Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BACK/SEAT SECTION TLT PADS

Facility

$2,528.05

Hospital Charge Code	270656356
Hospital Revenue Code	272
Min. Negotiated Rate	$379.21
Max. Negotiated Rate	$379.21
Rate for Payer: Qualcare PPO/HMO/WC	$379.21

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.28
Rate for Payer: Aetna Commercial	$6.29
Rate for Payer: Aetna Medicare Advantage	$4.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.22
Rate for Payer: Cigna Commercial	$8.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.96
Rate for Payer: Oxford Commercial	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.48
Rate for Payer: UnitedHealthcare Commercial	$3.31
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

BACLOFEN 20 MG TAB

Facility

$8.71

Service Code	NDC 63739048010
Hospital Charge Code	60627478
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

BACLOFEN 20 MG TAB

Facility

$8.71

Service Code	NDC 63739048010
Hospital Charge Code	60627478
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.61
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$23,107.17

Service Code	APR-DRG 0492
Min. Negotiated Rate	$22,654.09
Max. Negotiated Rate	$23,107.17
Rate for Payer: UnitedHealthcare Community & State	$22,654.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,107.17
Rate for Payer: Wellpoint Medicaid Managed Care	$22,654.09

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$10,848.19

Service Code	APR-DRG 0491
Min. Negotiated Rate	$10,635.48
Max. Negotiated Rate	$10,848.19
Rate for Payer: UnitedHealthcare Community & State	$10,635.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,848.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10,635.48

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$25,631.20

Service Code	APR-DRG 0493
Min. Negotiated Rate	$25,128.63
Max. Negotiated Rate	$25,631.20
Rate for Payer: UnitedHealthcare Community & State	$25,128.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,631.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25,128.63

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$42,150.53

Service Code	APR-DRG 0494
Min. Negotiated Rate	$41,324.05
Max. Negotiated Rate	$42,150.53
Rate for Payer: UnitedHealthcare Community & State	$41,324.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,150.53
Rate for Payer: Wellpoint Medicaid Managed Care	$41,324.05

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$85,498.08

Service Code	MSDRG 095
Min. Negotiated Rate	$26,033.07
Max. Negotiated Rate	$85,498.08
Rate for Payer: Aetna Medicare Advantage	$85,498.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,361.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,361.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,403.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,361.18
Rate for Payer: Cigna Commercial	$48,267.15
Rate for Payer: Cigna Medicare Advantage	$27,403.23
Rate for Payer: Clover Medicare Advantage	$26,033.07
Rate for Payer: EmblemHealth Commercial	$82,209.69
Rate for Payer: Humana Medicare Advantage	$28,225.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,403.23
Rate for Payer: Oxford Commercial	$34,690.24
Rate for Payer: UnitedHealthcare Commercial	$60,830.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,403.23
Rate for Payer: Wellcare Medicare Advantage	$27,403.23

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$115,886.91

Service Code	MSDRG 094
Min. Negotiated Rate	$35,286.08
Max. Negotiated Rate	$115,886.91
Rate for Payer: Aetna Medicare Advantage	$115,886.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84,204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84,204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37,143.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84,204.82
Rate for Payer: Cigna Commercial	$65,862.05
Rate for Payer: Cigna Medicare Advantage	$37,143.24
Rate for Payer: Clover Medicare Advantage	$35,286.08
Rate for Payer: EmblemHealth Commercial	$111,429.72
Rate for Payer: Humana Medicare Advantage	$38,257.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37,143.24
Rate for Payer: Oxford Commercial	$47,335.93
Rate for Payer: UnitedHealthcare Commercial	$83,005.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$37,143.24
Rate for Payer: Wellcare Medicare Advantage	$37,143.24

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$85,498.08

Service Code	MSDRG 096
Min. Negotiated Rate	$26,033.07
Max. Negotiated Rate	$85,498.08
Rate for Payer: Aetna Medicare Advantage	$85,498.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,708.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,708.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,403.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,708.98
Rate for Payer: Cigna Commercial	$48,267.15
Rate for Payer: Cigna Medicare Advantage	$27,403.23
Rate for Payer: Clover Medicare Advantage	$26,033.07
Rate for Payer: EmblemHealth Commercial	$82,209.69
Rate for Payer: Humana Medicare Advantage	$28,225.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,403.23
Rate for Payer: Oxford Commercial	$34,690.24
Rate for Payer: UnitedHealthcare Commercial	$60,830.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,403.23
Rate for Payer: Wellcare Medicare Advantage	$27,403.23

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$34.63
Rate for Payer: Aetna Medicare Advantage	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.95
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Humana Medicare Advantage	$13.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.73
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	$10.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526C
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

BACTERIAL ANTIGENS ALL SOURCES

Facility

$75.65

Service Code	HCPCS 87802
Hospital Charge Code	3006526A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.63
Rate for Payer: Aetna Medicare Advantage	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.95
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Humana Medicare Advantage	$13.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

BACTERIAL ANTIGENS ALL SOURCES

Facility

$75.65

Service Code	HCPCS 87802
Hospital Charge Code	3006526A
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

Know your out-of-pocket cost for care.

All Charges