Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AZTREONAM INJ 1GM/15ML

Facility

$122.25

Hospital Charge Code	6007157
Hospital Revenue Code	250
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

AZTREONAM INJ 1GM/15ML

Facility

$122.25

Hospital Charge Code	6007157
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

AZTREONAM IVPB 1GM/NS 100ML

Facility

$37.80

Hospital Charge Code	60627266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

AZTREONAM IVPB 1GM/NS 100ML

Facility

$37.80

Hospital Charge Code	60627266
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

AZTREONAM IVPB 2GM/NS 100ML

Facility

$198.40

Hospital Charge Code	60627268
Hospital Revenue Code	250
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$99.20
Rate for Payer: Aetna Commercial	$75.39
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.59
Rate for Payer: Cigna Commercial	$99.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.52
Rate for Payer: Oxford Commercial	$39.68
Rate for Payer: Qualcare PPO/HMO/WC	$29.76
Rate for Payer: UnitedHealthcare Commercial	$39.68
Rate for Payer: UnitedHealthcare Community & State	$4.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.26

AZTREONAM IVPB 2GM/NS 100ML

Facility

$198.40

Hospital Charge Code	60627268
Hospital Revenue Code	250
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$29.76
Rate for Payer: Qualcare PPO/HMO/WC	$29.76

AZTREONAM IVPB 500MG/NS 50ML

Facility

$51.20

Hospital Charge Code	60627270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.60
Rate for Payer: Aetna Commercial	$19.46
Rate for Payer: Aetna Medicare Advantage	$15.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.06
Rate for Payer: Cigna Commercial	$25.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.36
Rate for Payer: Oxford Commercial	$10.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.68
Rate for Payer: UnitedHealthcare Commercial	$10.24
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

AZTREONAM IVPB 500MG/NS 50ML

Facility

$51.20

Hospital Charge Code	60627270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$7.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.68

AZULFIDINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632524
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AZULFIDINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632524
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

AZULFIDINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632523
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

AZULFIDINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632523
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AZULFIDINE EN/TAB

Facility

$3.00

Hospital Charge Code	60634352
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AZULFIDINE EN/TAB

Facility

$3.00

Hospital Charge Code	60634352
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

B2 GLYCOPROTEIN AB IGG

Facility

$180.20

Service Code	HCPCS 86146
Hospital Charge Code	38478097
Hospital Revenue Code	309
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$90.10
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.03
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.78

B2 GLYCOPROTEIN AB IGG

Facility

$180.20

Service Code	HCPCS 86146
Hospital Charge Code	38478097
Hospital Revenue Code	309
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$27.03
Rate for Payer: Qualcare PPO/HMO/WC	$27.03

B2 GLYCOPROTEIN I (IGG,A, I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B2 GLYCOPROTEIN I (IGG,A, I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B2 GLYCOPROTEIN I (IGG,A, II

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B2 GLYCOPROTEIN I (IGG,A, II

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B2 GLYCOPROTEIN I (IGG,A, III

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B2 GLYCOPROTEIN I (IGG,A, III

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990011C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B2 GLYCOPROTEIN I (IGG,A, IV

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B2 GLYCOPROTEIN I (IGG,A, IV

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B2 GLYCOPROTEIN I (IGG,A, V

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011E
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges