Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETAMINOPHEN SUPP/2GR

Facility

$2.00

Hospital Charge Code	60634652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

ACETAMINOPHEN SUPP/2GR

Facility

$2.00

Hospital Charge Code	60634652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

ACETAMINOPHEN SUPP/325MG

Facility

$2.00

Hospital Charge Code	60632384
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

ACETAMINOPHEN SUPP/325MG

Facility

$2.00

Hospital Charge Code	60632384
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

ACETAMINOPHEN SUPP/650MG

Facility

$2.00

Hospital Charge Code	60632386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

ACETAMINOPHEN SUPP/650MG

Facility

$2.00

Hospital Charge Code	60632386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

ACETAMINOPHEN TAB 325MG

Facility

$1.95

Hospital Charge Code	6022115
Hospital Revenue Code	257
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

ACETAMINOPHEN TAB 325MG

Facility

$1.95

Hospital Charge Code	6022115
Hospital Revenue Code	257
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

ACETAMINOPHEN (TYLENOL)

Facility

$457.00

Service Code	HCPCS 80329
Hospital Charge Code	38472026
Hospital Revenue Code	301
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$228.50
Rate for Payer: Aetna Commercial	$173.66
Rate for Payer: Aetna Medicare Advantage	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.53
Rate for Payer: Cigna Commercial	$228.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$12.11

ACETAMINOPHEN (TYLENOL)

Facility

$457.00

Service Code	HCPCS 80329
Hospital Charge Code	38472026
Hospital Revenue Code	301
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$68.55
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

ACETAMINOPHEN UDC 160MG/5ML

Facility

$8.58

Service Code	NDC 121065705
Hospital Charge Code	60630207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.57
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

ACETAMINOPHEN UDC 160MG/5ML

Facility

$8.58

Service Code	NDC 121065705
Hospital Charge Code	60630207
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

ACETAMINOPHEN W/COD/500ML

Facility

$26.00

Hospital Charge Code	60632387
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

ACETAMINOPHEN W/COD/500ML

Facility

$26.00

Hospital Charge Code	60632387
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

ACETAMINOPTHEN 80MG CHEW TAB

Facility

$2.45

Hospital Charge Code	60627730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

ACETAMINOPTHEN 80MG CHEW TAB

Facility

$2.45

Hospital Charge Code	60627730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

ACETAZOLAMIDE 250 MG TAB

Facility

$19.30

Service Code	NDC 51672402301
Hospital Charge Code	60628043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

ACETAZOLAMIDE 250 MG TAB

Facility

$19.30

Service Code	NDC 51672402301
Hospital Charge Code	60628043
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

ACETAZOLAMIDE 500 MG INJ

Facility

$293.46

Service Code	HCPCS J1120
Hospital Charge Code	60628045
Hospital Revenue Code	636
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$71.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.02
Rate for Payer: Qualcare PPO/HMO/WC	$44.02

ACETAZOLAMIDE 500 MG INJ

Facility

$293.46

Service Code	HCPCS J1120
Hospital Charge Code	60628045
Hospital Revenue Code	636
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$146.73
Rate for Payer: Aetna Commercial	$111.51
Rate for Payer: Aetna Medicare Advantage	$88.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.83
Rate for Payer: Cigna Commercial	$146.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.02
Rate for Payer: Qualcare PPO/HMO/WC	$44.02
Rate for Payer: UnitedHealthcare Community & State	$7.07
Rate for Payer: Wellpoint Medicaid Managed Care	$7.78

ACETAZOLAMIDE 500 MG SR CAP

Facility

$28.74

Service Code	NDC 23155012001
Hospital Charge Code	60628044
Hospital Revenue Code	250
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

ACETAZOLAMIDE 500 MG SR CAP

Facility

$28.74

Service Code	NDC 23155012001
Hospital Charge Code	60628044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.37
Rate for Payer: Aetna Commercial	$10.92
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.33
Rate for Payer: Cigna Commercial	$14.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.62
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.31
Rate for Payer: UnitedHealthcare Commercial	$5.75
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

ACETAZOLAMINE INJ 250MG

Facility

$265.60

Hospital Charge Code	6008866
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna Commercial	$100.93
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.68
Rate for Payer: Oxford Commercial	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$53.12
Rate for Payer: UnitedHealthcare Community & State	$6.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.04

ACETAZOLAMINE INJ 250MG

Facility

$265.60

Hospital Charge Code	6008866
Hospital Revenue Code	250
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

ACETIC ACID 0.25% IRRIG SOL

Facility

$19.30

Service Code	NDC 990614309
Hospital Charge Code	60627980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

Know your out-of-pocket cost for care.

All Charges