Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ATOMOXETINE HYDROCHLORIDE 18 M

Facility

$74.71

Service Code	NDC 2323830
Hospital Charge Code	6063943181
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$37.35
Rate for Payer: Aetna Commercial	$28.39
Rate for Payer: Aetna Medicare Advantage	$22.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.05
Rate for Payer: Cigna Commercial	$37.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.41
Rate for Payer: Oxford Commercial	$14.94
Rate for Payer: Qualcare PPO/HMO/WC	$11.21
Rate for Payer: UnitedHealthcare Commercial	$14.94
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

ATOMOXETINE HYDROCHLORIDE 40 M

Facility

$81.14

Service Code	NDC 2322930
Hospital Charge Code	6063943182
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$40.57
Rate for Payer: Aetna Commercial	$30.83
Rate for Payer: Aetna Medicare Advantage	$24.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.69
Rate for Payer: Cigna Commercial	$40.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.34
Rate for Payer: Oxford Commercial	$16.23
Rate for Payer: Qualcare PPO/HMO/WC	$12.17
Rate for Payer: UnitedHealthcare Commercial	$16.23
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

ATOMOXETINE HYDROCHLORIDE 40 M

Facility

$81.14

Service Code	NDC 2322930
Hospital Charge Code	6063943182
Hospital Revenue Code	250
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.17

ATOMOXETINE HYDROCHLORIDE 80 M

Facility

$87.57

Service Code	NDC 2325030
Hospital Charge Code	6063943183
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$43.78
Rate for Payer: Aetna Commercial	$33.28
Rate for Payer: Aetna Medicare Advantage	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.33
Rate for Payer: Cigna Commercial	$43.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.27
Rate for Payer: Oxford Commercial	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$13.14
Rate for Payer: UnitedHealthcare Commercial	$17.51
Rate for Payer: UnitedHealthcare Community & State	$2.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.32

ATOMOXETINE HYDROCHLORIDE 80 M

Facility

$87.57

Service Code	NDC 2325030
Hospital Charge Code	6063943183
Hospital Revenue Code	250
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$13.14
Rate for Payer: Qualcare PPO/HMO/WC	$13.14

ATORVASTATIN 10 MG TAB

Facility

$51.12

Service Code	NDC 71015540
Hospital Charge Code	60627618
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.56
Rate for Payer: Aetna Commercial	$19.43
Rate for Payer: Aetna Medicare Advantage	$15.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.04
Rate for Payer: Cigna Commercial	$25.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$10.22
Rate for Payer: Qualcare PPO/HMO/WC	$7.67
Rate for Payer: UnitedHealthcare Commercial	$10.22
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

ATORVASTATIN 10 MG TAB

Facility

$51.12

Service Code	NDC 71015540
Hospital Charge Code	60627618
Hospital Revenue Code	250
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$7.67

ATORVASTATIN 20 MG TAB

Facility

$72.90

Service Code	NDC 71015640
Hospital Charge Code	60628829
Hospital Revenue Code	250
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

ATORVASTATIN 20 MG TAB

Facility

$72.90

Service Code	NDC 71015640
Hospital Charge Code	60628829
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.45
Rate for Payer: Aetna Commercial	$27.70
Rate for Payer: Aetna Medicare Advantage	$21.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.59
Rate for Payer: Cigna Commercial	$36.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.87
Rate for Payer: Oxford Commercial	$14.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
Rate for Payer: UnitedHealthcare Commercial	$14.58
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

ATORVASTATIN 40MG TAB

Facility

$72.90

Service Code	NDC 71015740
Hospital Charge Code	60630070
Hospital Revenue Code	250
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

ATORVASTATIN 40MG TAB

Facility

$72.90

Service Code	NDC 71015740
Hospital Charge Code	60630070
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.45
Rate for Payer: Aetna Commercial	$27.70
Rate for Payer: Aetna Medicare Advantage	$21.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.59
Rate for Payer: Cigna Commercial	$36.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.87
Rate for Payer: Oxford Commercial	$14.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
Rate for Payer: UnitedHealthcare Commercial	$14.58
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

ATORVASTATIN CALCIUM TAB 10MG

Facility

$13.45

Hospital Charge Code	6020002
Hospital Revenue Code	252
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

ATORVASTATIN CALCIUM TAB 10MG

Facility

$13.45

Hospital Charge Code	6020002
Hospital Revenue Code	252
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.04
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

