITAMINS ROWELL/CAP

Facility

$3.00

Hospital Charge Code	60633466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MULTIVITAMINS ROWELL/CAP

Facility

$3.00

Hospital Charge Code	60633466
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

MULTIVITAMIN WITH MINERALS TAB

Facility

$4.00

Service Code	NDC 904549261
Hospital Charge Code	60628509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MULTIVITAMIN WITH MINERALS TAB

Facility

$4.00

Service Code	NDC 904549261
Hospital Charge Code	60628509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MULTIVIT CONCENTR 5ML

Facility

$11.25

Hospital Charge Code	60628661
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

MULTIVIT CONCENTR 5ML

Facility

$11.25

Hospital Charge Code	60628661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

MULTIVIT LIQ 5ML

Facility

$3.20

Hospital Charge Code	6023345
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

Know your out-of-pocket cost for care.

All Charges