Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEANUT ENDOSCOPIC DEVICE 5MM

Facility

$99.75

Hospital Charge Code	270660429
Hospital Revenue Code	272
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$14.96
Rate for Payer: Qualcare PPO/HMO/WC	$14.96

PEANUT (F13) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900353
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PEANUT (F13) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900353
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PEANUTS 16

Facility

$141.65

Hospital Charge Code	270608412
Hospital Revenue Code	270
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PEANUTS 16

Facility

$141.65

Hospital Charge Code	270608412
Hospital Revenue Code	270
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$70.83
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$28.33
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$28.33
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

PECA 4X30MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705984
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$2,225.00
Rate for Payer: Aetna Commercial	$1,691.00
Rate for Payer: Aetna Medicare Advantage	$1,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.75
Rate for Payer: Cigna Commercial	$2,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50
Rate for Payer: UnitedHealthcare Community & State	$107.25
Rate for Payer: Wellpoint Medicaid Managed Care	$117.92

PECA 4X30MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705984
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$1,076.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50

PECA 4X42MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705983
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$2,225.00
Rate for Payer: Aetna Commercial	$1,691.00
Rate for Payer: Aetna Medicare Advantage	$1,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.75
Rate for Payer: Cigna Commercial	$2,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50
Rate for Payer: UnitedHealthcare Community & State	$107.25
Rate for Payer: Wellpoint Medicaid Managed Care	$117.92

PECA 4X42MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705983
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$1,076.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50

PECTIN/GEL ORAL OINT 5GM

Facility

$21.15

Hospital Charge Code	6004089
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PECTIN/GEL ORAL OINT 5GM

Facility

$21.15

Hospital Charge Code	6004089
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$203.30
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,530.64
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$203.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$223.54

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,265.32
Max. Negotiated Rate	$1,265.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

PEDIALYTE SOL .237ML

Facility

$17.95

Hospital Charge Code	6027155
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PEDIALYTE SOL .237ML

Facility

$17.95

Hospital Charge Code	6027155
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

PEDIAPRED/6.7MG/5ML

Facility

$21.00

Hospital Charge Code	60633617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PEDIAPRED/6.7MG/5ML

Facility

$21.00

Hospital Charge Code	60633617
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$108.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$223.68
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna Medicare Advantage	$134.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.08
Rate for Payer: Cigna Commercial	$223.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10
Rate for Payer: UnitedHealthcare Community & State	$10.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.86

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$84.54
Max. Negotiated Rate	$84.54
Rate for Payer: Qualcare PPO/HMO/WC	$84.54

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$281.80
Rate for Payer: Aetna Commercial	$214.17
Rate for Payer: Aetna Medicare Advantage	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.72
Rate for Payer: Cigna Commercial	$281.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.08
Rate for Payer: Oxford Commercial	$112.72
Rate for Payer: Qualcare PPO/HMO/WC	$84.54
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Community & State	$13.58
Rate for Payer: Wellpoint Medicaid Managed Care	$14.94

PEDIASURE

Facility

$5.00

Hospital Charge Code	60634856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PEDIASURE

Facility

$5.00

Hospital Charge Code	60634856
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

Know your out-of-pocket cost for care.

All Charges