Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FORMALDEHYDE 10% 100ML-BLADDER

Facility

$181.15

Hospital Charge Code	6010227
Hospital Revenue Code	251
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$27.17
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

FORMALDEHYDE 10% 100ML-BLADDER

Facility

$181.15

Hospital Charge Code	6010227
Hospital Revenue Code	251
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$68.84
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$36.23
Rate for Payer: Qualcare PPO/HMO/WC	$27.17
Rate for Payer: UnitedHealthcare Commercial	$36.23
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

FOR ODDS AND ENDS

Facility

$200.00

Hospital Charge Code	270666777
Hospital Revenue Code	270
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

FOR ODDS AND ENDS

Facility

$200.00

Hospital Charge Code	270666777
Hospital Revenue Code	270
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

FORTAZ 1GM/50ML

Facility

$83.00

Hospital Charge Code	60635026
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

FORTAZ 1GM/50ML

Facility

$83.00

Hospital Charge Code	60635026
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

FORTAZ/1GM/ADD DEX

Facility

$107.00

Hospital Charge Code	60634833
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

FORTAZ/1GM/ADD DEX

Facility

$107.00

Hospital Charge Code	60634833
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

FORTAZ/1GM/ADD SALINE

Facility

$79.00

Hospital Charge Code	60634834
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

FORTAZ/1GM/ADD SALINE

Facility

$79.00

Hospital Charge Code	60634834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$15.80
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

FORTAZ 2GM/50ML

Facility

$110.00

Hospital Charge Code	60635027
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

FORTAZ 2GM/50ML

Facility

$110.00

Hospital Charge Code	60635027
Hospital Revenue Code	250
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

FORTAZ/2GM/ADD DEX

Facility

$181.00

Hospital Charge Code	60634835
Hospital Revenue Code	250
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$27.15
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

FORTAZ/2GM/ADD DEX

Facility

$181.00

Hospital Charge Code	60634835
Hospital Revenue Code	250
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$68.78
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.16
Rate for Payer: Cigna Commercial	$90.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Oxford Commercial	$36.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.15
Rate for Payer: UnitedHealthcare Commercial	$36.20
Rate for Payer: UnitedHealthcare Community & State	$4.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

FORTAZ/2GM/ADD SALINE

Facility

$181.00

Hospital Charge Code	60634836
Hospital Revenue Code	250
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$27.15
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

FORTAZ/2GM/ADD SALINE

Facility

$181.00

Hospital Charge Code	60634836
Hospital Revenue Code	250
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$68.78
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.16
Rate for Payer: Cigna Commercial	$90.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Oxford Commercial	$36.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.15
Rate for Payer: UnitedHealthcare Commercial	$36.20
Rate for Payer: UnitedHealthcare Community & State	$4.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

FORTAZ/500MG

Facility

$34.00

Hospital Charge Code	60633013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

FORTAZ/500MG

Facility

$34.00

Hospital Charge Code	60633013
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

FORTAZ/6GM

Facility

$490.00

Hospital Charge Code	60633015
Hospital Revenue Code	250
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

FORTAZ/6GM

Facility

$490.00

Hospital Charge Code	60633015
Hospital Revenue Code	250
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.00
Rate for Payer: Oxford Commercial	$98.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$98.00
Rate for Payer: UnitedHealthcare Community & State	$11.81
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

FORTE CNCLLOUS SCRE 4.0MMX12MM

Facility

$299.10

Hospital Charge Code	270663184
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRE 4.0MMX12MM

Facility

$299.10

Hospital Charge Code	270663184
Hospital Revenue Code	278
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$113.66
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.87
Rate for Payer: UnitedHealthcare Community & State	$7.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7.93

FORTE CNCLLOUS SCRW 4.0MMX10MM

Facility

$299.10

Hospital Charge Code	270663183
Hospital Revenue Code	278
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$113.66
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.87
Rate for Payer: UnitedHealthcare Community & State	$7.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7.93

FORTE CNCLLOUS SCRW 4.0MMX10MM

Facility

$299.10

Hospital Charge Code	270663183
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX18MM

Facility

$299.10

Hospital Charge Code	270663185
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

Know your out-of-pocket cost for care.

All Charges