Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACYCLOVIR ODD DOSE IVPB

Facility

$301.45

Hospital Charge Code	60627336
Hospital Revenue Code	250
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$150.72
Rate for Payer: Aetna Commercial	$114.55
Rate for Payer: Aetna Medicare Advantage	$90.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.87
Rate for Payer: Cigna Commercial	$150.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.44
Rate for Payer: Oxford Commercial	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$45.22
Rate for Payer: UnitedHealthcare Commercial	$60.29
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.99

ACYCLOVIR SSP 200MG/ML 120 ML

Facility

$31.56

Service Code	HCPCS J8499
Hospital Charge Code	60628562
Hospital Revenue Code	636
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna Commercial	$11.99
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.05
Rate for Payer: Cigna Commercial	$15.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.73
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

ACYCLOVIR SSP 200MG/ML 120 ML

Facility

$31.56

Service Code	HCPCS J8499
Hospital Charge Code	60628562
Hospital Revenue Code	636
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.73

ACYCLOVIR TAB 400MG

Facility

$16.65

Hospital Charge Code	60628779
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.32
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: Aetna Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.25
Rate for Payer: Cigna Commercial	$8.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.00
Rate for Payer: Oxford Commercial	$3.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.50
Rate for Payer: UnitedHealthcare Commercial	$3.33
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

ACYCLOVIR TAB 400MG

Facility

$16.65

Hospital Charge Code	60628779
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.50

ACYCLOVIR VL 500MG

Facility

$419.85

Hospital Charge Code	6007462
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$209.93
Rate for Payer: Aetna Commercial	$159.54
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.95
Rate for Payer: Oxford Commercial	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$83.97
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

ACYCLOVIR VL 500MG

Facility

$419.85

Hospital Charge Code	6007462
Hospital Revenue Code	250
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

ACYLCARNITINE PLASMA

Facility

$390.00

Service Code	HCPCS 82017
Hospital Charge Code	39708050
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACYLCARNITINE PLASMA

Facility

$390.00

Service Code	HCPCS 82017
Hospital Charge Code	39708050
Hospital Revenue Code	307
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.90
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACYLCARNITINES QUANT EA

Facility

$119.00

Service Code	HCPCS 82017
Hospital Charge Code	38477142
Hospital Revenue Code	307
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.90
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

ACYLCARNITINES QUANT EA

Facility

$119.00

Service Code	HCPCS 82017
Hospital Charge Code	38477142
Hospital Revenue Code	307
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

AD-5230 HUMAN MEMBRANE

Facility

$2,975.00

Hospital Charge Code	270657198
Hospital Revenue Code	278
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$654.50
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Community & State	$71.70
Rate for Payer: Wellpoint Medicaid Managed Care	$78.84

AD-5230 HUMAN MEMBRANE

Facility

$2,975.00

Hospital Charge Code	270657198
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$654.50
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

ADACEL (TDAP)

Facility

$269.85

Service Code	HCPCS 90715
Hospital Charge Code	60635831
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$134.93
Rate for Payer: Aetna Commercial	$102.54
Rate for Payer: Aetna Medicare Advantage	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.81
Rate for Payer: Cigna Commercial	$134.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.30
Rate for Payer: Qualcare PPO/HMO/WC	$40.48
Rate for Payer: UnitedHealthcare Community & State	$6.50
Rate for Payer: Wellpoint Medicaid Managed Care	$7.15

ADACEL (TDAP)

Facility

$269.85

Service Code	HCPCS 90715
Hospital Charge Code	60635831
Hospital Revenue Code	636
Min. Negotiated Rate	$40.48
Max. Negotiated Rate	$65.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.30
Rate for Payer: Qualcare PPO/HMO/WC	$40.48

ADALAT/10MG/CAP

Facility

$4.00

Hospital Charge Code	60632398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ADALAT/10MG/CAP

Facility

$3.00

Hospital Charge Code	60632399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ADALAT/10MG/CAP

Facility

$3.00

Hospital Charge Code	60632399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ADALAT/10MG/CAP

Facility

$4.00

Hospital Charge Code	60632398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ADALAT/10MG/CAP

Facility

$3.00

Hospital Charge Code	60632397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ADALAT/10MG/CAP

Facility

$3.00

Hospital Charge Code	60632397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ADALAT/20MG/CAP

Facility

$3.00

Hospital Charge Code	60632400
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ADALAT/20MG/CAP

Facility

$3.00

Hospital Charge Code	60632400
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ADALIMUMAB ANTIDRUG AB FOR IBD

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520G
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

ADALIMUMAB ANTIDRUG AB FOR IBD

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520G
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges