Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETYLCYSTEINE OPH 20%

Facility

$21.15

Hospital Charge Code	6005839
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

ACETYLCYSTEINE OPH 20%

Facility

$21.15

Hospital Charge Code	6005839
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

ACETYLCYSTEINE SOL 10% 30ML

Facility

$45.55

Hospital Charge Code	60628002
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$6.83

ACETYLCYSTEINE SOL 10% 30ML

Facility

$45.55

Hospital Charge Code	60628002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.77
Rate for Payer: Aetna Commercial	$17.31
Rate for Payer: Aetna Medicare Advantage	$13.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.62
Rate for Payer: Cigna Commercial	$22.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.66
Rate for Payer: Oxford Commercial	$9.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.83
Rate for Payer: UnitedHealthcare Commercial	$9.11
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

ACETYLCYSTEINE SOL 10% 4ML

Facility

$26.50

Hospital Charge Code	60628003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

ACETYLCYSTEINE SOL 10% 4ML

Facility

$26.50

Hospital Charge Code	60628003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna Commercial	$10.07
Rate for Payer: Aetna Medicare Advantage	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.76
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.95
Rate for Payer: Oxford Commercial	$5.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$5.30
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

ACETYLCYSTEINE SOL 20% 4ML

Facility

$100.23

Service Code	NDC 517760425
Hospital Charge Code	60628005
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$50.12
Rate for Payer: Aetna Commercial	$38.09
Rate for Payer: Aetna Medicare Advantage	$30.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.56
Rate for Payer: Cigna Commercial	$50.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.07
Rate for Payer: Oxford Commercial	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.03
Rate for Payer: UnitedHealthcare Commercial	$20.05
Rate for Payer: UnitedHealthcare Community & State	$2.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

ACETYLCYSTEINE SOL 20% 4ML

Facility

$100.23

Service Code	NDC 517760425
Hospital Charge Code	60628005
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$15.03

ACETYLCYSTEINE SOL 20% 4ML

Facility

$9.00

Hospital Charge Code	6012165
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

ACETYLCYSTEINE SOL 20% 4ML

Facility

$9.00

Hospital Charge Code	6012165
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

ACE WRAP ELASTIC BANDAGE

Facility

$7.98

Hospital Charge Code	270667805
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ACE WRAP ELASTIC BANDAGE

Facility

$7.98

Hospital Charge Code	270667805
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.99
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.39
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

ACHILLES SPEEDBRIDGE

Facility

$8,575.00

Hospital Charge Code	270656487
Hospital Revenue Code	278
Min. Negotiated Rate	$206.66
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$206.66
Rate for Payer: Wellpoint Medicaid Managed Care	$227.24

ACHILLES SPEEDBRIDGE

Facility

$8,575.00

Hospital Charge Code	270656487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

ACHILLES SPEEDBRIDGE KIT

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270648346
Hospital Revenue Code	278
Min. Negotiated Rate	$1,305.00
Max. Negotiated Rate	$2,105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,914.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00

ACHILLES SPEEDBRIDGE KIT

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270648346
Hospital Revenue Code	278
Min. Negotiated Rate	$209.67
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$2,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,218.50
Rate for Payer: Cigna Commercial	$4,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,914.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00
Rate for Payer: UnitedHealthcare Community & State	$209.67
Rate for Payer: Wellpoint Medicaid Managed Care	$230.55

ACHILLES SPEEDBRIDGEW/JUMPSTAR

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270682063
Hospital Revenue Code	278
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

ACHILLES SPEEDBRIDGEW/JUMPSTAR

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270682063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

ACHILLES TEN-BONE BLOCK

Facility

$13,026.25

Hospital Charge Code	270666869
Hospital Revenue Code	272
Min. Negotiated Rate	$1,953.94
Max. Negotiated Rate	$1,953.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.94

ACHILLES TEN-BONE BLOCK

Facility

$13,026.25

Hospital Charge Code	270666869
Hospital Revenue Code	272
Min. Negotiated Rate	$313.93
Max. Negotiated Rate	$6,513.12
Rate for Payer: Aetna Commercial	$4,949.98
Rate for Payer: Aetna Medicare Advantage	$3,907.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,321.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,321.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,321.69
Rate for Payer: Cigna Commercial	$6,513.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,907.88
Rate for Payer: Oxford Commercial	$2,605.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.94
Rate for Payer: UnitedHealthcare Commercial	$2,605.25
Rate for Payer: UnitedHealthcare Community & State	$313.93
Rate for Payer: Wellpoint Medicaid Managed Care	$345.20

ACHROMYCIN IM/250MG/VIAL

Facility

$71.00

Hospital Charge Code	60634283
Hospital Revenue Code	250
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: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ACHROMYCIN IM/250MG/VIAL

Facility

$71.00

Hospital Charge Code	60634283
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

ACHROMYCIN IV/500MG

Facility

$122.00

Hospital Charge Code	60632389
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

ACHROMYCIN IV/500MG

Facility

$122.00

Hospital Charge Code	60632389
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

ACID CITRIC 900GM

Facility

$76.85

Hospital Charge Code	270605263
Hospital Revenue Code	250
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

Know your out-of-pocket cost for care.

All Charges