Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALUPENT/650MCG/14GM

Facility

$69.00

Hospital Charge Code	60632430
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

ALUPENT/650MCG/14GM

Facility

$69.00

Hospital Charge Code	60632430
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

ALVEO SAMPLER KIT***

Facility

$48.00

Hospital Charge Code	2300895
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

ALVEO SAMPLER KIT***

Facility

$48.00

Hospital Charge Code	2300895
Hospital Revenue Code	271
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	160000251
Hospital Revenue Code	360
Min. Negotiated Rate	$1,563.21
Max. Negotiated Rate	$1,563.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	1600000614
Hospital Revenue Code	360
Min. Negotiated Rate	$1,563.21
Max. Negotiated Rate	$1,563.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	160000251
Hospital Revenue Code	360
Min. Negotiated Rate	$251.16
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,960.13
Rate for Payer: Aetna Medicare Advantage	$3,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,657.46
Rate for Payer: Cigna Commercial	$5,210.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,126.42
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$251.16
Rate for Payer: Wellpoint Medicaid Managed Care	$276.17

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	1600000614
Hospital Revenue Code	360
Min. Negotiated Rate	$251.16
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,960.13
Rate for Payer: Aetna Medicare Advantage	$3,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,657.46
Rate for Payer: Cigna Commercial	$5,210.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,126.42
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$251.16
Rate for Payer: Wellpoint Medicaid Managed Care	$276.17

AMANTADINE 100 MG CAP

Facility

$6.50

Service Code	NDC 52959000710
Hospital Charge Code	60628566
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

AMANTADINE 100 MG CAP

Facility

$6.50

Service Code	NDC 52959000710
Hospital Charge Code	60628566
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

AMANTADINE LIQ 50MG/5ML-16 OZ

Facility

$432.00

Hospital Charge Code	6005987
Hospital Revenue Code	252
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$164.16
Rate for Payer: Aetna Medicare Advantage	$129.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.16
Rate for Payer: Cigna Commercial	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.60
Rate for Payer: Oxford Commercial	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$64.80
Rate for Payer: UnitedHealthcare Commercial	$86.40
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: Wellpoint Medicaid Managed Care	$11.45

AMANTADINE LIQ 50MG/5ML-16 OZ

Facility

$432.00

Hospital Charge Code	6005987
Hospital Revenue Code	252
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMANTADINE ORAL 100MG 10MLDOSE

Facility

$33.10

Service Code	NDC 121064610
Hospital Charge Code	606390422
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$4.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.96

AMANTADINE ORAL 100MG 10MLDOSE

Facility

$33.10

Service Code	NDC 121064610
Hospital Charge Code	606390422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.55
Rate for Payer: Aetna Commercial	$12.58
Rate for Payer: Aetna Medicare Advantage	$9.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.44
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.93
Rate for Payer: Oxford Commercial	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.96
Rate for Payer: UnitedHealthcare Commercial	$6.62
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

AMARYL 1MG TAB

Facility

$8.04

Service Code	NDC 39022110
Hospital Charge Code	60635513
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

AMARYL 1MG TAB

Facility

$8.04

Service Code	NDC 39022110
Hospital Charge Code	60635513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

AMARYL 4MG TAB

Facility

$45.00

Hospital Charge Code	60635514
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

AMARYL 4MG TAB

Facility

$45.00

Hospital Charge Code	60635514
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

AMAXILLO FACEAL FRACTURE KIT

Facility

$212.00

Hospital Charge Code	270332022
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

AMAXILLO FACEAL FRACTURE KIT

Facility

$212.00

Hospital Charge Code	270332022
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.60
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

AMBEIN/10MG/TAB/U/D

Facility

$5.00

Hospital Charge Code	60634933
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

AMBEIN/10MG/TAB/U/D

Facility

$5.00

Hospital Charge Code	60634933
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

AMBEIN/5MG/TAB/U/D

Facility

$12.00

Hospital Charge Code	60634932
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

AMBEIN/5MG/TAB/U/D

Facility

$12.00

Hospital Charge Code	60634932
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

AMBICOR PENILE PROTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.96
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$26,457.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,317.50
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75
Rate for Payer: UnitedHealthcare Community & State	$1,677.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1,845.06

Know your out-of-pocket cost for care.

All Charges