Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

I SNARE SYSTEM 25G 5MM

Facility

$425.00

Hospital Charge Code	270680913
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

ISOCET/TAB

Facility

$3.00

Hospital Charge Code	60633193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ISOCET/TAB

Facility

$3.00

Hospital Charge Code	60633193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ISOETHARINE 0.61% AEROSOL

Facility

$294.40

Hospital Charge Code	60627453
Hospital Revenue Code	250
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$147.20
Rate for Payer: Aetna Commercial	$111.87
Rate for Payer: Aetna Medicare Advantage	$88.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.07
Rate for Payer: Cigna Commercial	$147.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.32
Rate for Payer: Oxford Commercial	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$44.16
Rate for Payer: UnitedHealthcare Commercial	$58.88
Rate for Payer: UnitedHealthcare Community & State	$7.10
Rate for Payer: Wellpoint Medicaid Managed Care	$7.80

ISOETHARINE 0.61% AEROSOL

Facility

$294.40

Hospital Charge Code	60627453
Hospital Revenue Code	250
Min. Negotiated Rate	$44.16
Max. Negotiated Rate	$44.16
Rate for Payer: Qualcare PPO/HMO/WC	$44.16

ISOETHARINE INH 10ML

Facility

$136.35

Hospital Charge Code	6003180
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

ISOETHARINE INH 10ML

Facility

$136.35

Hospital Charge Code	6003180
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

ISOETHARINE SOL 0.1%

Facility

$8.35

Hospital Charge Code	60627452
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$1.67
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

ISOETHARINE SOL 0.1%

Facility

$8.35

Hospital Charge Code	60627452
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

ISOFLURANE 100 ML LIQ

Facility

$1,310.45

Hospital Charge Code	60627669
Hospital Revenue Code	250
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ISOFLURANE 100 ML LIQ

Facility

$1,310.45

Hospital Charge Code	60627669
Hospital Revenue Code	250
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$497.97
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.13
Rate for Payer: Oxford Commercial	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$262.09
Rate for Payer: UnitedHealthcare Community & State	$31.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34.73

ISOFLURANE 100ML-LONG 6+ HOURS

Facility

$685.45

Hospital Charge Code	6007546
Hospital Revenue Code	250
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$102.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.82

ISOFLURANE 100ML-LONG 6+ HOURS

Facility

$685.45

Hospital Charge Code	6007546
Hospital Revenue Code	250
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$342.73
Rate for Payer: Aetna Commercial	$260.47
Rate for Payer: Aetna Medicare Advantage	$205.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.79
Rate for Payer: Cigna Commercial	$342.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.63
Rate for Payer: Oxford Commercial	$137.09
Rate for Payer: Qualcare PPO/HMO/WC	$102.82
Rate for Payer: UnitedHealthcare Commercial	$137.09
Rate for Payer: UnitedHealthcare Community & State	$16.52
Rate for Payer: Wellpoint Medicaid Managed Care	$18.16

ISOFLURANE GAS INTERMD 3-6 HRS

Facility

$344.35

Hospital Charge Code	6010441
Hospital Revenue Code	250
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$172.18
Rate for Payer: Aetna Commercial	$130.85
Rate for Payer: Aetna Medicare Advantage	$103.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.81
Rate for Payer: Cigna Commercial	$172.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.31
Rate for Payer: Oxford Commercial	$68.87
Rate for Payer: Qualcare PPO/HMO/WC	$51.65
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: UnitedHealthcare Community & State	$8.30
Rate for Payer: Wellpoint Medicaid Managed Care	$9.13

ISOFLURANE GAS INTERMD 3-6 HRS

Facility

$344.35

Hospital Charge Code	6010441
Hospital Revenue Code	250
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$51.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.65

ISOFLURANE GAS SHORT 0-3 HOURS

Facility

$174.75

Hospital Charge Code	6010458
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

ISOFLURANE GAS SHORT 0-3 HOURS

Facility

$174.75

Hospital Charge Code	6010458
Hospital Revenue Code	250
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$26.53
Max. Negotiated Rate	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$26.53

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.44
Rate for Payer: Aetna Commercial	$67.21
Rate for Payer: Aetna Medicare Advantage	$53.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$88.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.06
Rate for Payer: Oxford Commercial	$35.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.53
Rate for Payer: UnitedHealthcare Commercial	$35.38
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

ISOFLURANE SOLUTION 100 ML

Facility

$21.80

Hospital Charge Code	60629264
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

ISOFLURANE SOLUTION 100 ML

Facility

$21.80

Hospital Charge Code	60629264
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.90
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.56
Rate for Payer: Cigna Commercial	$10.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.54
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.36
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

ISOFORANE

Facility

$946.60

Hospital Charge Code	6009708
Hospital Revenue Code	250
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$359.71
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.98
Rate for Payer: Oxford Commercial	$189.32
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$189.32
Rate for Payer: UnitedHealthcare Community & State	$22.81
Rate for Payer: Wellpoint Medicaid Managed Care	$25.08

ISOFORANE

Facility

$946.60

Hospital Charge Code	6009708
Hospital Revenue Code	250
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$141.99
Rate for Payer: Qualcare PPO/HMO/WC	$141.99

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

Know your out-of-pocket cost for care.

All Charges