Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OPIATES,URINE

Facility

$190.00

Service Code	HCPCS 80300
Hospital Charge Code	38479112
Hospital Revenue Code	301
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

OPIATES,URINE

Facility

$190.00

Service Code	HCPCS 80300
Hospital Charge Code	38479112
Hospital Revenue Code	301
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

OP INC FINGER FLEXOR

Facility

$6,353.16

Service Code	HCPCS 26455
Hospital Charge Code	16000446
Hospital Revenue Code	360
Min. Negotiated Rate	$153.11
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.95
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$952.97
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$153.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$168.36

OP INC FINGER FLEXOR

Facility

$6,353.16

Service Code	HCPCS 26455
Hospital Charge Code	16000446
Hospital Revenue Code	360
Min. Negotiated Rate	$952.97
Max. Negotiated Rate	$952.97
Rate for Payer: Qualcare PPO/HMO/WC	$952.97

OP INC FOOT/TOE EXTENSOR TENDN

Facility

$19,998.60

Service Code	HCPCS 28234
Hospital Charge Code	16000481
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

OP INC FOOT/TOE EXTENSOR TENDN

Facility

$19,998.60

Service Code	HCPCS 28234
Hospital Charge Code	16000481
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

OPIOID ABUSE AND DEPENDENCE

Facility

$5,164.28

Service Code	APR-DRG 7732
Min. Negotiated Rate	$5,063.02
Max. Negotiated Rate	$5,164.28
Rate for Payer: UnitedHealthcare Community & State	$5,063.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,164.28
Rate for Payer: Wellpoint Medicaid Managed Care	$5,063.02

OPIOID ABUSE AND DEPENDENCE

Facility

$9,738.72

Service Code	APR-DRG 7733
Min. Negotiated Rate	$9,547.76
Max. Negotiated Rate	$9,738.72
Rate for Payer: UnitedHealthcare Community & State	$9,547.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,738.72
Rate for Payer: Wellpoint Medicaid Managed Care	$9,547.76

OPIOID ABUSE AND DEPENDENCE

Facility

$22,471.32

Service Code	APR-DRG 7734
Min. Negotiated Rate	$22,030.71
Max. Negotiated Rate	$22,471.32
Rate for Payer: UnitedHealthcare Community & State	$22,030.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,471.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22,030.71

OPIOID ABUSE AND DEPENDENCE

Facility

$3,583.75

Service Code	APR-DRG 7731
Min. Negotiated Rate	$3,513.48
Max. Negotiated Rate	$3,583.75
Rate for Payer: UnitedHealthcare Community & State	$3,513.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$3,583.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3,513.48

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	3039033
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	39990233
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	39990233
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	38430033
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	38430033
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOID &OPIATE ANALOG 5/MORE

Facility

$190.45

Service Code	HCPCS 80364
Hospital Charge Code	3039033
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	38430031
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	39990231
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	38430031
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	3039031
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	3039031
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOIDS & OPIATE ANALOGS 1/2

Facility

$190.45

Service Code	HCPCS 80362
Hospital Charge Code	39990231
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOIDS & OPIATE ANALOGS 3/4

Facility

$190.45

Service Code	HCPCS 80363
Hospital Charge Code	38430032
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIOIDS & OPIATE ANALOGS 3/4

Facility

$190.45

Service Code	HCPCS 80363
Hospital Charge Code	38430032
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

OPIOIDS & OPIATE ANALOGS 3/4

Facility

$190.45

Service Code	HCPCS 80363
Hospital Charge Code	3039032
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

Know your out-of-pocket cost for care.

All Charges