Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PREGNENOLONE

Facility

$147.00

Hospital Charge Code	3010550
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.86
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

PREGNENOLONE

Facility

$147.00

Hospital Charge Code	3010550
Hospital Revenue Code	301
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

PREGNENOLONE

Facility

$142.10

Service Code	HCPCS 84140
Hospital Charge Code	39900121
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$21.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.32

PREGNENOLONE

Facility

$142.10

Service Code	HCPCS 84140
Hospital Charge Code	39900121
Hospital Revenue Code	301
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.61
Rate for Payer: Cigna Commercial	$71.05
Rate for Payer: Cigna Medicare Advantage	$20.67
Rate for Payer: Clover Medicare Advantage	$19.64
Rate for Payer: EmblemHealth Commercial	$62.01
Rate for Payer: Humana Medicare Advantage	$21.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.32
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.67
Rate for Payer: Wellcare Medicare Advantage	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

PREGNENOLONE

Facility

$141.65

Service Code	HCPCS 84140
Hospital Charge Code	3000551
Hospital Revenue Code	301
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.61
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$20.67
Rate for Payer: Clover Medicare Advantage	$19.64
Rate for Payer: EmblemHealth Commercial	$62.01
Rate for Payer: Humana Medicare Advantage	$21.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.67
Rate for Payer: Wellcare Medicare Advantage	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

PREGNYL/10000U

Facility

$152.00

Hospital Charge Code	60633705
Hospital Revenue Code	636
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

PREGNYL/10000U

Facility

$152.00

Hospital Charge Code	60633705
Hospital Revenue Code	636
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$36.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

PREG TEST (SERUM HCG QUAL)

Facility

$667.59

Service Code	HCPCS 84703
Hospital Charge Code	3006350
Hospital Revenue Code	301
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$20.45
Rate for Payer: Aetna Medicare Advantage	$24.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.14
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$7.52
Rate for Payer: Clover Medicare Advantage	$7.14
Rate for Payer: EmblemHealth Commercial	$22.56
Rate for Payer: Humana Medicare Advantage	$7.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.52
Rate for Payer: Wellcare Medicare Advantage	$7.52
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PREG TEST (SERUM HCG QUAL)

Facility

$667.59

Service Code	HCPCS 84703
Hospital Charge Code	3006350
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PREKALLIKREIN ACTIVITY

Facility

$131.25

Service Code	HCPCS 85292
Hospital Charge Code	3032350
Hospital Revenue Code	300
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

PREKALLIKREIN ACTIVITY

Facility

$131.25

Service Code	HCPCS 85292
Hospital Charge Code	3032350
Hospital Revenue Code	300
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$51.49
Rate for Payer: Aetna Medicare Advantage	$61.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.33
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: Cigna Medicare Advantage	$18.93
Rate for Payer: Clover Medicare Advantage	$17.98
Rate for Payer: EmblemHealth Commercial	$56.79
Rate for Payer: Humana Medicare Advantage	$19.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.93
Rate for Payer: Wellcare Medicare Advantage	$18.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

PREKALLIKREIN(FLETCHER FACTOR)

Facility

$233.00

Service Code	HCPCS 85292
Hospital Charge Code	401385292
Hospital Revenue Code	305
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

PREKALLIKREIN(FLETCHER FACTOR)

Facility

$233.00

Service Code	HCPCS 85292
Hospital Charge Code	401385292
Hospital Revenue Code	305
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$51.49
Rate for Payer: Aetna Medicare Advantage	$61.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.33
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: Cigna Medicare Advantage	$18.93
Rate for Payer: Clover Medicare Advantage	$17.98
Rate for Payer: EmblemHealth Commercial	$56.79
Rate for Payer: Humana Medicare Advantage	$19.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.93
Rate for Payer: Wellcare Medicare Advantage	$18.93
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

PRELONE 15MG/ML LIQ

Facility

$18.00

Hospital Charge Code	60635184
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PRELONE 15MG/ML LIQ

Facility

$18.00

Hospital Charge Code	60635184
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PRELUDE SYNC EVO DEVICE

Facility

$125.00

Service Code	HCPCS A4649
Hospital Charge Code	270692530S
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

PRELUDE SYNC EVO DEVICE

Facility

$125.00

Service Code	HCPCS A4649
Hospital Charge Code	270692530S
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

PREMARIN/0.625MG/TAB

Facility

$3.00

Hospital Charge Code	60633706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PREMARIN/0.625MG/TAB

Facility

$3.00

Hospital Charge Code	60633706
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

PREMARIN/0.625MG/TAB

Facility

$3.00

Hospital Charge Code	60633707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PREMARIN/0.625MG/TAB

Facility

$3.00

Hospital Charge Code	60633707
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

PREMARIN/1.25MG/TAB

Facility

$3.00

Hospital Charge Code	60633708
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

PREMARIN/1.25MG/TAB

Facility

$3.00

Hospital Charge Code	60633708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PREMATURITY WITH MAJOR PROBLEMS

Facility

$133,327.65

Service Code	MSDRG 791
Min. Negotiated Rate	$3,533.00
Max. Negotiated Rate	$133,327.65
Rate for Payer: Aetna Commercial	$91,868.62
Rate for Payer: Aetna Medicare Advantage	$133,327.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95,370.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95,370.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,733.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95,370.10
Rate for Payer: Cigna Commercial	$75,960.13
Rate for Payer: Cigna Medicare Advantage	$42,733.22
Rate for Payer: Clover Medicare Advantage	$40,596.56
Rate for Payer: EmblemHealth Commercial	$128,199.66
Rate for Payer: Humana Medicare Advantage	$44,015.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,733.22
Rate for Payer: Oxford Commercial	$3,533.00
Rate for Payer: UnitedHealthcare Commercial	$6,193.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,733.22
Rate for Payer: Wellcare Medicare Advantage	$42,733.22

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$81,296.25

Service Code	MSDRG 792
Min. Negotiated Rate	$3,028.00
Max. Negotiated Rate	$81,296.25
Rate for Payer: Aetna Commercial	$56,117.12
Rate for Payer: Aetna Medicare Advantage	$81,296.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57,454.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57,454.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,056.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57,454.67
Rate for Payer: Cigna Commercial	$45,834.33
Rate for Payer: Cigna Medicare Advantage	$26,056.49
Rate for Payer: Clover Medicare Advantage	$24,753.67
Rate for Payer: EmblemHealth Commercial	$78,169.47
Rate for Payer: Humana Medicare Advantage	$26,838.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,056.49
Rate for Payer: Oxford Commercial	$3,028.00
Rate for Payer: UnitedHealthcare Commercial	$5,309.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,056.49
Rate for Payer: Wellcare Medicare Advantage	$26,056.49

Know your out-of-pocket cost for care.

All Charges