Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ADVAIR 45/21 INH

Facility

$1,291.96

Service Code	NDC 173071522
Hospital Charge Code	6063943052
Hospital Revenue Code	250
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$645.98
Rate for Payer: Aetna Commercial	$490.94
Rate for Payer: Aetna Medicare Advantage	$387.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.45
Rate for Payer: Cigna Commercial	$645.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.59
Rate for Payer: Oxford Commercial	$258.39
Rate for Payer: Qualcare PPO/HMO/WC	$193.79
Rate for Payer: UnitedHealthcare Commercial	$258.39
Rate for Payer: UnitedHealthcare Community & State	$31.14
Rate for Payer: Wellpoint Medicaid Managed Care	$34.24

ADVAIR DISKUS 100/50

Facility

$86.00

Hospital Charge Code	60635493
Hospital Revenue Code	250
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

ADVAIR DISKUS 100/50

Facility

$86.00

Hospital Charge Code	60635493
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$32.68
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.93
Rate for Payer: Cigna Commercial	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$17.20
Rate for Payer: UnitedHealthcare Community & State	$2.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

ADVAIR DISKUS 250/50

Facility

$4.00

Hospital Charge Code	60635418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ADVAIR DISKUS 250/50

Facility

$4.00

Hospital Charge Code	60635418
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

ADVAIR DISKUS 500/50

Facility

$5.00

Hospital Charge Code	60635419
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

ADVAIR DISKUS 500/50

Facility

$5.00

Hospital Charge Code	60635419
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ADVAIR DSK 250/50 MCG

Facility

$50.28

Service Code	NDC 173069604
Hospital Charge Code	60629363
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.14
Rate for Payer: Aetna Commercial	$19.11
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.82
Rate for Payer: Cigna Commercial	$25.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$10.06
Rate for Payer: Qualcare PPO/HMO/WC	$7.54
Rate for Payer: UnitedHealthcare Commercial	$10.06
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

ADVAIR DSK 250/50 MCG

Facility

$50.28

Service Code	NDC 173069604
Hospital Charge Code	60629363
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$7.54

ADVANCE EVOLUTION PIN PINPACK

Facility

$2,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270678419
Hospital Revenue Code	278
Min. Negotiated Rate	$51.67
Max. Negotiated Rate	$1,071.95
Rate for Payer: Aetna Commercial	$814.68
Rate for Payer: Aetna Medicare Advantage	$643.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$546.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$546.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$546.69
Rate for Payer: Cigna Commercial	$1,071.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$518.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$471.66
Rate for Payer: Qualcare PPO/HMO/WC	$321.58
Rate for Payer: UnitedHealthcare Community & State	$51.67
Rate for Payer: Wellpoint Medicaid Managed Care	$56.81

ADVANCE EVOLUTION PIN PINPACK

Facility

$2,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270678419
Hospital Revenue Code	278
Min. Negotiated Rate	$321.58
Max. Negotiated Rate	$518.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$518.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$471.66
Rate for Payer: Qualcare PPO/HMO/WC	$321.58

ADVANIX RX PANC ST KIT STR 4FR

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270670852
Hospital Revenue Code	278
Min. Negotiated Rate	$127.82
Max. Negotiated Rate	$206.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82

ADVANIX RX PANC ST KIT STR 4FR

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270680471
Hospital Revenue Code	278
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$426.07
Rate for Payer: Aetna Commercial	$323.82
Rate for Payer: Aetna Medicare Advantage	$255.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.30
Rate for Payer: Cigna Commercial	$426.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$22.58

ADVANIX RX PANC ST KIT STR 4FR

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270680471
Hospital Revenue Code	278
Min. Negotiated Rate	$127.82
Max. Negotiated Rate	$206.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82

ADVANIX RX PANC ST KIT STR 4FR

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270670852
Hospital Revenue Code	278
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$426.07
Rate for Payer: Aetna Commercial	$323.82
Rate for Payer: Aetna Medicare Advantage	$255.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.30
Rate for Payer: Cigna Commercial	$426.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.47
Rate for Payer: Qualcare PPO/HMO/WC	$127.82
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$22.58

ADVANIX RX PANC ST KIT STR 5FR

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679132
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

ADVANIX RX PANC ST KIT STR 5FR

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679132
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

ADV LIFE SUPP (ALS) LVL 1 - ER

Facility

$1,800.00

Hospital Charge Code	26000511
Hospital Revenue Code	540
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

ADV LIFE SUPP (ALS) LVL 1 - ER

Facility

$1,800.00

Hospital Charge Code	26000511
Hospital Revenue Code	540
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.00
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

ADV LIFE SUPP (ALS) LVL 2 - ER

Facility

$2,500.00

Hospital Charge Code	26000514
Hospital Revenue Code	540
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

ADV LIFE SUPP (ALS) LVL 2 - ER

Facility

$2,500.00

Hospital Charge Code	26000514
Hospital Revenue Code	540
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

ADV POST TIBIAL TNDON W EXC NA

Facility

$57,834.50

Service Code	HCPCS 28238
Hospital Charge Code	16000364
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,350.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,393.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,532.61

ADV POST TIBIAL TNDON W EXC NA

Facility

$57,834.50

Service Code	HCPCS 28238
Hospital Charge Code	16000364
Hospital Revenue Code	360
Min. Negotiated Rate	$8,675.17
Max. Negotiated Rate	$8,675.17
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17

AEP NEURODIAGNOSTIC I&R

Facility

$1,597.40

Service Code	HCPCS 92653
Hospital Charge Code	309292653
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

AEP NEURODIAGNOSTIC I&R

Facility

$1,597.40

Service Code	HCPCS 92653
Hospital Charge Code	404392653
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

Know your out-of-pocket cost for care.

All Charges