Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSULIN GLARGINE 100 UNIT ML

Facility

$774.92

Service Code	NDC 88221905
Hospital Charge Code	6063943390
Hospital Revenue Code	250
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.46
Rate for Payer: Aetna Commercial	$294.47
Rate for Payer: Aetna Medicare Advantage	$232.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.60
Rate for Payer: Cigna Commercial	$387.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.48
Rate for Payer: Oxford Commercial	$154.98
Rate for Payer: Qualcare PPO/HMO/WC	$116.24
Rate for Payer: UnitedHealthcare Commercial	$154.98
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

INSULIN GLARGINE 100 UNIT ML

Facility

$774.92

Service Code	NDC 88221905
Hospital Charge Code	6063943390
Hospital Revenue Code	250
Min. Negotiated Rate	$116.24
Max. Negotiated Rate	$116.24
Rate for Payer: Qualcare PPO/HMO/WC	$116.24

INSULIN GLARGINE YFGN 100ML

Facility

$739.68

Service Code	NDC 83257001532
Hospital Charge Code	6063943378
Hospital Revenue Code	250
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$369.84
Rate for Payer: Aetna Commercial	$281.08
Rate for Payer: Aetna Medicare Advantage	$221.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.62
Rate for Payer: Cigna Commercial	$369.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.90
Rate for Payer: Oxford Commercial	$147.94
Rate for Payer: Qualcare PPO/HMO/WC	$110.95
Rate for Payer: UnitedHealthcare Commercial	$147.94
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19.60

INSULIN GLARGINE YFGN 100ML

Facility

$739.68

Service Code	NDC 83257001532
Hospital Charge Code	6063943378
Hospital Revenue Code	250
Min. Negotiated Rate	$110.95
Max. Negotiated Rate	$110.95
Rate for Payer: Qualcare PPO/HMO/WC	$110.95

INSULIN HUMAN INJ (IV DRIP)

Facility

$136.35

Hospital Charge Code	6010235
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

INSULIN HUMAN INJ (IV DRIP)

Facility

$136.35

Hospital Charge Code	6010235
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

INSULIN INJ GLARGINE U-100

Facility

$237.65

Hospital Charge Code	60629201
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$118.83
Rate for Payer: Aetna Commercial	$90.31
Rate for Payer: Aetna Medicare Advantage	$71.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.60
Rate for Payer: Cigna Commercial	$118.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.30
Rate for Payer: Oxford Commercial	$47.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.65
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: UnitedHealthcare Community & State	$5.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.30

INSULIN INJ GLARGINE U-100

Facility

$237.65

Hospital Charge Code	60629201
Hospital Revenue Code	250
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$35.65
Rate for Payer: Qualcare PPO/HMO/WC	$35.65

INSULIN INSTRUCT F/U PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200020
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

INSULIN INSTRUCT F/U PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200020
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN LENT HUM 10ML 100U/ML

Facility

$12.80

Hospital Charge Code	6003073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.84
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

INSULIN LENT HUM 10ML 100U/ML

Facility

$12.80

Hospital Charge Code	6003073
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

INSULIN LIKE GROWTH FACTOR BP3

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001670
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

INSULIN LIKE GROWTH FACTOR BP3

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001670
Hospital Revenue Code	301
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

INSULIN LISPRO 100u/ml MED COV

Facility

$256.00

Hospital Charge Code	60629885
Hospital Revenue Code	250
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$97.28
Rate for Payer: Aetna Medicare Advantage	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.28
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.80
Rate for Payer: Oxford Commercial	$51.20
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$51.20
Rate for Payer: UnitedHealthcare Community & State	$6.17
Rate for Payer: Wellpoint Medicaid Managed Care	$6.78

INSULIN LISPRO 100u/ml MED COV

Facility

$256.00

Hospital Charge Code	60629885
Hospital Revenue Code	250
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

INSULIN LISPRO HUGH COVERAGE

Facility

$256.00

Hospital Charge Code	60629887
Hospital Revenue Code	250
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

INSULIN LISPRO HUGH COVERAGE

Facility

$256.00

Hospital Charge Code	60629887
Hospital Revenue Code	250
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$97.28
Rate for Payer: Aetna Medicare Advantage	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.28
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.80
Rate for Payer: Oxford Commercial	$51.20
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$51.20
Rate for Payer: UnitedHealthcare Community & State	$6.17
Rate for Payer: Wellpoint Medicaid Managed Care	$6.78

INSULIN LISPRO INJ 75%/25%U100

Facility

$37.80

Hospital Charge Code	60629116
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

INSULIN LISPRO INJ 75%/25%U100

Facility

$37.80

Hospital Charge Code	60629116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$43.64
Max. Negotiated Rate	$43.64
Rate for Payer: Qualcare PPO/HMO/WC	$43.64

Know your out-of-pocket cost for care.

All Charges