Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PET IMAGE W/CT SKULL-THIGH-PC

Facility

$648.25

Service Code	HCPCS 7881526
Hospital Charge Code	80000025
Hospital Revenue Code	404
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$246.34
Rate for Payer: Aetna Medicare Advantage	$194.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.30
Rate for Payer: Cigna Commercial	$324.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.47
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.24
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$15.62
Rate for Payer: Wellpoint Medicaid Managed Care	$17.18

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PET IMAGE W/CT SKULL-THIGH- TC

Facility

$6,147.90

Service Code	HCPCS 78815
Hospital Charge Code	80000020
Hospital Revenue Code	404
Min. Negotiated Rate	$148.16
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,090.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.37
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.18
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$148.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$162.92

PET IMAGE W/CT SKULL-THIGH- TC

Facility

$6,147.90

Service Code	HCPCS 78815
Hospital Charge Code	80000020
Hospital Revenue Code	404
Min. Negotiated Rate	$922.18
Max. Negotiated Rate	$922.18
Rate for Payer: Qualcare PPO/HMO/WC	$922.18

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,090.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH- PS

Facility

$40,000.00

Service Code	HCPCS 78815PS
Hospital Charge Code	80000015PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH- PS

Facility

$40,000.00

Service Code	HCPCS 78815PS
Hospital Charge Code	80000015PS
Hospital Revenue Code	404
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PET MYOCARD IMAG METAB EVAL

Facility

$18,188.25

Service Code	HCPCS 78459
Hospital Charge Code	4501028
Hospital Revenue Code	404
Min. Negotiated Rate	$235.69
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,538.08
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,456.48
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$438.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$481.99

PET MYOCARD IMAG METAB EVAL

Facility

$18,188.25

Service Code	HCPCS 78459
Hospital Charge Code	4501028
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PET MYOCARD IMAG MPL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78492
Hospital Charge Code	4501030
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PET MYOCARD IMAG MPL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78492
Hospital Charge Code	4501030
Hospital Revenue Code	404
Min. Negotiated Rate	$272.98
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,456.48
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$438.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$481.99

PET MYOCARD IMAG SGL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78491
Hospital Charge Code	4501029
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PET MYOCARD IMAG SGL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78491
Hospital Charge Code	4501029
Hospital Revenue Code	404
Min. Negotiated Rate	$226.51
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,456.48
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$438.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$481.99

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$864.42
Max. Negotiated Rate	$864.42
Rate for Payer: Qualcare PPO/HMO/WC	$864.42

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,728.84
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.42
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$138.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$152.71

PETROLATUM/30GM

Facility

$2.00

Hospital Charge Code	60633644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PETROLATUM/30GM

Facility

$2.00

Hospital Charge Code	60633644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.01
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.31
Rate for Payer: Cigna Commercial	$18.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.96
Rate for Payer: Oxford Commercial	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.48
Rate for Payer: UnitedHealthcare Commercial	$7.30
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.48

PETROLATUM OINTMENT 454G TOP

Facility

$39.70

Hospital Charge Code	60629147
Hospital Revenue Code	250
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.96

PETROLATUM OINTMENT 454G TOP

Facility

$39.70

Hospital Charge Code	60629147
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.85
Rate for Payer: Aetna Commercial	$15.09
Rate for Payer: Aetna Medicare Advantage	$11.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.12
Rate for Payer: Cigna Commercial	$19.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.91
Rate for Payer: Oxford Commercial	$7.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.96
Rate for Payer: UnitedHealthcare Commercial	$7.94
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

Know your out-of-pocket cost for care.

All Charges