Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHYSICAL PERFORMANCE TEST

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	84202090
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.74
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.84
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

PHYSICS TX PLAN 3D

Facility

$3,149.45

Service Code	HCPCS 77295
Hospital Charge Code	4800138
Hospital Revenue Code	333
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$4,472.71
Rate for Payer: Aetna Medicare Advantage	$5,327.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,644.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,935.72
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: Cigna Medicare Advantage	$1,151.07
Rate for Payer: Clover Medicare Advantage	$1,562.16
Rate for Payer: EmblemHealth Commercial	$4,933.14
Rate for Payer: Humana Medicare Advantage	$1,693.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,644.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.84
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.42
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$75.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,644.38
Rate for Payer: Wellcare Medicare Advantage	$1,644.38
Rate for Payer: Wellpoint Medicaid Managed Care	$83.46

PHYSICS TX PLAN 3D

Facility

$3,149.45

Service Code	HCPCS 77295
Hospital Charge Code	4800138
Hospital Revenue Code	333
Min. Negotiated Rate	$472.42
Max. Negotiated Rate	$472.42
Rate for Payer: Qualcare PPO/HMO/WC	$472.42

PHYSOSTIGMN SALC INJ 1MG/ML2ML

Facility

$105.00

Hospital Charge Code	6004311
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PHYSOSTIGMN SALC INJ 1MG/ML2ML

Facility

$105.00

Hospital Charge Code	6004311
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

PHYSOSTIGMN SULF OINT OPH3.5GM

Facility

$19.85

Hospital Charge Code	6004329
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

PHYSOSTIGMN SULF OINT OPH3.5GM

Facility

$19.85

Hospital Charge Code	6004329
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6.48

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$7.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.51
Rate for Payer: Aetna Commercial	$11.79
Rate for Payer: Aetna Medicare Advantage	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

PHYTONADIONE 1MG/.5ML AMP

Facility

$12.00

Hospital Charge Code	60635791
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

PHYTONADIONE 1MG/.5ML AMP

Facility

$12.00

Hospital Charge Code	60635791
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.93

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Aetna Medicare Advantage	$31.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.08
Rate for Payer: Cigna Commercial	$53.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.86
Rate for Payer: Oxford Commercial	$21.24
Rate for Payer: Qualcare PPO/HMO/WC	$15.93
Rate for Payer: UnitedHealthcare Commercial	$21.24
Rate for Payer: UnitedHealthcare Community & State	$2.56
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.06
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.49
Rate for Payer: Cigna Commercial	$46.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

PHYTONADIONE INJ 10MG/ML

Facility

$31.15

Hospital Charge Code	6004337A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.57
Rate for Payer: Aetna Commercial	$11.84
Rate for Payer: Aetna Medicare Advantage	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.94
Rate for Payer: Cigna Commercial	$15.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.35
Rate for Payer: Oxford Commercial	$6.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.67
Rate for Payer: UnitedHealthcare Commercial	$6.23
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

PHYTONADIONE INJ 10MG/ML

Facility

$31.15

Hospital Charge Code	6004337A
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.67

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$22.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82

PHYTONADIONE INJ 2MG/ML

Facility

$53.20

Hospital Charge Code	60628494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: Aetna Medicare Advantage	$15.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.57
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.96
Rate for Payer: Oxford Commercial	$10.64
Rate for Payer: Qualcare PPO/HMO/WC	$7.98
Rate for Payer: UnitedHealthcare Commercial	$10.64
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

PHYTONADIONE INJ 2MG/ML

Facility

$53.20

Hospital Charge Code	60628494
Hospital Revenue Code	250
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$7.98
Rate for Payer: Qualcare PPO/HMO/WC	$7.98

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
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	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$392.41
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.19
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.59
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$59.59
Max. Negotiated Rate	$59.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.59

Know your out-of-pocket cost for care.

All Charges