Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMIFOSTINE INJ 500MG

Facility

$1,731.20

Hospital Charge Code	6017099
Hospital Revenue Code	636
Min. Negotiated Rate	$259.68
Max. Negotiated Rate	$418.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.95
Rate for Payer: Qualcare PPO/HMO/WC	$259.68

AMIKACIN

Facility

$180.00

Service Code	HCPCS 80150
Hospital Charge Code	38472074
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

AMIKACIN

Facility

$180.00

Service Code	HCPCS 80150
Hospital Charge Code	38472074
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

AMIKACIN

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900316
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

AMIKACIN

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900316
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKACIN 500 MG/2ML INJ

Facility

$98.56

Service Code	HCPCS J0278
Hospital Charge Code	6007645
Hospital Revenue Code	636
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$23.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

AMIKACIN 500 MG/2ML INJ

Facility

$98.56

Service Code	HCPCS J0278
Hospital Charge Code	6007645
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$49.28
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.13
Rate for Payer: Cigna Commercial	$49.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.78
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

AMIKACIN INJ 500MG/2ML

Facility

$421.15

Hospital Charge Code	6007579
Hospital Revenue Code	250
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$210.57
Rate for Payer: Aetna Commercial	$160.04
Rate for Payer: Aetna Medicare Advantage	$126.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.39
Rate for Payer: Cigna Commercial	$210.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.34
Rate for Payer: Oxford Commercial	$84.23
Rate for Payer: Qualcare PPO/HMO/WC	$63.17
Rate for Payer: UnitedHealthcare Commercial	$84.23
Rate for Payer: UnitedHealthcare Community & State	$10.15
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

AMIKACIN INJ 500MG/2ML

Facility

$421.15

Hospital Charge Code	6007579
Hospital Revenue Code	250
Min. Negotiated Rate	$63.17
Max. Negotiated Rate	$63.17
Rate for Payer: Qualcare PPO/HMO/WC	$63.17

AMIKACIN OPH DROPS

Facility

$254.75

Hospital Charge Code	6006019
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$127.38
Rate for Payer: Aetna Commercial	$96.81
Rate for Payer: Aetna Medicare Advantage	$76.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.96
Rate for Payer: Cigna Commercial	$127.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.42
Rate for Payer: Oxford Commercial	$50.95
Rate for Payer: Qualcare PPO/HMO/WC	$38.21
Rate for Payer: UnitedHealthcare Commercial	$50.95
Rate for Payer: UnitedHealthcare Community & State	$6.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.75

AMIKACIN OPH DROPS

Facility

$254.75

Hospital Charge Code	6006019
Hospital Revenue Code	250
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$38.21
Rate for Payer: Qualcare PPO/HMO/WC	$38.21

AMIKACIN OPH IVT 4MG/ML

Facility

$432.00

Hospital Charge Code	6005995
Hospital Revenue Code	250
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

AMIKACIN OPH IVT 4MG/ML

Facility

$432.00

Hospital Charge Code	6005995
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMIKACIN,PEAK

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900315
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKACIN,PEAK

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900315
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

AMIKACIN PEAK OR TROUGH

Facility

$119.25

Service Code	HCPCS 80150
Hospital Charge Code	3008158
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

AMIKACIN PEAK OR TROUGH

Facility

$119.25

Service Code	HCPCS 80150
Hospital Charge Code	3008158
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

AMIKACIN TROUGH***

Facility

$88.00

Service Code	HCPCS 80150
Hospital Charge Code	3008166
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

AMIKACIN TROUGH***

Facility

$88.00

Service Code	HCPCS 80150
Hospital Charge Code	3008166
Hospital Revenue Code	301
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

AMIKACIN,TROUGH

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900003
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

AMIKACIN,TROUGH

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900003
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKIN/250MG/1ML

Facility

$257.00

Hospital Charge Code	60632433
Hospital Revenue Code	250
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$128.50
Rate for Payer: Aetna Commercial	$97.66
Rate for Payer: Aetna Medicare Advantage	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.53
Rate for Payer: Cigna Commercial	$128.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.10
Rate for Payer: Oxford Commercial	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.55
Rate for Payer: UnitedHealthcare Commercial	$51.40
Rate for Payer: UnitedHealthcare Community & State	$6.19
Rate for Payer: Wellpoint Medicaid Managed Care	$6.81

AMIKIN/250MG/1ML

Facility

$197.05

Service Code	NDC 703904003
Hospital Charge Code	60632432
Hospital Revenue Code	250
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$29.56
Rate for Payer: Qualcare PPO/HMO/WC	$29.56

AMIKIN/250MG/1ML

Facility

$257.00

Hospital Charge Code	60632433
Hospital Revenue Code	250
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

AMIKIN/250MG/1ML

Facility

$197.05

Service Code	NDC 703904003
Hospital Charge Code	60632432
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Commercial	$74.88
Rate for Payer: Aetna Medicare Advantage	$59.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.25
Rate for Payer: Cigna Commercial	$98.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.12
Rate for Payer: Oxford Commercial	$39.41
Rate for Payer: Qualcare PPO/HMO/WC	$29.56
Rate for Payer: UnitedHealthcare Commercial	$39.41
Rate for Payer: UnitedHealthcare Community & State	$4.75
Rate for Payer: Wellpoint Medicaid Managed Care	$5.22

Know your out-of-pocket cost for care.

All Charges