Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$145.46
Rate for Payer: Aetna Commercial	$110.55
Rate for Payer: Aetna Medicare Advantage	$87.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.18
Rate for Payer: Cigna Commercial	$145.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.27
Rate for Payer: Oxford Commercial	$58.18
Rate for Payer: Qualcare PPO/HMO/WC	$43.64
Rate for Payer: UnitedHealthcare Commercial	$58.18
Rate for Payer: UnitedHealthcare Community & State	$7.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

INSULIN PUR PORK NPH INJ U-100

Facility

$215.05

Hospital Charge Code	60628227
Hospital Revenue Code	250
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$81.72
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.52
Rate for Payer: Oxford Commercial	$43.01
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$43.01
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

INSULIN PUR PORK NPH INJ U-100

Facility

$215.05

Hospital Charge Code	60628227
Hospital Revenue Code	250
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

INSULIN PUR PORK REG INJ U-100

Facility

$336.05

Hospital Charge Code	60628228
Hospital Revenue Code	250
Min. Negotiated Rate	$50.41
Max. Negotiated Rate	$50.41
Rate for Payer: Qualcare PPO/HMO/WC	$50.41

INSULIN PUR PORK REG INJ U-100

Facility

$336.05

Hospital Charge Code	60628228
Hospital Revenue Code	250
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$168.03
Rate for Payer: Aetna Commercial	$127.70
Rate for Payer: Aetna Medicare Advantage	$100.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.69
Rate for Payer: Cigna Commercial	$168.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.81
Rate for Payer: Oxford Commercial	$67.21
Rate for Payer: Qualcare PPO/HMO/WC	$50.41
Rate for Payer: UnitedHealthcare Commercial	$67.21
Rate for Payer: UnitedHealthcare Community & State	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$8.91

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$39.69

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$132.29
Rate for Payer: Aetna Commercial	$100.54
Rate for Payer: Aetna Medicare Advantage	$79.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.47
Rate for Payer: Cigna Commercial	$132.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.37
Rate for Payer: Oxford Commercial	$52.92
Rate for Payer: Qualcare PPO/HMO/WC	$39.69
Rate for Payer: UnitedHealthcare Commercial	$52.92
Rate for Payer: UnitedHealthcare Community & State	$6.38
Rate for Payer: Wellpoint Medicaid Managed Care	$7.01

INSULIN REG HUM 100U/ML 10ML

Facility

$12.80

Hospital Charge Code	6003099
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 REG HUM 100U/ML 10ML

Facility

$12.80

Hospital Charge Code	6003099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

INSULIN REGULAR HIGH COVERAGE

Facility

$100.85

Hospital Charge Code	60629888
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$38.32
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Oxford Commercial	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$20.17
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

INSULIN REGULAR HIGH COVERAGE

Facility

$100.85

Hospital Charge Code	60629888
Hospital Revenue Code	250
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

INSULIN SEM ILENT 10ML 1000ML

Facility

$97.30

Hospital Charge Code	6003107
Hospital Revenue Code	250
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

INSULIN SEM ILENT 10ML 1000ML

Facility

$97.30

Hospital Charge Code	6003107
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.19
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

INSULIN SERUM

Facility

$91.25

Service Code	HCPCS 83525
Hospital Charge Code	3001658
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

INSULIN SERUM

Facility

$91.25

Service Code	HCPCS 83525
Hospital Charge Code	3001658
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.26
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$11.43
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Medicare Advantage	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

INSULIN,SERUM

Facility

$667.59

Service Code	HCPCS 83525
Hospital Charge Code	39900099
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

INSULIN,SERUM

Facility

$667.59

Service Code	HCPCS 83525
Hospital Charge Code	39900099
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.26
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.43
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Medicare Advantage	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

INSULIN,TOTAL

Facility

$360.00

Service Code	HCPCS 83525
Hospital Charge Code	38472422
Hospital Revenue Code	301
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

INSULIN,TOTAL

Facility

$360.00

Service Code	HCPCS 83525
Hospital Charge Code	38472422
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.26
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: Cigna Medicare Advantage	$11.43
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Medicare Advantage	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

INSULIN ULTRALEN BEEF 10ML

Facility

$12.80

Hospital Charge Code	6003115
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 ULTRALEN BEEF 10ML

Facility

$12.80

Hospital Charge Code	6003115
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

INS URETERAL STENT-BIL

Facility

$5,100.00

Hospital Charge Code	2690725
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

INS URETERAL STENT-BIL

Facility

$5,100.00

Hospital Charge Code	2690725
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

INS URETERAL STENT-LT

Facility

$2,717.00

Hospital Charge Code	2691790
Hospital Revenue Code	320
Min. Negotiated Rate	$65.48
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,032.46
Rate for Payer: Aetna Medicare Advantage	$815.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.84
Rate for Payer: Cigna Commercial	$1,358.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$65.48
Rate for Payer: Wellpoint Medicaid Managed Care	$72.00

INS URETERAL STENT-LT

Facility

$2,717.00

Hospital Charge Code	2691790
Hospital Revenue Code	320
Min. Negotiated Rate	$407.55
Max. Negotiated Rate	$407.55
Rate for Payer: Qualcare PPO/HMO/WC	$407.55

Know your out-of-pocket cost for care.

All Charges