Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CYTO SPUTUM

Facility

$390.00

Service Code	HCPCS 88108
Hospital Charge Code	3001336
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYTOTEC/100MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60634757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.65
Rate for Payer: Oxford Commercial	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.82
Rate for Payer: UnitedHealthcare Commercial	$3.77
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CYTOTEC/100MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60634757
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

CYTOTEC/200MCG/TAB

Facility

$6.00

Hospital Charge Code	60632769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CYTOTEC/200MCG/TAB

Facility

$6.00

Hospital Charge Code	60632769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CYTOTEC 200MCG TABLET

Facility

$27.40

Service Code	NDC 25146134
Hospital Charge Code	60632358
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

CYTOTEC 200MCG TABLET

Facility

$27.40

Service Code	NDC 25146134
Hospital Charge Code	60632358
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

CYTOTEC 25MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60635563
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.65
Rate for Payer: Oxford Commercial	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.82
Rate for Payer: UnitedHealthcare Commercial	$3.77
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CYTOTEC 25MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60635563
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

CYTOVENE

Facility

$19.00

Hospital Charge Code	60635010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

CYTOVENE

Facility

$19.00

Hospital Charge Code	60635010
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

CYTOXAN, 25MG,TAB

Facility

$2.00

Hospital Charge Code	60635433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

CYTOXAN, 25MG,TAB

Facility

$2.00

Hospital Charge Code	60635433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CYTOXAN 50MG ORAL

Facility

$115.11

Service Code	NDC 54038325
Hospital Charge Code	60634363
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$43.74
Rate for Payer: Aetna Medicare Advantage	$34.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.35
Rate for Payer: Cigna Commercial	$57.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.53
Rate for Payer: Oxford Commercial	$23.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.27
Rate for Payer: UnitedHealthcare Commercial	$23.02
Rate for Payer: UnitedHealthcare Community & State	$2.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

CYTOXAN 50MG ORAL

Facility

$115.11

Service Code	NDC 54038325
Hospital Charge Code	60634363
Hospital Revenue Code	250
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$17.27
Rate for Payer: Qualcare PPO/HMO/WC	$17.27

CYT PATH THIN LAYER AUTO,MD SU

Facility

$150.39

Service Code	HCPCS 88174
Hospital Charge Code	38478091
Hospital Revenue Code	311
Min. Negotiated Rate	$22.56
Max. Negotiated Rate	$22.56
Rate for Payer: Qualcare PPO/HMO/WC	$22.56

CYT PATH THIN LAYER AUTO,MD SU

Facility

$150.39

Service Code	HCPCS 88174
Hospital Charge Code	38478091
Hospital Revenue Code	311
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$69.01
Rate for Payer: Aetna Medicare Advantage	$82.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.58
Rate for Payer: Cigna Commercial	$75.19
Rate for Payer: Cigna Medicare Advantage	$25.37
Rate for Payer: Clover Medicare Advantage	$24.10
Rate for Payer: EmblemHealth Commercial	$76.11
Rate for Payer: Humana Medicare Advantage	$26.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.56
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$20.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.37
Rate for Payer: Wellcare Medicare Advantage	$25.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

D10 W NACL 0.2% 250ML

Facility

$45.69

Service Code	NDC 264762320
Hospital Charge Code	606390152
Hospital Revenue Code	258
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: Qualcare PPO/HMO/WC	$6.85

D10 W NACL 0.2% 250ML

Facility

$45.69

Service Code	NDC 264762320
Hospital Charge Code	606390152
Hospital Revenue Code	258
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.84
Rate for Payer: Aetna Commercial	$17.36
Rate for Payer: Aetna Medicare Advantage	$13.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.65
Rate for Payer: Cigna Commercial	$22.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.71
Rate for Payer: Oxford Commercial	$9.14
Rate for Payer: Qualcare PPO/HMO/WC	$6.85
Rate for Payer: UnitedHealthcare Commercial	$9.14
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

D50 SYRINGE

Facility

$36.00

Hospital Charge Code	60627956W
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

D50 SYRINGE

Facility

$36.00

Hospital Charge Code	60627956W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

D5W 1000ML POLYOLEFIN

Facility

$64.00

Hospital Charge Code	60635084
Hospital Revenue Code	258
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

D5W 1000ML POLYOLEFIN

Facility

$64.00

Hospital Charge Code	60635084
Hospital Revenue Code	258
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

DABIGATRA ETEX MESYLAT 150 CAP

Facility

$42.14

Service Code	NDC 597036082
Hospital Charge Code	60630061
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

DABIGATRA ETEX MESYLAT 150 CAP

Facility

$42.14

Service Code	NDC 597036082
Hospital Charge Code	60630061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.07
Rate for Payer: Aetna Commercial	$16.01
Rate for Payer: Aetna Medicare Advantage	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.75
Rate for Payer: Cigna Commercial	$21.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.64
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$8.43
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

Know your out-of-pocket cost for care.

All Charges