Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PAROXETINE TAB 40MG

Facility

$14.75

Hospital Charge Code	60629032
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

PAROXETINE TAB 40MG

Facility

$14.75

Hospital Charge Code	60629032
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

PART EXC BONE; DISTAL PHALANX

Facility

$17,164.20

Service Code	HCPCS 26236
Hospital Charge Code	16000555
Hospital Revenue Code	360
Min. Negotiated Rate	$413.66
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	$5,149.26
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$413.66
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	$454.85

PART EXC BONE; DISTAL PHALANX

Facility

$17,164.20

Service Code	HCPCS 26236
Hospital Charge Code	16000555
Hospital Revenue Code	360
Min. Negotiated Rate	$2,574.63
Max. Negotiated Rate	$2,574.63
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63

PARTIAL CARE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84517027
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PARTIAL CARE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84511027
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PARTIAL CARE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84511027
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PARTIAL CARE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84517027
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PARTIAL CARE GROUP

Facility

$433.40

Service Code	HCPCS 90853
Hospital Charge Code	84518027
Hospital Revenue Code	915
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.02
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

PARTIAL CARE GROUP

Facility

$433.40

Service Code	HCPCS 90853
Hospital Charge Code	84518027
Hospital Revenue Code	915
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

PARTIAL CARE GROUP NON MCAID

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84509027
Hospital Revenue Code	912
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PARTIAL CARE GROUP NON MCAID

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84509027
Hospital Revenue Code	912
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PARTIAL CARE GROUP W/MD

Facility

$367.85

Service Code	HCPCS 90853
Hospital Charge Code	87504070
Hospital Revenue Code	915
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

PARTIAL CARE GROUP W/MD

Facility

$367.85

Service Code	HCPCS 90853
Hospital Charge Code	87504070
Hospital Revenue Code	915
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PARTIAL CARE GROUP W/NON MD

Facility

$367.85

Service Code	HCPCS 90853
Hospital Charge Code	87504075
Hospital Revenue Code	915
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

PARTIAL CARE GROUP W/NON MD

Facility

$367.85

Service Code	HCPCS 90853
Hospital Charge Code	87504075
Hospital Revenue Code	915
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PARTIAL CARE INDIV MD 20-30MIN

Facility

$409.00

Service Code	HCPCS 90817
Hospital Charge Code	84310040
Hospital Revenue Code	912
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

PARTIAL CARE INDIV MD 20-30MIN

Facility

$409.00

Service Code	HCPCS 90817
Hospital Charge Code	84310040
Hospital Revenue Code	912
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

PARTIAL CARE IND/NON MD 20-30M

Facility

$409.00

Service Code	HCPCS 90816
Hospital Charge Code	84310035
Hospital Revenue Code	912
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

PARTIAL CARE IND/NON MD 20-30M

Facility

$409.00

Service Code	HCPCS 90816
Hospital Charge Code	84310035
Hospital Revenue Code	912
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

PARTIAL CARE IND/NON MD 45-50M

Facility

$563.00

Service Code	HCPCS 90818
Hospital Charge Code	84310045
Hospital Revenue Code	912
Min. Negotiated Rate	$84.45
Max. Negotiated Rate	$84.45
Rate for Payer: Qualcare PPO/HMO/WC	$84.45

PARTIAL CARE IND/NON MD 45-50M

Facility

$563.00

Service Code	HCPCS 90818
Hospital Charge Code	84310045
Hospital Revenue Code	912
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$281.50
Rate for Payer: Aetna Commercial	$213.94
Rate for Payer: Aetna Medicare Advantage	$168.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.56
Rate for Payer: Cigna Commercial	$281.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.45
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

PARTIAL CARE INDV MD 45-50 MIN

Facility

$596.00

Service Code	HCPCS 90819
Hospital Charge Code	84310050
Hospital Revenue Code	912
Min. Negotiated Rate	$89.40
Max. Negotiated Rate	$89.40
Rate for Payer: Qualcare PPO/HMO/WC	$89.40

PARTIAL CARE INDV MD 45-50 MIN

Facility

$596.00

Service Code	HCPCS 90819
Hospital Charge Code	84310050
Hospital Revenue Code	912
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$298.00
Rate for Payer: Aetna Commercial	$226.48
Rate for Payer: Aetna Medicare Advantage	$178.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.98
Rate for Payer: Cigna Commercial	$298.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$89.40
Rate for Payer: UnitedHealthcare Community & State	$14.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.79

PARTIAL CARE MULTI-FAMILY

Facility

$336.35

Service Code	HCPCS 90849
Hospital Charge Code	84310110
Hospital Revenue Code	912
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$50.45
Rate for Payer: Qualcare PPO/HMO/WC	$50.45

Know your out-of-pocket cost for care.

All Charges