Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NA,URINE RANDOM

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38479039
Hospital Revenue Code	301
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

NA,URINE RANDOM

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38479039
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

NAVANE/10MG/CAP

Facility

$5.00

Hospital Charge Code	60633508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NAVANE/10MG/CAP

Facility

$5.00

Hospital Charge Code	60633508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NAVANE/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633509
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

NAVANE/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NAVANE/2MG/CAP

Facility

$3.00

Hospital Charge Code	60633507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NAVANE/2MG/CAP

Facility

$3.00

Hospital Charge Code	60633507
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

NAVANE/5MG

Facility

$13.00

Hospital Charge Code	60633510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

NAVANE/5MG

Facility

$13.00

Hospital Charge Code	60633510
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

NAVANE/5MG/1ML

Facility

$127.00

Hospital Charge Code	60633505
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

NAVANE/5MG/1ML

Facility

$127.00

Hospital Charge Code	60633505
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

NAVANE/5MG/CAP

Facility

$5.00

Hospital Charge Code	60633506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NAVANE/5MG/CAP

Facility

$5.00

Hospital Charge Code	60633506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NAVELBINE 10MG

Facility

$1,483.00

Hospital Charge Code	60635009
Hospital Revenue Code	636
Min. Negotiated Rate	$222.45
Max. Negotiated Rate	$358.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.89
Rate for Payer: Qualcare PPO/HMO/WC	$222.45

NAVELBINE 10MG

Facility

$1,483.00

Hospital Charge Code	60635009
Hospital Revenue Code	636
Min. Negotiated Rate	$35.74
Max. Negotiated Rate	$741.50
Rate for Payer: Aetna Commercial	$563.54
Rate for Payer: Aetna Medicare Advantage	$444.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.17
Rate for Payer: Cigna Commercial	$741.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.89
Rate for Payer: Qualcare PPO/HMO/WC	$222.45
Rate for Payer: UnitedHealthcare Community & State	$35.74
Rate for Payer: Wellpoint Medicaid Managed Care	$39.30

NAVIFLEX RX DELIVERY SYS 10FR

Facility

$404.90

Hospital Charge Code	270675437
Hospital Revenue Code	272
Min. Negotiated Rate	$60.73
Max. Negotiated Rate	$60.73
Rate for Payer: Qualcare PPO/HMO/WC	$60.73

NAVIFLEX RX DELIVERY SYS 10FR

Facility

$404.90

Hospital Charge Code	270675437
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.45
Rate for Payer: Aetna Commercial	$153.86
Rate for Payer: Aetna Medicare Advantage	$121.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.25
Rate for Payer: Cigna Commercial	$202.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.47
Rate for Payer: Oxford Commercial	$80.98
Rate for Payer: Qualcare PPO/HMO/WC	$60.73
Rate for Payer: UnitedHealthcare Commercial	$80.98
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

NAVI FLEX RX DELIVERY SYST10FR

Facility

$405.90

Hospital Charge Code	270659233
Hospital Revenue Code	272
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$202.95
Rate for Payer: Aetna Commercial	$154.24
Rate for Payer: Aetna Medicare Advantage	$121.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.50
Rate for Payer: Cigna Commercial	$202.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.77
Rate for Payer: Oxford Commercial	$81.18
Rate for Payer: Qualcare PPO/HMO/WC	$60.88
Rate for Payer: UnitedHealthcare Commercial	$81.18
Rate for Payer: UnitedHealthcare Community & State	$9.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

NAVI FLEX RX DELIVERY SYST10FR

Facility

$405.90

Hospital Charge Code	270659233
Hospital Revenue Code	272
Min. Negotiated Rate	$60.88
Max. Negotiated Rate	$60.88
Rate for Payer: Qualcare PPO/HMO/WC	$60.88

NAVIFLEX RX DELIVERY SYSTEM

Facility

$405.90

Hospital Charge Code	270675172
Hospital Revenue Code	272
Min. Negotiated Rate	$60.88
Max. Negotiated Rate	$60.88
Rate for Payer: Qualcare PPO/HMO/WC	$60.88

NAVIFLEX RX DELIVERY SYSTEM

Facility

$405.90

Hospital Charge Code	270675172
Hospital Revenue Code	272
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$202.95
Rate for Payer: Aetna Commercial	$154.24
Rate for Payer: Aetna Medicare Advantage	$121.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.50
Rate for Payer: Cigna Commercial	$202.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.77
Rate for Payer: Oxford Commercial	$81.18
Rate for Payer: Qualcare PPO/HMO/WC	$60.88
Rate for Payer: UnitedHealthcare Commercial	$81.18
Rate for Payer: UnitedHealthcare Community & State	$9.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

NAVIFLEX RX DELIVERY SYSTM 7FR

Facility

$405.90

Hospital Charge Code	270659227
Hospital Revenue Code	272
Min. Negotiated Rate	$60.88
Max. Negotiated Rate	$60.88
Rate for Payer: Qualcare PPO/HMO/WC	$60.88

NAVIFLEX RX DELIVERY SYSTM 7FR

Facility

$405.90

Hospital Charge Code	270659227
Hospital Revenue Code	272
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$202.95
Rate for Payer: Aetna Commercial	$154.24
Rate for Payer: Aetna Medicare Advantage	$121.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.50
Rate for Payer: Cigna Commercial	$202.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.77
Rate for Payer: Oxford Commercial	$81.18
Rate for Payer: Qualcare PPO/HMO/WC	$60.88
Rate for Payer: UnitedHealthcare Commercial	$81.18
Rate for Payer: UnitedHealthcare Community & State	$9.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

NAVIGATION LANTERN ASSIST DEV

Facility

$6,000.00

Hospital Charge Code	270694804
Hospital Revenue Code	271
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges