Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALBUMIN SERUM

Facility

$667.59

Service Code	HCPCS 82040
Hospital Charge Code	3002847
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ALBUMIN SERUM

Facility

$667.59

Service Code	HCPCS 82040
Hospital Charge Code	3002847
Hospital Revenue Code	307
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ALBUMIN SERUM 25% 50ML

Facility

$515.20

Hospital Charge Code	6005862
Hospital Revenue Code	636
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$257.60
Rate for Payer: Aetna Commercial	$195.78
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$257.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.68
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Community & State	$12.42
Rate for Payer: Wellpoint Medicaid Managed Care	$13.65

ALBUMIN SERUM 25% 50ML

Facility

$515.20

Hospital Charge Code	6005862
Hospital Revenue Code	636
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$124.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.68
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

ALBUMIN SYNOVIAL FLUID

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3002846
Hospital Revenue Code	307
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

ALBUMIN SYNOVIAL FLUID

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3002846
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$68.75
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

ALBUTERAL 2.5MG IPRA 0.5MG

Facility

$100.00

Hospital Charge Code	83652539
Hospital Revenue Code	250
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

ALBUTERAL 2.5MG IPRA 0.5MG

Facility

$100.00

Hospital Charge Code	83652539
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

ALBUTEROL2.5MG/IPRATRPM O.5MG

Facility

$14.67

Service Code	NDC 487020103
Hospital Charge Code	60629271
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare Advantage	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.74
Rate for Payer: Cigna Commercial	$7.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.40
Rate for Payer: Oxford Commercial	$2.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.20
Rate for Payer: UnitedHealthcare Commercial	$2.93
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

ALBUTEROL2.5MG/IPRATRPM O.5MG

Facility

$14.67

Service Code	NDC 487020103
Hospital Charge Code	60629271
Hospital Revenue Code	250
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.20

ALBUTEROL 2 MG/5 ML SYRUP

Facility

$1.65

Hospital Charge Code	60627441
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna Commercial	$0.63
Rate for Payer: Aetna Medicare Advantage	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.42
Rate for Payer: Cigna Commercial	$0.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.25
Rate for Payer: UnitedHealthcare Commercial	$0.33
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

ALBUTEROL 2 MG/5 ML SYRUP

Facility

$1.65

Hospital Charge Code	60627441
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.25

ALBUTEROL 2MG/5ML UD

Facility

$4.29

Service Code	NDC 50383074016
Hospital Charge Code	60635051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

ALBUTEROL 2MG/5ML UD

Facility

$4.29

Service Code	NDC 50383074016
Hospital Charge Code	60635051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.15
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.09
Rate for Payer: Cigna Commercial	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.29
Rate for Payer: Oxford Commercial	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$0.86
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALBUTEROL 2 MG TAB

Facility

$1.60

Hospital Charge Code	60627440
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.61
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.48
Rate for Payer: Oxford Commercial	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.32
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

ALBUTEROL 2 MG TAB

Facility

$1.60

Hospital Charge Code	60627440
Hospital Revenue Code	251
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

ALBUTEROL 90 MCG INHALER

Facility

$1,254.24

Service Code	NDC 54569616600
Hospital Charge Code	60627439
Hospital Revenue Code	250
Min. Negotiated Rate	$188.14
Max. Negotiated Rate	$188.14
Rate for Payer: Qualcare PPO/HMO/WC	$188.14

ALBUTEROL 90 MCG INHALER

Facility

$1,254.24

Service Code	NDC 54569616600
Hospital Charge Code	60627439
Hospital Revenue Code	250
Min. Negotiated Rate	$30.23
Max. Negotiated Rate	$627.12
Rate for Payer: Aetna Commercial	$476.61
Rate for Payer: Aetna Medicare Advantage	$376.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.83
Rate for Payer: Cigna Commercial	$627.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.27
Rate for Payer: Oxford Commercial	$250.85
Rate for Payer: Qualcare PPO/HMO/WC	$188.14
Rate for Payer: UnitedHealthcare Commercial	$250.85
Rate for Payer: UnitedHealthcare Community & State	$30.23
Rate for Payer: Wellpoint Medicaid Managed Care	$33.24

ALBUTEROL 90MCG/SPRAY MDI

Facility

$74.90

Hospital Charge Code	60629141
Hospital Revenue Code	259
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

ALBUTEROL 90MCG/SPRAY MDI

Facility

$74.90

Hospital Charge Code	60629141
Hospital Revenue Code	259
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

ALBUTEROL INH 0.083% 3 ML

Facility

$5.36

Service Code	NDC 487950101
Hospital Charge Code	6005870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

ALBUTEROL INH 0.083% 3 ML

Facility

$5.36

Service Code	NDC 487950101
Hospital Charge Code	6005870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

ALBUTEROL INH.0.83MG/ML SOL

Facility

$19.00

Hospital Charge Code	83652547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

ALBUTEROL INH.0.83MG/ML SOL

Facility

$19.00

Hospital Charge Code	83652547
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

ALBUTEROL INH SOL 0.83% 3ML

Facility

$4.85

Hospital Charge Code	6012199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

Know your out-of-pocket cost for care.

All Charges