ATOVAQUONE 750 MG/5 ML SUSP

Facility

$232.89

Service Code	NDC 173054700
Hospital Charge Code	60628939
Hospital Revenue Code	250
Min. Negotiated Rate	$34.93
Max. Negotiated Rate	$34.93
Rate for Payer: Qualcare PPO/HMO/WC	$34.93

ATOVAQUONE 750 MG/5 ML SUSP

Facility

$232.89

Service Code	NDC 173054700
Hospital Charge Code	60628939
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$116.44
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$69.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.39
Rate for Payer: Cigna Commercial	$116.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.87
Rate for Payer: Oxford Commercial	$46.58
Rate for Payer: Qualcare PPO/HMO/WC	$34.93
Rate for Payer: UnitedHealthcare Commercial	$46.58
Rate for Payer: UnitedHealthcare Community & State	$5.61
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

AT PROCEDURE UNSCHEDULE

Facility

$3,240.00

Hospital Charge Code	270605797
Hospital Revenue Code	272
Min. Negotiated Rate	$486.00
Max. Negotiated Rate	$486.00
Rate for Payer: Qualcare PPO/HMO/WC	$486.00

AT PROCEDURE UNSCHEDULE

Facility

$3,240.00

Hospital Charge Code	270605797
Hospital Revenue Code	272
Min. Negotiated Rate	$78.08
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,231.20
Rate for Payer: Aetna Medicare Advantage	$972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.20
Rate for Payer: Cigna Commercial	$1,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$972.00
Rate for Payer: Oxford Commercial	$648.00
Rate for Payer: Qualcare PPO/HMO/WC	$486.00
Rate for Payer: UnitedHealthcare Commercial	$648.00
Rate for Payer: UnitedHealthcare Community & State	$78.08
Rate for Payer: Wellpoint Medicaid Managed Care	$85.86

ATRACURIUM 50 MG/5ML INJ

Facility

$66.33

Service Code	NDC 25021065905
Hospital Charge Code	6012223
Hospital Revenue Code	250
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$9.95
Rate for Payer: Qualcare PPO/HMO/WC	$9.95

ATRACURIUM 50 MG/5ML INJ

Facility

$66.33

Service Code	NDC 25021065905
Hospital Charge Code	6012223
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.16
Rate for Payer: Aetna Commercial	$25.21
Rate for Payer: Aetna Medicare Advantage	$19.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.91
Rate for Payer: Cigna Commercial	$33.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.90
Rate for Payer: Oxford Commercial	$13.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.95
Rate for Payer: UnitedHealthcare Commercial	$13.27
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

ATRACURIUM BES INJ 10MG/ML

Facility

$104.52

Service Code	NDC 409110502
Hospital Charge Code	606390317
Hospital Revenue Code	250
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$15.68
Rate for Payer: Qualcare PPO/HMO/WC	$15.68

ATRACURIUM BES INJ 10MG/ML

Facility

$104.52

Service Code	NDC 409110502
Hospital Charge Code	606390317
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$39.72
Rate for Payer: Aetna Medicare Advantage	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.65
Rate for Payer: Cigna Commercial	$52.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.68
Rate for Payer: UnitedHealthcare Commercial	$20.90
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

ATRACURIUM INJ 50MG, 10ML

Facility

$419.85

Hospital Charge Code	6000475
Hospital Revenue Code	250
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

ATRACURIUM INJ 50MG, 10ML

Facility

$419.85

Hospital Charge Code	6000475
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$209.93
Rate for Payer: Aetna Commercial	$159.54
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.95
Rate for Payer: Oxford Commercial	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$83.97
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

ATRACURIUM INJ 50MG, 10ML****

Facility

$205.00

Hospital Charge Code	600475
Hospital Revenue Code	259
Min. Negotiated Rate	$30.75
Max. Negotiated Rate	$30.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.75

ATRACURIUM INJ 50MG, 10ML****

Facility

$205.00

Hospital Charge Code	600475
Hospital Revenue Code	259
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$102.50
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna Medicare Advantage	$61.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.27
Rate for Payer: Cigna Commercial	$102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.50
Rate for Payer: Oxford Commercial	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.75
Rate for Payer: UnitedHealthcare Commercial	$41.00
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

Know your out-of-pocket cost for care.

All Charges