Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SERZONE 100MG

Facility

$7.00

Hospital Charge Code	60635098
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SERZONE 150MG

Facility

$5.00

Hospital Charge Code	60635099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SERZONE 150MG

Facility

$5.00

Hospital Charge Code	60635099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SERZONE 200MG

Facility

$5.00

Hospital Charge Code	60635100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SERZONE 200MG

Facility

$5.00

Hospital Charge Code	60635100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SERZONE 250MG

Facility

$6.00

Hospital Charge Code	60635101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SERZONE 250MG

Facility

$6.00

Hospital Charge Code	60635101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SESAMOIDECTOMY FIRST TOE

Facility

$19,998.60

Service Code	HCPCS 28315
Hospital Charge Code	16000452
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

SESAMOIDECTOMY FIRST TOE

Facility

$19,998.60

Service Code	HCPCS 28315
Hospital Charge Code	16000452
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

SET ADMIN****

Facility

$23.00

Hospital Charge Code	7000383
Hospital Revenue Code	279
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SET ADMIN****

Facility

$23.00

Hospital Charge Code	7000383
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SET ADM PUMP MED****

Facility

$38.00

Hospital Charge Code	7000441
Hospital Revenue Code	279
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

SET ADM PUMP MED****

Facility

$38.00

Hospital Charge Code	7000441
Hospital Revenue Code	279
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

SET ANGIO FOR CAT SCAN

Facility

$9.65

Hospital Charge Code	270600457
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SET ANGIO FOR CAT SCAN

Facility

$9.65

Hospital Charge Code	270600457
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SET ASEPTIC TRANSFER 3508400

Facility

$324.85

Hospital Charge Code	270624223
Hospital Revenue Code	272
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$48.73
Rate for Payer: Qualcare PPO/HMO/WC	$48.73

SET ASEPTIC TRANSFER 3508400

Facility

$324.85

Hospital Charge Code	270624223
Hospital Revenue Code	272
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.43
Rate for Payer: Aetna Commercial	$123.44
Rate for Payer: Aetna Medicare Advantage	$97.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.84
Rate for Payer: Cigna Commercial	$162.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.45
Rate for Payer: Oxford Commercial	$64.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.73
Rate for Payer: UnitedHealthcare Commercial	$64.97
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

SET ATX HARVEST10/11 AR198010S

Facility

$3,069.65

Hospital Charge Code	270624403
Hospital Revenue Code	272
Min. Negotiated Rate	$73.98
Max. Negotiated Rate	$1,534.83
Rate for Payer: Aetna Commercial	$1,166.47
Rate for Payer: Aetna Medicare Advantage	$920.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.76
Rate for Payer: Cigna Commercial	$1,534.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.89
Rate for Payer: Oxford Commercial	$613.93
Rate for Payer: Qualcare PPO/HMO/WC	$460.45
Rate for Payer: UnitedHealthcare Commercial	$613.93
Rate for Payer: UnitedHealthcare Community & State	$73.98
Rate for Payer: Wellpoint Medicaid Managed Care	$81.35

SET ATX HARVEST10/11 AR198010S

Facility

$3,069.65

Hospital Charge Code	270624403
Hospital Revenue Code	272
Min. Negotiated Rate	$460.45
Max. Negotiated Rate	$460.45
Rate for Payer: Qualcare PPO/HMO/WC	$460.45

SET ATX HARVEST 5/6 AR1980-05S

Facility

$3,250.45

Hospital Charge Code	270622880
Hospital Revenue Code	272
Min. Negotiated Rate	$78.34
Max. Negotiated Rate	$1,625.22
Rate for Payer: Aetna Commercial	$1,235.17
Rate for Payer: Aetna Medicare Advantage	$975.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.86
Rate for Payer: Cigna Commercial	$1,625.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.13
Rate for Payer: Oxford Commercial	$650.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.57
Rate for Payer: UnitedHealthcare Commercial	$650.09
Rate for Payer: UnitedHealthcare Community & State	$78.34
Rate for Payer: Wellpoint Medicaid Managed Care	$86.14

SET ATX HARVEST 5/6 AR1980-05S

Facility

$3,250.45

Hospital Charge Code	270622880
Hospital Revenue Code	272
Min. Negotiated Rate	$487.57
Max. Negotiated Rate	$487.57
Rate for Payer: Qualcare PPO/HMO/WC	$487.57

SET ATX HARVEST 6/7 AR1980-06S

Facility

$3,069.65

Hospital Charge Code	270624404
Hospital Revenue Code	272
Min. Negotiated Rate	$73.98
Max. Negotiated Rate	$1,534.83
Rate for Payer: Aetna Commercial	$1,166.47
Rate for Payer: Aetna Medicare Advantage	$920.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.76
Rate for Payer: Cigna Commercial	$1,534.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.89
Rate for Payer: Oxford Commercial	$613.93
Rate for Payer: Qualcare PPO/HMO/WC	$460.45
Rate for Payer: UnitedHealthcare Commercial	$613.93
Rate for Payer: UnitedHealthcare Community & State	$73.98
Rate for Payer: Wellpoint Medicaid Managed Care	$81.35

SET ATX HARVEST 6/7 AR1980-06S

Facility

$3,069.65

Hospital Charge Code	270624404
Hospital Revenue Code	272
Min. Negotiated Rate	$460.45
Max. Negotiated Rate	$460.45
Rate for Payer: Qualcare PPO/HMO/WC	$460.45

SET ATX HARVEST 7/8 AR1980-07S

Facility

$3,250.45

Hospital Charge Code	270622881
Hospital Revenue Code	272
Min. Negotiated Rate	$487.57
Max. Negotiated Rate	$487.57
Rate for Payer: Qualcare PPO/HMO/WC	$487.57

SET ATX HARVEST 7/8 AR1980-07S

Facility

$3,250.45

Hospital Charge Code	270622881
Hospital Revenue Code	272
Min. Negotiated Rate	$78.34
Max. Negotiated Rate	$1,625.22
Rate for Payer: Aetna Commercial	$1,235.17
Rate for Payer: Aetna Medicare Advantage	$975.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.86
Rate for Payer: Cigna Commercial	$1,625.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.13
Rate for Payer: Oxford Commercial	$650.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.57
Rate for Payer: UnitedHealthcare Commercial	$650.09
Rate for Payer: UnitedHealthcare Community & State	$78.34
Rate for Payer: Wellpoint Medicaid Managed Care	$86.14

Know your out-of-pocket cost for care.

All Charges