Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366C
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

POLIO ANTIBODIES

Facility

$312.00

Service Code	HCPCS 86658
Hospital Charge Code	38472926
Hospital Revenue Code	302
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$46.80

POLIO ANTIBODIES

Facility

$312.00

Service Code	HCPCS 86658
Hospital Charge Code	38472926
Hospital Revenue Code	302
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.03
Rate for Payer: Cigna Commercial	$156.00
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$8.27

POLIOVIRUS I

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$54.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.91
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	$61.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.91
Rate for Payer: Clover Medicare Advantage	$16.06
Rate for Payer: EmblemHealth Commercial	$50.73
Rate for Payer: Humana Medicare Advantage	$17.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.91
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	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.91
Rate for Payer: Wellcare Medicare Advantage	$16.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

POLIOVIRUS I

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POLIOVIRUS II

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POLIOVIRUS II

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$54.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.91
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	$61.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.91
Rate for Payer: Clover Medicare Advantage	$16.06
Rate for Payer: EmblemHealth Commercial	$50.73
Rate for Payer: Humana Medicare Advantage	$17.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.91
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	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.91
Rate for Payer: Wellcare Medicare Advantage	$16.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

POLIOVIRUS III

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POLIOVIRUS III

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$54.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.91
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	$61.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.91
Rate for Payer: Clover Medicare Advantage	$16.06
Rate for Payer: EmblemHealth Commercial	$50.73
Rate for Payer: Humana Medicare Advantage	$17.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.91
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	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.91
Rate for Payer: Wellcare Medicare Advantage	$16.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

POLIOVIRUS SPV SC/IM

Facility

$169.68

Service Code	HCPCS 90713
Hospital Charge Code	412390713
Hospital Revenue Code	636
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$41.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.06
Rate for Payer: Qualcare PPO/HMO/WC	$25.45

POLIOVIRUS SPV SC/IM

Facility

$169.68

Service Code	HCPCS 90713
Hospital Charge Code	412390713
Hospital Revenue Code	636
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$84.84
Rate for Payer: Aetna Commercial	$64.48
Rate for Payer: Aetna Medicare Advantage	$50.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.27
Rate for Payer: Cigna Commercial	$84.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.06
Rate for Payer: Qualcare PPO/HMO/WC	$25.45
Rate for Payer: UnitedHealthcare Community & State	$4.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

POLIOVIRUS VACCINE

Facility

$192.00

Hospital Charge Code	60628308
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$72.96
Rate for Payer: Aetna Medicare Advantage	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.96
Rate for Payer: Cigna Commercial	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.60
Rate for Payer: Oxford Commercial	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.80
Rate for Payer: UnitedHealthcare Commercial	$38.40
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.09

POLIOVIRUS VACCINE

Facility

$192.00

Hospital Charge Code	60628308
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.80

POLIOVIRUS VACCINE, ORAL 0-5ML

Facility

$84.50

Service Code	HCPCS 90712
Hospital Charge Code	6017719
Hospital Revenue Code	636
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$20.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.68

POLIOVIRUS VACCINE, ORAL 0-5ML

Facility

$84.50

Service Code	HCPCS 90712
Hospital Charge Code	6017719
Hospital Revenue Code	636
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.25
Rate for Payer: Aetna Commercial	$32.11
Rate for Payer: Aetna Medicare Advantage	$25.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.55
Rate for Payer: Cigna Commercial	$42.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.68
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

POLISHER TIP

Facility

$130.25

Hospital Charge Code	270655639
Hospital Revenue Code	271
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$65.12
Rate for Payer: Aetna Commercial	$49.49
Rate for Payer: Aetna Medicare Advantage	$39.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.21
Rate for Payer: Cigna Commercial	$65.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.08
Rate for Payer: Oxford Commercial	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.54
Rate for Payer: UnitedHealthcare Commercial	$26.05
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.45

POLISHER TIP

Facility

$130.25

Hospital Charge Code	270655639
Hospital Revenue Code	271
Min. Negotiated Rate	$19.54
Max. Negotiated Rate	$19.54
Rate for Payer: Qualcare PPO/HMO/WC	$19.54

POLLICIZATION OF A DIGIT

Facility

$12,172.00

Service Code	HCPCS 26550T9
Hospital Charge Code	5780070
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,086.00
Rate for Payer: Aetna Commercial	$4,625.36
Rate for Payer: Aetna Medicare Advantage	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,103.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,103.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,103.86
Rate for Payer: Cigna Commercial	$6,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,651.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$322.56

POLLICIZATION OF A DIGIT

Facility

$12,172.00

Service Code	HCPCS 26550T9
Hospital Charge Code	5780070
Hospital Revenue Code	450
Min. Negotiated Rate	$1,825.80
Max. Negotiated Rate	$1,825.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80

POLOCAINE 1% 30MG 10MG/ML

Facility

$54.67

Service Code	NDC 63323026037
Hospital Charge Code	60635357
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.20

POLOCAINE 1% 30MG 10MG/ML

Facility

$54.67

Service Code	NDC 63323026037
Hospital Charge Code	60635357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.34
Rate for Payer: Aetna Commercial	$20.77
Rate for Payer: Aetna Medicare Advantage	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.94
Rate for Payer: Cigna Commercial	$27.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.40
Rate for Payer: Oxford Commercial	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$8.20
Rate for Payer: UnitedHealthcare Commercial	$10.93
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

POLOCAINE 2% 20ML 20MG/ML

Facility

$20.00

Hospital Charge Code	60635358
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

POLOCAINE 2% 20ML 20MG/ML

Facility

$20.00

Hospital Charge Code	60635358
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

POLRCTH.035 5x100 P510012001

Facility

$3,695.50

Hospital Charge Code	270638809C
Hospital Revenue Code	278
Min. Negotiated Rate	$554.33
Max. Negotiated Rate	$894.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$813.01
Rate for Payer: Qualcare PPO/HMO/WC	$554.33

Know your out-of-pocket cost for care.

All Charges