Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

selenium sulfide topical 2.5%

Facility

$132.66

Service Code	NDC 45802004064
Hospital Charge Code	6063943318
Hospital Revenue Code	250
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.90

selenium sulfide topical 2.5%

Facility

$132.66

Service Code	NDC 45802004064
Hospital Charge Code	6063943318
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$66.33
Rate for Payer: Aetna Commercial	$50.41
Rate for Payer: Aetna Medicare Advantage	$39.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.83
Rate for Payer: Cigna Commercial	$66.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.80
Rate for Payer: Oxford Commercial	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.90
Rate for Payer: UnitedHealthcare Commercial	$26.53
Rate for Payer: UnitedHealthcare Community & State	$3.20
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Hospital Charge Code	24746295
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246295
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246295
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Hospital Charge Code	24846295
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Hospital Charge Code	24846295
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SELF AWARENESS GROUP PSYCHOTPY

Facility

$800.80

Hospital Charge Code	24746295
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SELF BLOOD GLUC MONITOR EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200022
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

SELF BLOOD GLUC MONITOR EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200022
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

SELF BLOOD GLUC MONITOR F/U PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200027
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

SELF BLOOD GLUC MONITOR F/U PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200027
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

SELF BLOOD GLUC MONITOR NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200021
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

SELF BLOOD GLUC MONITOR NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200021
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	9109139
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GP
Hospital Charge Code	84202045
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	84201147
Hospital Revenue Code	439
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	84201147
Hospital Revenue Code	439
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	9109139
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GP
Hospital Charge Code	84202045
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	74203105
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GO
Hospital Charge Code	74203105
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GP
Hospital Charge Code	84201129
Hospital Revenue Code	429
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8987GP
Hospital Charge Code	84201129
Hospital Revenue Code	429
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CARE CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8987GPCH
Hospital Charge Code	84202045CH
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges