Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALBUTEROL INH SOL 0.83% 3ML

Facility

$4.85

Hospital Charge Code	6012199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

ALBUTEROL-IPRATROPIUM INHALER

Facility

$2,237.80

Service Code	NDC 597002402
Hospital Charge Code	60628929
Hospital Revenue Code	250
Min. Negotiated Rate	$53.93
Max. Negotiated Rate	$1,118.90
Rate for Payer: Aetna Commercial	$850.36
Rate for Payer: Aetna Medicare Advantage	$671.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.64
Rate for Payer: Cigna Commercial	$1,118.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.34
Rate for Payer: Oxford Commercial	$447.56
Rate for Payer: Qualcare PPO/HMO/WC	$335.67
Rate for Payer: UnitedHealthcare Commercial	$447.56
Rate for Payer: UnitedHealthcare Community & State	$53.93
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

ALBUTEROL-IPRATROPIUM INHALER

Facility

$2,237.80

Service Code	NDC 597002402
Hospital Charge Code	60628929
Hospital Revenue Code	250
Min. Negotiated Rate	$335.67
Max. Negotiated Rate	$335.67
Rate for Payer: Qualcare PPO/HMO/WC	$335.67

ALBUTEROL RESP 5MG/ML 20ML

Facility

$82.60

Hospital Charge Code	6005888
Hospital Revenue Code	250
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

ALBUTEROL RESP 5MG/ML 20ML

Facility

$82.60

Hospital Charge Code	6005888
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.78
Rate for Payer: Oxford Commercial	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$16.52
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

ALBUTEROL SULFT 0.042% 3ML SOL

Facility

$10.65

Service Code	NDC 487990401
Hospital Charge Code	60630093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.33
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare Advantage	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.72
Rate for Payer: Cigna Commercial	$5.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.19
Rate for Payer: Oxford Commercial	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.60
Rate for Payer: UnitedHealthcare Commercial	$2.13
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

ALBUTEROL SULFT 0.042% 3ML SOL

Facility

$10.65

Service Code	NDC 487990401
Hospital Charge Code	60630093
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.60

ALBUTEROL TAB 4MG

Facility

$4.50

Hospital Charge Code	60627442
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

ALBUTEROL TAB 4MG

Facility

$4.50

Hospital Charge Code	60627442
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

ALBUTEROL TAB CR 4MG

Facility

$8.35

Hospital Charge Code	60627443
Hospital Revenue Code	252
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$1.67
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

ALBUTEROL TAB CR 4MG

Facility

$8.35

Hospital Charge Code	60627443
Hospital Revenue Code	252
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

ALCHOHOL ETHYL 190 PROOF-5GAL

Facility

$251.25

Hospital Charge Code	270657896
Hospital Revenue Code	272
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$125.62
Rate for Payer: Aetna Commercial	$95.47
Rate for Payer: Aetna Medicare Advantage	$75.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.07
Rate for Payer: Cigna Commercial	$125.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.38
Rate for Payer: Oxford Commercial	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$37.69
Rate for Payer: UnitedHealthcare Commercial	$50.25
Rate for Payer: UnitedHealthcare Community & State	$6.06
Rate for Payer: Wellpoint Medicaid Managed Care	$6.66

ALCHOHOL ETHYL 190 PROOF-5GAL

Facility

$251.25

Hospital Charge Code	270657896
Hospital Revenue Code	272
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$37.69
Rate for Payer: Qualcare PPO/HMO/WC	$37.69

ALCIAN BLUE STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005251
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

ALCIAN BLUE STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005251
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

ALCOHOL 70%

Facility

$6.88

Hospital Charge Code	270650527
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.44
Rate for Payer: Aetna Commercial	$2.61
Rate for Payer: Aetna Medicare Advantage	$2.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.75
Rate for Payer: Cigna Commercial	$3.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.03
Rate for Payer: UnitedHealthcare Commercial	$1.38
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

ALCOHOL 70%

Facility

$6.88

Hospital Charge Code	270650527
Hospital Revenue Code	272
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.03

ALCOHOL 70% BOTTLE

Facility

$4.50

Hospital Charge Code	6012207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

ALCOHOL 70% BOTTLE

Facility

$4.50

Hospital Charge Code	6012207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

ALCOHOL ABUSE AND DEPENDENCE

Facility

$11,078.03

Service Code	APR-DRG 7753
Min. Negotiated Rate	$10,860.81
Max. Negotiated Rate	$11,078.03
Rate for Payer: UnitedHealthcare Community & State	$10,860.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,078.03
Rate for Payer: Wellpoint Medicaid Managed Care	$10,860.81

ALCOHOL ABUSE AND DEPENDENCE

Facility

$25,549.54

Service Code	APR-DRG 7754
Min. Negotiated Rate	$25,048.57
Max. Negotiated Rate	$25,549.54
Rate for Payer: UnitedHealthcare Community & State	$25,048.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,549.54
Rate for Payer: Wellpoint Medicaid Managed Care	$25,048.57

ALCOHOL ABUSE AND DEPENDENCE

Facility

$6,442.25

Service Code	APR-DRG 7752
Min. Negotiated Rate	$6,315.93
Max. Negotiated Rate	$6,442.25
Rate for Payer: UnitedHealthcare Community & State	$6,315.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,442.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6,315.93

ALCOHOL ABUSE AND DEPENDENCE

Facility

$4,769.80

Service Code	APR-DRG 7751
Min. Negotiated Rate	$4,676.27
Max. Negotiated Rate	$4,769.80
Rate for Payer: UnitedHealthcare Community & State	$4,676.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,769.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4,676.27

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$7,056.38

Service Code	APR-DRG 7722
Min. Negotiated Rate	$6,918.02
Max. Negotiated Rate	$7,056.38
Rate for Payer: UnitedHealthcare Community & State	$6,918.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,056.38
Rate for Payer: Wellpoint Medicaid Managed Care	$6,918.02

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$8,816.98

Service Code	APR-DRG 7723
Min. Negotiated Rate	$8,644.10
Max. Negotiated Rate	$8,816.98
Rate for Payer: UnitedHealthcare Community & State	$8,644.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,816.98
Rate for Payer: Wellpoint Medicaid Managed Care	$8,644.10

Know your out-of-pocket cost for care.

All Charges