Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EZETIMIBE 10 MG TAB

Facility

$57.69

Service Code	NDC 66582041431
Hospital Charge Code	60629852
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$21.92
Rate for Payer: Aetna Medicare Advantage	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.71
Rate for Payer: Cigna Commercial	$28.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.31
Rate for Payer: Oxford Commercial	$11.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$11.54
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

EZETIMIBE 10 MG TAB

Facility

$57.69

Service Code	NDC 66582041431
Hospital Charge Code	60629852
Hospital Revenue Code	250
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

EZETIMIBE-VASTATIN 10-20MG TAB

Facility

$14.80

Hospital Charge Code	60629940
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$2.96
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

EZETIMIBE-VASTATIN 10-20MG TAB

Facility

$14.80

Hospital Charge Code	60629940
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

EZETIMIBE-VASTATIN 10-40MG TAB

Facility

$14.80

Hospital Charge Code	60629941
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

EZETIMIBE-VASTATIN 10-40MG TAB

Facility

$14.80

Hospital Charge Code	60629941
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$2.96
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

EZETIMIBE-VASTATIN 10-80MG TAB

Facility

$14.80

Hospital Charge Code	60629942
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

EZETIMIBE-VASTATIN 10-80MG TAB

Facility

$14.80

Hospital Charge Code	60629942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$2.96
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

E-Z GAS II

Facility

$11.34

Hospital Charge Code	60635824
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.67
Rate for Payer: Aetna Commercial	$4.31
Rate for Payer: Aetna Medicare Advantage	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.89
Rate for Payer: Cigna Commercial	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.40
Rate for Payer: Oxford Commercial	$2.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.70
Rate for Payer: UnitedHealthcare Commercial	$2.27
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

E-Z GAS II

Facility

$11.34

Hospital Charge Code	60635824
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.70

E-Z GAS II GRANULES

Facility

$18.96

Service Code	NDC 10361079301
Hospital Charge Code	606380028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.83
Rate for Payer: Cigna Commercial	$9.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.69
Rate for Payer: Oxford Commercial	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.84
Rate for Payer: UnitedHealthcare Commercial	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

E-Z GAS II GRANULES

Facility

$18.96

Service Code	NDC 10361079301
Hospital Charge Code	606380028
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.84

E-Z HD 98%

Facility

$45.16

Service Code	NDC 32909076401
Hospital Charge Code	60635822
Hospital Revenue Code	250
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$6.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.77

E-Z HD 98%

Facility

$45.16

Service Code	NDC 32909076401
Hospital Charge Code	60635822
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$22.58
Rate for Payer: Aetna Commercial	$17.16
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.52
Rate for Payer: Cigna Commercial	$22.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: Oxford Commercial	$9.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.77
Rate for Payer: UnitedHealthcare Commercial	$9.03
Rate for Payer: UnitedHealthcare Community & State	$1.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

EZ-M READY CAT 450ml

Facility

$20.56

Hospital Charge Code	270600436
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

EZ-M READY CAT 450ml

Facility

$20.56

Hospital Charge Code	270600436
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.28
Rate for Payer: Aetna Commercial	$7.81
Rate for Payer: Aetna Medicare Advantage	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.24
Rate for Payer: Cigna Commercial	$10.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$3.08
Rate for Payer: UnitedHealthcare Commercial	$4.11
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
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

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,928.00
Max. Negotiated Rate	$40,000.00
Rate for Payer: Aetna Commercial	$30,400.00
Rate for Payer: Aetna Medicare Advantage	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,400.00
Rate for Payer: Cigna Commercial	$40,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00
Rate for Payer: UnitedHealthcare Community & State	$1,928.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2,120.00

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$12,000.00
Max. Negotiated Rate	$19,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00

F3D-C2 STAND ALONE CERVICAL 7M

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706211
Hospital Revenue Code	278
Min. Negotiated Rate	$374.75
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$5,909.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50
Rate for Payer: UnitedHealthcare Community & State	$374.75
Rate for Payer: Wellpoint Medicaid Managed Care	$412.07

F3D-C2 STAND ALONE CERVICAL 7M

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$692.88
Max. Negotiated Rate	$14,375.00
Rate for Payer: Aetna Commercial	$10,925.00
Rate for Payer: Aetna Medicare Advantage	$8,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,331.25
Rate for Payer: Cigna Commercial	$14,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,325.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50
Rate for Payer: UnitedHealthcare Community & State	$692.88
Rate for Payer: Wellpoint Medicaid Managed Care	$761.88

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$4,312.50
Max. Negotiated Rate	$6,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,325.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Oxford Commercial	$22.59
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$22.59
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

Know your out-of-pocket cost for care.

All Charges