Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALENDRONATE SOD 35MG TAB

Facility

$138.22

Service Code	NDC 16714063201
Hospital Charge Code	606390411
Hospital Revenue Code	250
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$20.73
Rate for Payer: Qualcare PPO/HMO/WC	$20.73

ALENDRONATE TAB 10MG

Facility

$9.00

Hospital Charge Code	6016547
Hospital Revenue Code	252
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

ALENDRONATE TAB 10MG

Facility

$9.00

Hospital Charge Code	6016547
Hospital Revenue Code	252
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

ALEUTAIN 24X30MM 10DEG LOR 9MM

Facility

$21,870.00

Hospital Charge Code	270670094
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 10DEG LOR 9MM

Facility

$21,870.00

Hospital Charge Code	270670094
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG CON 13MM

Facility

$20,795.00

Hospital Charge Code	270670107
Hospital Revenue Code	278
Min. Negotiated Rate	$501.16
Max. Negotiated Rate	$10,397.50
Rate for Payer: Aetna Commercial	$7,902.10
Rate for Payer: Aetna Medicare Advantage	$6,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,302.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,302.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,302.73
Rate for Payer: Cigna Commercial	$10,397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,032.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,574.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,119.25
Rate for Payer: UnitedHealthcare Community & State	$501.16
Rate for Payer: Wellpoint Medicaid Managed Care	$551.07

ALEUTAIN 24X30MM 10DG CON 13MM

Facility

$20,795.00

Hospital Charge Code	270670107
Hospital Revenue Code	278
Min. Negotiated Rate	$3,119.25
Max. Negotiated Rate	$5,032.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,032.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,574.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,119.25

ALEUTAIN 24X30MM 10DG LOR 11MM

Facility

$21,870.00

Hospital Charge Code	270670101
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 10DG LOR 11MM

Facility

$21,870.00

Hospital Charge Code	270670101
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG LOR 13MM

Facility

$21,870.00

Hospital Charge Code	270670110
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 10DG LOR 13MM

Facility

$21,870.00

Hospital Charge Code	270670110
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG LOR 15MM

Facility

$21,870.00

Hospital Charge Code	270670118
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG LOR 15MM

Facility

$21,870.00

Hospital Charge Code	270670118
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 10DG LOR 17MM

Facility

$21,870.00

Hospital Charge Code	270670126
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 10DG LOR 17MM

Facility

$21,870.00

Hospital Charge Code	270670126
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG LOR 19MM

Facility

$21,870.00

Hospital Charge Code	270670133
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 10DG LOR 19MM

Facility

$21,870.00

Hospital Charge Code	270670133
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 15DG LOR 11MM

Facility

$21,870.00

Hospital Charge Code	270670100
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 15DG LOR 11MM

Facility

$21,870.00

Hospital Charge Code	270670100
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 15DG LOR 13MM

Facility

$21,870.00

Hospital Charge Code	270670108
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 15DG LOR 13MM

Facility

$21,870.00

Hospital Charge Code	270670108
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 15DG LOR 15MM

Facility

$21,870.00

Hospital Charge Code	270670117
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 15DG LOR 15MM

Facility

$21,870.00

Hospital Charge Code	270670117
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

ALEUTAIN 24X30MM 15DG LOR 17MM

Facility

$21,870.00

Hospital Charge Code	270670125
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.50
Max. Negotiated Rate	$5,292.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50

ALEUTAIN 24X30MM 15DG LOR 17MM

Facility

$21,870.00

Hospital Charge Code	270670125
Hospital Revenue Code	278
Min. Negotiated Rate	$527.07
Max. Negotiated Rate	$10,935.00
Rate for Payer: Aetna Commercial	$8,310.60
Rate for Payer: Aetna Medicare Advantage	$6,561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,576.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,576.85
Rate for Payer: Cigna Commercial	$10,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,292.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,811.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,280.50
Rate for Payer: UnitedHealthcare Community & State	$527.07
Rate for Payer: Wellpoint Medicaid Managed Care	$579.55

Know your out-of-pocket cost for care.

All Charges