Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERSANTINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERSANTINE/25MG/TAB/BULK

Facility

$3.00

Hospital Charge Code	60634662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/25MG/TAB/BULK

Facility

$3.00

Hospital Charge Code	60634662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERSANTINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERSANTINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633640
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

PERSANTINE/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERSANTINE/75MG/BULK

Facility

$3.00

Hospital Charge Code	60634633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERSANTINE/75MG/BULK

Facility

$3.00

Hospital Charge Code	60634633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/75MG/TAB

Facility

$3.00

Hospital Charge Code	60633641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/75MG/TAB

Facility

$3.00

Hospital Charge Code	60633641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERSANTINE IV 10ML

Facility

$1,000.00

Hospital Charge Code	60635021
Hospital Revenue Code	250
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

PERSANTINE IV 10ML

Facility

$1,000.00

Hospital Charge Code	60635021
Hospital Revenue Code	250
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

PERSANTINE IV/5MG/1ML

Facility

$6.00

Hospital Charge Code	60634347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PERSANTINE IV/5MG/1ML

Facility

$6.00

Hospital Charge Code	60634347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PERSONA EXT TAPERD CEM 14X30MM

Facility

$6,042.00

Service Code	HCPCS C1776
Hospital Charge Code	270686934
Hospital Revenue Code	278
Min. Negotiated Rate	$145.61
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,295.96
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30
Rate for Payer: UnitedHealthcare Community & State	$145.61
Rate for Payer: Wellpoint Medicaid Managed Care	$160.11

PERSONA EXT TAPERD CEM 14X30MM

Facility

$6,042.00

Service Code	HCPCS C1776
Hospital Charge Code	270686934
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PERSONA LEFT ARTICULAR SURFACE

Facility

$13,181.25

Service Code	HCPCS C1776
Hospital Charge Code	270703896
Hospital Revenue Code	278
Min. Negotiated Rate	$317.67
Max. Negotiated Rate	$6,590.62
Rate for Payer: Aetna Commercial	$5,008.88
Rate for Payer: Aetna Medicare Advantage	$3,954.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.22
Rate for Payer: Cigna Commercial	$6,590.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.19
Rate for Payer: UnitedHealthcare Community & State	$317.67
Rate for Payer: Wellpoint Medicaid Managed Care	$349.30

PERSONA LEFT ARTICULAR SURFACE

Facility

$13,181.25

Service Code	HCPCS C1776
Hospital Charge Code	270703896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.19
Max. Negotiated Rate	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.19

PERSONALITY DISORDERS

Facility

$45,168.72

Service Code	APR-DRG 7524
Min. Negotiated Rate	$44,283.06
Max. Negotiated Rate	$45,168.72
Rate for Payer: UnitedHealthcare Community & State	$44,283.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,168.72
Rate for Payer: Wellpoint Medicaid Managed Care	$44,283.06

PERSONALITY DISORDERS

Facility

$3,510.95

Service Code	APR-DRG 7521
Min. Negotiated Rate	$3,442.11
Max. Negotiated Rate	$3,510.95
Rate for Payer: UnitedHealthcare Community & State	$3,442.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$3,510.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3,442.11

PERSONALITY DISORDERS

Facility

$12,376.45

Service Code	APR-DRG 7523
Min. Negotiated Rate	$12,133.77
Max. Negotiated Rate	$12,376.45
Rate for Payer: UnitedHealthcare Community & State	$12,133.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,376.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12,133.77

PERSONALITY DISORDERS

Facility

$4,977.93

Service Code	APR-DRG 7522
Min. Negotiated Rate	$4,880.32
Max. Negotiated Rate	$4,977.93
Rate for Payer: UnitedHealthcare Community & State	$4,880.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,977.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4,880.32

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	4512631
Hospital Revenue Code	911
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$615.60
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

Know your out-of-pocket cost for care.

All Charges