Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AYR BABY SALINE

Facility

$9.56

Hospital Charge Code	60635816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

AYR BABY SALINE

Facility

$9.56

Hospital Charge Code	60635816
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$2,352.67
Rate for Payer: Aetna Commercial	$1,788.03
Rate for Payer: Aetna Medicare Advantage	$1,411.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.86
Rate for Payer: Cigna Commercial	$2,352.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80
Rate for Payer: UnitedHealthcare Community & State	$113.40
Rate for Payer: Wellpoint Medicaid Managed Care	$124.69

AZACITIDINE 100 MG REC

Facility

$2,941.15

Hospital Charge Code	60629945A
Hospital Revenue Code	636
Min. Negotiated Rate	$441.17
Max. Negotiated Rate	$711.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.76
Rate for Payer: Qualcare PPO/HMO/WC	$441.17

AZACITIDINE 100 MG REC

Facility

$2,941.15

Hospital Charge Code	60629945A
Hospital Revenue Code	636
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$1,470.58
Rate for Payer: Aetna Commercial	$1,117.64
Rate for Payer: Aetna Medicare Advantage	$882.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$749.99
Rate for Payer: Cigna Commercial	$1,470.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.76
Rate for Payer: Qualcare PPO/HMO/WC	$441.17
Rate for Payer: UnitedHealthcare Community & State	$70.88
Rate for Payer: Wellpoint Medicaid Managed Care	$77.94

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$705.80
Max. Negotiated Rate	$1,138.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.19
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

AZACTAM 1GM/50ML PREMIXED

Facility

$63.00

Hospital Charge Code	60635013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$12.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

AZACTAM 1GM/50ML PREMIXED

Facility

$63.00

Hospital Charge Code	60635013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

AZACTAM 2G/50ML

Facility

$112.00

Hospital Charge Code	60635023
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

AZACTAM 2G/50ML

Facility

$112.00

Hospital Charge Code	60635023
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$22.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$22.40
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

AZACTAM/2GM

Facility

$110.00

Hospital Charge Code	60632519
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

AZACTAM/2GM

Facility

$110.00

Hospital Charge Code	60632519
Hospital Revenue Code	250
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

AZACTAM/500MG

Facility

$34.00

Hospital Charge Code	60632518
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

AZACTAM/500MG

Facility

$34.00

Hospital Charge Code	60632518
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

AZATHIOPRINE ORAL 50MG

Facility

$7.00

Hospital Charge Code	60633164
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

AZATHIOPRINE ORAL 50MG

Facility

$7.00

Hospital Charge Code	60633164
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

AZELASTINE NSL SPR 137MCG

Facility

$348.85

Hospital Charge Code	60628751
Hospital Revenue Code	250
Min. Negotiated Rate	$52.33
Max. Negotiated Rate	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$52.33

AZELASTINE NSL SPR 137MCG

Facility

$348.85

Hospital Charge Code	60628751
Hospital Revenue Code	250
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$174.43
Rate for Payer: Aetna Commercial	$132.56
Rate for Payer: Aetna Medicare Advantage	$104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.96
Rate for Payer: Cigna Commercial	$174.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.66
Rate for Payer: Oxford Commercial	$69.77
Rate for Payer: Qualcare PPO/HMO/WC	$52.33
Rate for Payer: UnitedHealthcare Commercial	$69.77
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$9.24

AZILECT 0.5MG TABLET

Facility

$38.00

Hospital Charge Code	60635571
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

AZILECT 0.5MG TABLET

Facility

$38.00

Hospital Charge Code	60635571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$6.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.35

Know your out-of-pocket cost for care.

All Charges