Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALPRAZOLAM TAB 0.5MG

Facility

$7.70

Hospital Charge Code	60620036
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

ALPRAZOLAM TAB 0.5MG

Facility

$7.70

Hospital Charge Code	60620036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$15.59
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$223.53
Rate for Payer: Aetna Medicare Advantage	$176.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.00
Rate for Payer: Cigna Commercial	$294.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.24
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$15.59

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$88.24
Max. Negotiated Rate	$88.24
Rate for Payer: Qualcare PPO/HMO/WC	$88.24

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

ALPROSTADIL 0.5 MG/ML LNJ

Facility

$600.00

Hospital Charge Code	60628746
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ALPROSTADIL 0.5 MG/ML LNJ

Facility

$600.00

Hospital Charge Code	60628746
Hospital Revenue Code	250
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

ALTACE/1.25MG/TAB

Facility

$4.00

Hospital Charge Code	60634894
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

ALTACE/1.25MG/TAB

Facility

$4.00

Hospital Charge Code	60634894
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALTACE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634895
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTACE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634895
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ALTACE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634896
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTACE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634896
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ALTACE CAPS 10 MG

Facility

$3.00

Hospital Charge Code	60635340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTACE CAPS 10 MG

Facility

$3.00

Hospital Charge Code	60635340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$917.89
Max. Negotiated Rate	$1,480.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$90.34
Max. Negotiated Rate	$1,480.86
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.25
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89
Rate for Payer: UnitedHealthcare Community & State	$147.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$162.16

ALTEPLASE 2MG/2ML

Facility

$289.65

Hospital Charge Code	60628942
Hospital Revenue Code	636
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

ALTEPLASE 2MG/2ML

Facility

$289.65

Hospital Charge Code	60628942
Hospital Revenue Code	636
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$145.89
Max. Negotiated Rate	$235.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$343.25
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.25
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89
Rate for Payer: UnitedHealthcare Community & State	$23.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$25.77

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$90.34
Max. Negotiated Rate	$3,487.71
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.25
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81
Rate for Payer: UnitedHealthcare Community & State	$347.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$381.92

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$2,161.81
Max. Negotiated Rate	$3,487.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81

ALTEPLASE INJ 100MG

Facility

$18,581.80

Hospital Charge Code	6007041
Hospital Revenue Code	636
Min. Negotiated Rate	$447.82
Max. Negotiated Rate	$9,290.90
Rate for Payer: Aetna Commercial	$7,061.08
Rate for Payer: Aetna Medicare Advantage	$5,574.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,738.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,738.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,738.36
Rate for Payer: Cigna Commercial	$9,290.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,496.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.27
Rate for Payer: UnitedHealthcare Community & State	$447.82
Rate for Payer: Wellpoint Medicaid Managed Care	$492.42

Know your out-of-pocket cost for care.

All Charges