Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMIODARONE 200 MG TAB

Facility

$49.78

Service Code	NDC 68382022714
Hospital Charge Code	60627545
Hospital Revenue Code	250
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$7.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.47

AMIODARONE 200 MG TAB

Facility

$49.78

Service Code	NDC 68382022714
Hospital Charge Code	60627545
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$24.89
Rate for Payer: Aetna Commercial	$18.92
Rate for Payer: Aetna Medicare Advantage	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.69
Rate for Payer: Cigna Commercial	$24.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.93
Rate for Payer: Oxford Commercial	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.47
Rate for Payer: UnitedHealthcare Commercial	$9.96
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

AMIODARONE 450MG/9ML VIAL

Facility

$10.85

Hospital Charge Code	60630161
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare Advantage	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.77
Rate for Payer: Cigna Commercial	$5.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.63
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

AMIODARONE 450MG/9ML VIAL

Facility

$10.85

Hospital Charge Code	60630161
Hospital Revenue Code	636
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$2.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.63

AMIODARONE/DEX 150 MG/100 ML P

Facility

$263.18

Service Code	NDC 43066015010
Hospital Charge Code	60630087
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.59
Rate for Payer: Aetna Commercial	$100.01
Rate for Payer: Aetna Medicare Advantage	$78.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.11
Rate for Payer: Cigna Commercial	$131.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.95
Rate for Payer: Oxford Commercial	$52.64
Rate for Payer: Qualcare PPO/HMO/WC	$39.48
Rate for Payer: UnitedHealthcare Commercial	$52.64
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

AMIODARONE/DEX 150 MG/100 ML P

Facility

$263.18

Service Code	NDC 43066015010
Hospital Charge Code	60630087
Hospital Revenue Code	250
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$39.48
Rate for Payer: Qualcare PPO/HMO/WC	$39.48

AMIODARONE & METABOLITE

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	39990002EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIODARONE & METABOLITE

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	39990002EX
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
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	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

AMIODARONE & METABOLITE I

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990002A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

AMIODARONE & METABOLITE I

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990002A
Hospital Revenue Code	301
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$124.00
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	$36.48
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	$21.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
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	$1.93

AMIODARONE & METABOLITE II

Facility

$124.10

Service Code	HCPCS 82492
Hospital Charge Code	39990002B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

AMIODARONE & METABOLITE II

Facility

$124.10

Service Code	HCPCS 82492
Hospital Charge Code	39990002B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$47.16
Rate for Payer: Aetna Medicare Advantage	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.65
Rate for Payer: Cigna Commercial	$62.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.99
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

AMIODARONE SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035030
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
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	$90.83
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	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
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	$4.81

AMIODARONE SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035030
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

AMIODARONE TAB 200MG

Facility

$19.85

Hospital Charge Code	6006068
Hospital Revenue Code	252
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

AMIODARONE TAB 200MG

Facility

$19.85

Hospital Charge Code	6006068
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

AMISTEM COLLARED #6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM COLLARED #6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680130
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

AMISTEM FEM COLLARED TI SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697483
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

AMISTEM FEM COLLARED TI SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697483
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM H COLLARED STANDARD#5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680108
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

AMISTEM H COLLARED STANDARD#5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680108
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ0 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680381
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

AMISTEM-H CTD SZ0 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ1 CEMENTLESS

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270670739
Hospital Revenue Code	278
Min. Negotiated Rate	$276.67
Max. Negotiated Rate	$5,740.00
Rate for Payer: Aetna Commercial	$4,362.40
Rate for Payer: Aetna Medicare Advantage	$3,444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,927.40
Rate for Payer: Cigna Commercial	$5,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,525.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00
Rate for Payer: UnitedHealthcare Community & State	$276.67
Rate for Payer: Wellpoint Medicaid Managed Care	$304.22

Know your out-of-pocket cost for care.

All Charges