Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PREV CONTRACEPTIVE KIT

Facility

$14.20

Service Code	NDC 68462063729
Hospital Charge Code	60635461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$2.13

PREV CONTRACEPTIVE KIT

Facility

$14.20

Service Code	NDC 68462063729
Hospital Charge Code	60635461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.10
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.62
Rate for Payer: Cigna Commercial	$7.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.26
Rate for Payer: Oxford Commercial	$2.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.13
Rate for Payer: UnitedHealthcare Commercial	$2.84
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	73050830
Hospital Revenue Code	515
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	73050830
Hospital Revenue Code	515
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PREVENTIVE COUNSELING INDIV

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	395099401
Hospital Revenue Code	940
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

PREVENTIVE COUNSELING INDIV

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	395099401
Hospital Revenue Code	940
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

PREVENT.MED.COUNSELING 30 MTS

Facility

$62.00

Service Code	HCPCS 99402
Hospital Charge Code	83652499
Hospital Revenue Code	510
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

PREVENT.MED.COUNSELING 30 MTS

Facility

$62.00

Service Code	HCPCS 99402
Hospital Charge Code	83652499
Hospital Revenue Code	510
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$23.56
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

PREVENT.MED.COUNSELING 45 MTS

Facility

$131.00

Service Code	HCPCS 99403
Hospital Charge Code	83652501
Hospital Revenue Code	510
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

PREVENT.MED.COUNSELING 45 MTS

Facility

$131.00

Service Code	HCPCS 99403
Hospital Charge Code	83652501
Hospital Revenue Code	510
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

PREVENT.MED.COUNSELING-60MTS

Facility

$112.00

Service Code	HCPCS 99404
Hospital Charge Code	83652503
Hospital Revenue Code	510
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

PREVENT.MED.COUNSELING-60MTS

Facility

$112.00

Service Code	HCPCS 99404
Hospital Charge Code	83652503
Hospital Revenue Code	510
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

PREVNAR 0.5ML VIAL

Facility

$8,181.64

Service Code	HCPCS 90670
Hospital Charge Code	83652585
Hospital Revenue Code	636
Min. Negotiated Rate	$1,227.25
Max. Negotiated Rate	$1,979.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.25

PREVNAR 0.5ML VIAL

Facility

$8,181.64

Service Code	HCPCS 90670
Hospital Charge Code	83652585
Hospital Revenue Code	636
Min. Negotiated Rate	$197.18
Max. Negotiated Rate	$4,090.82
Rate for Payer: Aetna Commercial	$3,109.02
Rate for Payer: Aetna Medicare Advantage	$2,454.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,086.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,086.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,086.32
Rate for Payer: Cigna Commercial	$4,090.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.25
Rate for Payer: UnitedHealthcare Community & State	$197.18
Rate for Payer: Wellpoint Medicaid Managed Care	$216.81

PREVNAR 13 EX

Facility

$1,221.14

Service Code	NDC 5197102
Hospital Charge Code	60630182EX
Hospital Revenue Code	259
Min. Negotiated Rate	$29.43
Max. Negotiated Rate	$610.57
Rate for Payer: Aetna Commercial	$464.03
Rate for Payer: Aetna Medicare Advantage	$366.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.39
Rate for Payer: Cigna Commercial	$610.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.34
Rate for Payer: Oxford Commercial	$244.23
Rate for Payer: Qualcare PPO/HMO/WC	$183.17
Rate for Payer: UnitedHealthcare Commercial	$244.23
Rate for Payer: UnitedHealthcare Community & State	$29.43
Rate for Payer: Wellpoint Medicaid Managed Care	$32.36

PREVNAR 13 EX

Facility

$1,221.14

Service Code	NDC 5197102
Hospital Charge Code	60630182EX
Hospital Revenue Code	259
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$183.17
Rate for Payer: Qualcare PPO/HMO/WC	$183.17

