Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ATAZANAVIR 150 MG CAPSULE

Facility

$171.45

Service Code	NDC 3362412
Hospital Charge Code	60630010
Hospital Revenue Code	250
Min. Negotiated Rate	$25.72
Max. Negotiated Rate	$25.72
Rate for Payer: Qualcare PPO/HMO/WC	$25.72

ATAZANAVIR 200MG CAP

Facility

$171.45

Service Code	NDC 3363112
Hospital Charge Code	6063943059
Hospital Revenue Code	250
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$85.72
Rate for Payer: Aetna Commercial	$65.15
Rate for Payer: Aetna Medicare Advantage	$51.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.72
Rate for Payer: Cigna Commercial	$85.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.44
Rate for Payer: Oxford Commercial	$34.29
Rate for Payer: Qualcare PPO/HMO/WC	$25.72
Rate for Payer: UnitedHealthcare Commercial	$34.29
Rate for Payer: UnitedHealthcare Community & State	$4.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

ATAZANAVIR 200MG CAP

Facility

$171.45

Service Code	NDC 3363112
Hospital Charge Code	6063943059
Hospital Revenue Code	250
Min. Negotiated Rate	$25.72
Max. Negotiated Rate	$25.72
Rate for Payer: Qualcare PPO/HMO/WC	$25.72

ATAZANAVIR 300 MG CAPSULE

Facility

$339.62

Service Code	NDC 3362212
Hospital Charge Code	60630009
Hospital Revenue Code	250
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$169.81
Rate for Payer: Aetna Commercial	$129.06
Rate for Payer: Aetna Medicare Advantage	$101.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.60
Rate for Payer: Cigna Commercial	$169.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.89
Rate for Payer: Oxford Commercial	$67.92
Rate for Payer: Qualcare PPO/HMO/WC	$50.94
Rate for Payer: UnitedHealthcare Commercial	$67.92
Rate for Payer: UnitedHealthcare Community & State	$8.18
Rate for Payer: Wellpoint Medicaid Managed Care	$9.00

ATAZANAVIR 300 MG CAPSULE

Facility

$339.62

Service Code	NDC 3362212
Hospital Charge Code	60630009
Hospital Revenue Code	250
Min. Negotiated Rate	$50.94
Max. Negotiated Rate	$50.94
Rate for Payer: Qualcare PPO/HMO/WC	$50.94

ATEC SCREW INVICTUS MIS 2 FC C

Facility

$8,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270703996
Hospital Revenue Code	278
Min. Negotiated Rate	$213.89
Max. Negotiated Rate	$4,437.50
Rate for Payer: Aetna Commercial	$3,372.50
Rate for Payer: Aetna Medicare Advantage	$2,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,263.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,263.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,263.12
Rate for Payer: Cigna Commercial	$4,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,952.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.25
Rate for Payer: UnitedHealthcare Community & State	$213.89
Rate for Payer: Wellpoint Medicaid Managed Care	$235.19

ATEC SCREW INVICTUS MIS 2 FC C

Facility

$8,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270703996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,331.25
Max. Negotiated Rate	$2,147.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,952.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.25

ATEC SCREW INVICTUS MIS FC CC

Facility

$8,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704129
Hospital Revenue Code	278
Min. Negotiated Rate	$213.89
Max. Negotiated Rate	$4,437.50
Rate for Payer: Aetna Commercial	$3,372.50
Rate for Payer: Aetna Medicare Advantage	$2,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,263.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,263.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,263.12
Rate for Payer: Cigna Commercial	$4,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,952.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.25
Rate for Payer: UnitedHealthcare Community & State	$213.89
Rate for Payer: Wellpoint Medicaid Managed Care	$235.19

ATEC SCREW INVICTUS MIS FC CC

Facility

$8,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704129
Hospital Revenue Code	278
Min. Negotiated Rate	$1,331.25
Max. Negotiated Rate	$2,147.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,952.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.25

ATEC SYSTEM SIGMA LTP-LIF ILLU

Facility

$6,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270704043
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

ATEC SYSTEM SIGMA LTP-LIF ILLU

Facility

$6,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270704043
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

ATENOLOL 100MG TAB

Facility

$9.98

Service Code	NDC 51079068501
Hospital Charge Code	6063943060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

ATENOLOL 100MG TAB

Facility

$9.98

Service Code	NDC 51079068501
Hospital Charge Code	6063943060
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

ATENOLOL 12.5MG TAB

Facility

$3.00

Hospital Charge Code	60635655
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

ATENOLOL 12.5MG TAB

Facility

$3.00

Hospital Charge Code	60635655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ATENOLOL 25 MG TAB

Facility

$5.36

Service Code	NDC 51079075920
Hospital Charge Code	6027080
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

ATENOLOL 25 MG TAB

Facility

$5.36

Service Code	NDC 51079075920
Hospital Charge Code	6027080
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

ATENOLOL 50 MG TAB

Facility

$5.96

Service Code	NDC 51079068420
Hospital Charge Code	60627547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ATENOLOL 50 MG TAB

Facility

$5.96

Service Code	NDC 51079068420
Hospital Charge Code	60627547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

ATENOLOL TAB 12.5MG/0.5

Facility

$3.20

Hospital Charge Code	60628923
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ATENOLOL TAB 12.5MG/0.5

Facility

$3.20

Hospital Charge Code	60628923
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

ATF CANNISTER W/O GEL

Facility

$796.60

Hospital Charge Code	270635002
Hospital Revenue Code	270
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$398.30
Rate for Payer: Aetna Commercial	$302.71
Rate for Payer: Aetna Medicare Advantage	$238.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.13
Rate for Payer: Cigna Commercial	$398.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.98
Rate for Payer: Oxford Commercial	$159.32
Rate for Payer: Qualcare PPO/HMO/WC	$119.49
Rate for Payer: UnitedHealthcare Commercial	$159.32
Rate for Payer: UnitedHealthcare Community & State	$19.20
Rate for Payer: Wellpoint Medicaid Managed Care	$21.11

ATF CANNISTER W/O GEL

Facility

$796.60

Hospital Charge Code	270635002
Hospital Revenue Code	270
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$119.49
Rate for Payer: Qualcare PPO/HMO/WC	$119.49

ATGAM 50MG/ML 5ML

Facility

$1,491.00

Hospital Charge Code	60635104
Hospital Revenue Code	636
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$360.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.82
Rate for Payer: Qualcare PPO/HMO/WC	$223.65

ATGAM 50MG/ML 5ML

Facility

$1,491.00

Hospital Charge Code	60635104
Hospital Revenue Code	636
Min. Negotiated Rate	$35.93
Max. Negotiated Rate	$745.50
Rate for Payer: Aetna Commercial	$566.58
Rate for Payer: Aetna Medicare Advantage	$447.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.20
Rate for Payer: Cigna Commercial	$745.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.82
Rate for Payer: Qualcare PPO/HMO/WC	$223.65
Rate for Payer: UnitedHealthcare Community & State	$35.93
Rate for Payer: Wellpoint Medicaid Managed Care	$39.51

Know your out-of-pocket cost for care.

All Charges