Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$4.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.61
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NEBCIN/1.2GM

Facility

$71.00

Hospital Charge Code	60633511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

NEBCIN/1.2GM

Facility

$71.00

Hospital Charge Code	60633511
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

NEBCIN/40MG/1ML

Facility

$71.00

Hospital Charge Code	60633512
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

NEBCIN/40MG/1ML

Facility

$7.97

Service Code	NDC 67457047322
Hospital Charge Code	60633513
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

NEBCIN/40MG/1ML

Facility

$7.97

Service Code	NDC 67457047322
Hospital Charge Code	60633513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.39
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

NEBCIN/40MG/1ML

Facility

$71.00

Hospital Charge Code	60633512
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

NEBIVOLOL 10 MG TAB

Facility

$24.86

Service Code	NDC 456141030
Hospital Charge Code	606351003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

NEBIVOLOL 10 MG TAB

Facility

$24.86

Service Code	NDC 456141030
Hospital Charge Code	606351003
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

NEBULEZER COMPRESSOR AERO PLUS

Facility

$107.65

Hospital Charge Code	270647278
Hospital Revenue Code	272
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$16.15
Rate for Payer: Qualcare PPO/HMO/WC	$16.15

NEBULEZER COMPRESSOR AERO PLUS

Facility

$107.65

Hospital Charge Code	270647278
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.83
Rate for Payer: Aetna Commercial	$40.91
Rate for Payer: Aetna Medicare Advantage	$32.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.45
Rate for Payer: Cigna Commercial	$53.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.30
Rate for Payer: Oxford Commercial	$21.53
Rate for Payer: Qualcare PPO/HMO/WC	$16.15
Rate for Payer: UnitedHealthcare Commercial	$21.53
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

NEBULIZER***

Facility

$33.00

Service Code	HCPCS 94665
Hospital Charge Code	9500521
Hospital Revenue Code	419
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

NEBULIZER***

Facility

$33.00

Service Code	HCPCS 94665
Hospital Charge Code	9500521
Hospital Revenue Code	419
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

NEBULIZER 28% PREFILLED BTL

Facility

$37.65

Hospital Charge Code	270604860
Hospital Revenue Code	272
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

NEBULIZER 28% PREFILLED BTL

Facility

$37.65

Hospital Charge Code	270604860
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.29
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$7.53
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

NEBULIZER AEROCLIPSE II

Facility

$1,275.00

Hospital Charge Code	270690898
Hospital Revenue Code	271
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

NEBULIZER AEROCLIPSE II

Facility

$1,275.00

Hospital Charge Code	270690898
Hospital Revenue Code	271
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.50
Rate for Payer: Oxford Commercial	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$255.00
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

NEBULIZER AEROECLIPSE II B.A.N

Facility

$24.36

Hospital Charge Code	270648257
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

NEBULIZER AEROECLIPSE II B.A.N

Facility

$24.36

Hospital Charge Code	270648257
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$9.26
Rate for Payer: Aetna Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.31
Rate for Payer: Oxford Commercial	$4.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

NEBULIZER HAND***

Facility

$17.00

Hospital Charge Code	9500307
Hospital Revenue Code	279
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

NEBULIZER HAND***

Facility

$17.00

Hospital Charge Code	9500307
Hospital Revenue Code	279
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

Know your out-of-pocket cost for care.

All Charges