Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.54
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

PEPTAMEN

Facility

$71.00

Hospital Charge Code	60634857
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

PEPTAMEN

Facility

$71.00

Hospital Charge Code	60634857
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PEPTIC ULCER AND GASTRITIS

Facility

$13,794.84

Service Code	APR-DRG 2413
Min. Negotiated Rate	$13,524.35
Max. Negotiated Rate	$13,794.84
Rate for Payer: UnitedHealthcare Community & State	$13,524.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,794.84
Rate for Payer: Wellpoint Medicaid Managed Care	$13,524.35

PEPTIC ULCER AND GASTRITIS

Facility

$26,584.89

Service Code	APR-DRG 2414
Min. Negotiated Rate	$26,063.62
Max. Negotiated Rate	$26,584.89
Rate for Payer: UnitedHealthcare Community & State	$26,063.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,584.89
Rate for Payer: Wellpoint Medicaid Managed Care	$26,063.62

PEPTIC ULCER AND GASTRITIS

Facility

$9,387.64

Service Code	APR-DRG 2412
Min. Negotiated Rate	$9,203.57
Max. Negotiated Rate	$9,387.64
Rate for Payer: UnitedHealthcare Community & State	$9,203.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,387.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9,203.57

PEPTIC ULCER AND GASTRITIS

Facility

$7,582.36

Service Code	APR-DRG 2411
Min. Negotiated Rate	$7,433.69
Max. Negotiated Rate	$7,582.36
Rate for Payer: UnitedHealthcare Community & State	$7,433.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,582.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7,433.69

PEPTO-BISMOL LIQUID

Facility

$7.00

Hospital Charge Code	60634901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PEPTO-BISMOL LIQUID

Facility

$7.00

Hospital Charge Code	60634901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PEPTO-BISMOL TABS

Facility

$4.00

Service Code	NDC 904131546
Hospital Charge Code	60634891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PEPTO-BISMOL TABS

Facility

$4.00

Service Code	NDC 904131546
Hospital Charge Code	60634891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERATIVE

Facility

$7.00

Hospital Charge Code	60635157
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PERATIVE

Facility

$7.00

Hospital Charge Code	60635157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PERC/AUTO/VAC/ASSIST/BREST BIO

Facility

$6,420.00

Hospital Charge Code	75190110
Hospital Revenue Code	361
Min. Negotiated Rate	$154.72
Max. Negotiated Rate	$3,210.00
Rate for Payer: Aetna Commercial	$2,439.60
Rate for Payer: Aetna Medicare Advantage	$1,926.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.10
Rate for Payer: Cigna Commercial	$3,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,926.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.00
Rate for Payer: UnitedHealthcare Community & State	$154.72
Rate for Payer: Wellpoint Medicaid Managed Care	$170.13

PERC/AUTO/VAC/ASSIST/BREST BIO

Facility

$6,420.00

Hospital Charge Code	75190110
Hospital Revenue Code	361
Min. Negotiated Rate	$963.00
Max. Negotiated Rate	$963.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.00

PERC BIOPSY BREAST-LT

Facility

$1,049.00

Hospital Charge Code	2690890
Hospital Revenue Code	361
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$398.62
Rate for Payer: Aetna Medicare Advantage	$314.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.50
Rate for Payer: Cigna Commercial	$524.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.70
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$27.80

PERC BIOPSY BREAST-LT

Facility

$1,049.00

Hospital Charge Code	2690890
Hospital Revenue Code	361
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$157.35

PERC BX OR EXC LN, SUPERFICIAL

Facility

$7,367.00

Service Code	HCPCS 38505
Hospital Charge Code	1600000279
Hospital Revenue Code	360
Min. Negotiated Rate	$177.54
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.10
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,105.05
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$177.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$195.23

PERC BX OR EXC LN, SUPERFICIAL

Facility

$7,367.00

Service Code	HCPCS 38505
Hospital Charge Code	1600000279
Hospital Revenue Code	360
Min. Negotiated Rate	$1,105.05
Max. Negotiated Rate	$1,105.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,105.05

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	366847490
Hospital Revenue Code	361
Min. Negotiated Rate	$2,560.13
Max. Negotiated Rate	$2,560.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	366847490
Hospital Revenue Code	361
Min. Negotiated Rate	$411.33
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,120.27
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$411.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$452.29

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	411047490
Hospital Revenue Code	361
Min. Negotiated Rate	$411.33
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,120.27
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$411.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$452.29

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	411047490
Hospital Revenue Code	361
Min. Negotiated Rate	$2,560.13
Max. Negotiated Rate	$2,560.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13

PERC CHOLECYSTOSTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	2250452
Hospital Revenue Code	361
Min. Negotiated Rate	$2,560.13
Max. Negotiated Rate	$2,560.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13

Know your out-of-pocket cost for care.

All Charges