PREVNAR13(PNEUMOCOCCA VAC) 0.5

Facility

$1,221.14

Service Code	HCPCS 90670
Hospital Charge Code	60630182
Hospital Revenue Code	636
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$295.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.52
Rate for Payer: Qualcare PPO/HMO/WC	$183.17

PREVNAR13(PNEUMOCOCCA VAC) 0.5

Facility

$1,221.14

Service Code	HCPCS 90670
Hospital Charge Code	60630182
Hospital Revenue Code	636
Min. Negotiated Rate	$29.43
Max. Negotiated Rate	$610.57
Rate for Payer: Aetna Commercial	$464.03
Rate for Payer: Aetna Medicare Advantage	$366.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.39
Rate for Payer: Cigna Commercial	$610.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.52
Rate for Payer: Qualcare PPO/HMO/WC	$183.17
Rate for Payer: UnitedHealthcare Community & State	$29.43
Rate for Payer: Wellpoint Medicaid Managed Care	$32.36

PREZISTA 800MG TAB

Facility

$176.60

Hospital Charge Code	606351013
Hospital Revenue Code	250
Min. Negotiated Rate	$26.49
Max. Negotiated Rate	$26.49
Rate for Payer: Qualcare PPO/HMO/WC	$26.49

PREZISTA 800MG TAB

Facility

$176.60

Hospital Charge Code	606351013
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.30
Rate for Payer: Aetna Commercial	$67.11
Rate for Payer: Aetna Medicare Advantage	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.03
Rate for Payer: Cigna Commercial	$88.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.98
Rate for Payer: Oxford Commercial	$35.32
Rate for Payer: Qualcare PPO/HMO/WC	$26.49
Rate for Payer: UnitedHealthcare Commercial	$35.32
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.68

PRG FETL ANAT ABD US EA ADDTL

Facility

$2,042.00

Service Code	HCPCS 76812
Hospital Charge Code	83653055
Hospital Revenue Code	402
Min. Negotiated Rate	$306.30
Max. Negotiated Rate	$306.30
Rate for Payer: Qualcare PPO/HMO/WC	$306.30

PRG FETL ANAT ABD US EA ADDTL

Facility

$2,042.00

Service Code	HCPCS 76812
Hospital Charge Code	83653055
Hospital Revenue Code	402
Min. Negotiated Rate	$49.21
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$775.96
Rate for Payer: Aetna Medicare Advantage	$612.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.71
Rate for Payer: Cigna Commercial	$1,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.60
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.30
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$49.21
Rate for Payer: Wellpoint Medicaid Managed Care	$54.11

PRGMR PAT STMLTR S/NNKE111075N

Facility

$6,247.50

Hospital Charge Code	270640281
Hospital Revenue Code	278
Min. Negotiated Rate	$150.56
Max. Negotiated Rate	$3,123.75
Rate for Payer: Aetna Commercial	$2,374.05
Rate for Payer: Aetna Medicare Advantage	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.11
Rate for Payer: Cigna Commercial	$3,123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,374.45
Rate for Payer: Qualcare PPO/HMO/WC	$937.12
Rate for Payer: UnitedHealthcare Community & State	$150.56
Rate for Payer: Wellpoint Medicaid Managed Care	$165.56

PRGMR PAT STMLTR S/NNKE111075N

Facility

$6,247.50

Hospital Charge Code	270640281
Hospital Revenue Code	278
Min. Negotiated Rate	$937.12
Max. Negotiated Rate	$1,511.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,374.45
Rate for Payer: Qualcare PPO/HMO/WC	$937.12

PRG UTRUS FETL ANAT ABD US SIN

Facility

$2,455.60

Service Code	HCPCS 76811
Hospital Charge Code	83653050
Hospital Revenue Code	402
Min. Negotiated Rate	$368.34
Max. Negotiated Rate	$368.34
Rate for Payer: Qualcare PPO/HMO/WC	$368.34

Know your out-of-pocket cost for care.

All Charges