Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUB OT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GO
Hospital Charge Code	9109156
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUBOXONE SL FILM 2/0.5MG

Facility

$38.39

Service Code	NDC 12496120203
Hospital Charge Code	606390280
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$5.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.76

SUBOXONE SL FILM 2/0.5MG

Facility

$38.39

Service Code	NDC 12496120203
Hospital Charge Code	606390280
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna Commercial	$14.59
Rate for Payer: Aetna Medicare Advantage	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.79
Rate for Payer: Cigna Commercial	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.52
Rate for Payer: Oxford Commercial	$7.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.76
Rate for Payer: UnitedHealthcare Commercial	$7.68
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

SUBOXONE SL FILM 4/1.0 5MG

Facility

$56.62

Service Code	NDC 12496120403
Hospital Charge Code	606390283
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.31
Rate for Payer: Aetna Commercial	$21.52
Rate for Payer: Aetna Medicare Advantage	$16.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.44
Rate for Payer: Cigna Commercial	$28.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.99
Rate for Payer: Oxford Commercial	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$11.32
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

SUBOXONE SL FILM 4/1.0 5MG

Facility

$56.62

Service Code	NDC 12496120403
Hospital Charge Code	606390283
Hospital Revenue Code	250
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

SUB PT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	9109145
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

SUB PT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	9109145
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GP
Hospital Charge Code	9109147
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GP
Hospital Charge Code	9109147
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

SUB PT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GP
Hospital Charge Code	9109146
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GP
Hospital Charge Code	9109146
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

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	84201135
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

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	84201135
Hospital Revenue Code	429
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	84202075
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

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	84202075
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	84201153
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

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	84201153
Hospital Revenue Code	439
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	74203117
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	74203117
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

SUB PT/OT CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8993GOCH
Hospital Charge Code	74203117CH
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8993GOCH
Hospital Charge Code	74203117CH
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

SUB PT/OT CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8993GPCH
Hospital Charge Code	84202075CH
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8993GPCH
Hospital Charge Code	84202075CH
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

SUB PT/OT CURRENT STATUS CI

Facility

$0.01

Service Code	HCPCS G8993GOCI
Hospital Charge Code	74203117CI
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

SUB PT/OT CURRENT STATUS CI

Facility

$0.01

Service Code	HCPCS G8993GPCI
Hospital Charge Code	84202075CI
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges