Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMINOPHYLLINE INJ 500MG/20ML

Facility

$7.70

Hospital Charge Code	60628471
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

AMINOPHYLLINE LIQ DF 8OZ

Facility

$52.50

Hospital Charge Code	6012215
Hospital Revenue Code	251
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

AMINOPHYLLINE LIQ DF 8OZ

Facility

$52.50

Hospital Charge Code	6012215
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

AMINOPHYLLIN INJ/250MG

Facility

$4.00

Hospital Charge Code	60634284
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMINOPHYLLIN INJ/250MG

Facility

$4.00

Hospital Charge Code	60634284
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$48.84
Rate for Payer: Aetna Commercial	$37.12
Rate for Payer: Aetna Medicare Advantage	$29.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.91
Rate for Payer: Cigna Commercial	$48.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.31
Rate for Payer: Oxford Commercial	$19.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.65
Rate for Payer: UnitedHealthcare Commercial	$19.54
Rate for Payer: UnitedHealthcare Community & State	$2.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$14.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.65

AMINOSYN 10% 1000ML

Facility

$39.00

Hospital Charge Code	60635449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AMINOSYN 10% 1000ML

Facility

$39.00

Hospital Charge Code	60635449
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

AMINOSYN2 4.25%+10% DEXTR

Facility

$427.00

Hospital Charge Code	60634255
Hospital Revenue Code	250
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$64.05

AMINOSYN2 4.25%+10% DEXTR

Facility

$427.00

Hospital Charge Code	60634255
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.50
Rate for Payer: Aetna Commercial	$162.26
Rate for Payer: Aetna Medicare Advantage	$128.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.89
Rate for Payer: Cigna Commercial	$213.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.10
Rate for Payer: Oxford Commercial	$85.40
Rate for Payer: Qualcare PPO/HMO/WC	$64.05
Rate for Payer: UnitedHealthcare Commercial	$85.40
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.32

AMINOSYN2 4.25%+25%/1000C

Facility

$432.00

Hospital Charge Code	60634252
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMINOSYN2 4.25%+25%/1000C

Facility

$432.00

Hospital Charge Code	60634252
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

AMINOSYN2 4.25%+25%W/LYTE

Facility

$432.00

Hospital Charge Code	60634253
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

AMINOSYN2 4.25%+25%W/LYTE

Facility

$432.00

Hospital Charge Code	60634253
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMINOSYN 8.5%/500CC

Facility

$237.00

Hospital Charge Code	60634254
Hospital Revenue Code	250
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$35.55
Rate for Payer: Qualcare PPO/HMO/WC	$35.55

AMINOSYN 8.5%/500CC

Facility

$237.00

Hospital Charge Code	60634254
Hospital Revenue Code	250
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$90.06
Rate for Payer: Aetna Medicare Advantage	$71.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.44
Rate for Payer: Cigna Commercial	$118.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.10
Rate for Payer: Oxford Commercial	$47.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.55
Rate for Payer: UnitedHealthcare Commercial	$47.40
Rate for Payer: UnitedHealthcare Community & State	$5.71
Rate for Payer: Wellpoint Medicaid Managed Care	$6.28

AMINOSYN II 4.25%+25% DEX

Facility

$1,066.00

Hospital Charge Code	60634543
Hospital Revenue Code	250
Min. Negotiated Rate	$159.90
Max. Negotiated Rate	$159.90
Rate for Payer: Qualcare PPO/HMO/WC	$159.90

AMINOSYN II 4.25%+25% DEX

Facility

$1,066.00

Hospital Charge Code	60634543
Hospital Revenue Code	250
Min. Negotiated Rate	$25.69
Max. Negotiated Rate	$533.00
Rate for Payer: Aetna Commercial	$405.08
Rate for Payer: Aetna Medicare Advantage	$319.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.83
Rate for Payer: Cigna Commercial	$533.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.80
Rate for Payer: Oxford Commercial	$213.20
Rate for Payer: Qualcare PPO/HMO/WC	$159.90
Rate for Payer: UnitedHealthcare Commercial	$213.20
Rate for Payer: UnitedHealthcare Community & State	$25.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.25

AMINOSYN RF 5.2%/300ML

Facility

$414.00

Hospital Charge Code	60634297
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

AMINOSYN RF 5.2%/300ML

Facility

$414.00

Hospital Charge Code	60634297
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

AMINOSYN-RF 5.2%/300ML

Facility

$293.00

Hospital Charge Code	60632436
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$58.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$58.60
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

AMINOSYN-RF 5.2%/300ML

Facility

$293.00

Hospital Charge Code	60632436
Hospital Revenue Code	250
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$4.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

Know your out-of-pocket cost for care.

All Charges