Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NOVOLIN R 10ML VIAL (100U/ML)

Facility

$289.20

Hospital Charge Code	606390569
Hospital Revenue Code	250
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$43.38
Rate for Payer: Qualcare PPO/HMO/WC	$43.38

NOVOLIN R PER 5 UNITS

Facility

$4.00

Service Code	NDC 169183311
Hospital Charge Code	60632252
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NOVOLIN R PER 5 UNITS

Facility

$4.00

Service Code	NDC 169183311
Hospital Charge Code	60632252
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NOVOLOG 100UNITS/ML

Facility

$4.00

Service Code	NDC 169330312
Hospital Charge Code	60635373
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NOVOLOG 100UNITS/ML

Facility

$4.00

Service Code	NDC 169330312
Hospital Charge Code	60635373
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NOVOLOG 70/30 PEN

Facility

$2,472.50

Hospital Charge Code	6063943152
Hospital Revenue Code	250
Min. Negotiated Rate	$59.59
Max. Negotiated Rate	$1,236.25
Rate for Payer: Aetna Commercial	$939.55
Rate for Payer: Aetna Medicare Advantage	$741.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.49
Rate for Payer: Cigna Commercial	$1,236.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.75
Rate for Payer: Oxford Commercial	$494.50
Rate for Payer: Qualcare PPO/HMO/WC	$370.88
Rate for Payer: UnitedHealthcare Commercial	$494.50
Rate for Payer: UnitedHealthcare Community & State	$59.59
Rate for Payer: Wellpoint Medicaid Managed Care	$65.52

NOVOLOG 70/30 PEN

Facility

$2,472.50

Hospital Charge Code	6063943152
Hospital Revenue Code	250
Min. Negotiated Rate	$370.88
Max. Negotiated Rate	$370.88
Rate for Payer: Qualcare PPO/HMO/WC	$370.88

NOVOLOG MIX 70/30

Facility

$4.00

Service Code	NDC 169368512
Hospital Charge Code	60635483
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NOVOLOG MIX 70/30

Facility

$4.00

Service Code	NDC 169368512
Hospital Charge Code	60635483
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NOVOLOG PEN

Facility

$2,472.40

Hospital Charge Code	6063943153
Hospital Revenue Code	250
Min. Negotiated Rate	$59.58
Max. Negotiated Rate	$1,236.20
Rate for Payer: Aetna Commercial	$939.51
Rate for Payer: Aetna Medicare Advantage	$741.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.46
Rate for Payer: Cigna Commercial	$1,236.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.72
Rate for Payer: Oxford Commercial	$494.48
Rate for Payer: Qualcare PPO/HMO/WC	$370.86
Rate for Payer: UnitedHealthcare Commercial	$494.48
Rate for Payer: UnitedHealthcare Community & State	$59.58
Rate for Payer: Wellpoint Medicaid Managed Care	$65.52

NOVOLOG PEN

Facility

$2,472.40

Hospital Charge Code	6063943153
Hospital Revenue Code	250
Min. Negotiated Rate	$370.86
Max. Negotiated Rate	$370.86
Rate for Payer: Qualcare PPO/HMO/WC	$370.86

NOVOSTITCH CARTIDGE 0

Facility

$2,375.00

Hospital Charge Code	270688717
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

NOVOSTITCH CARTIDGE 0

Facility

$2,375.00

Hospital Charge Code	270688717
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

NOVOSTIT PRO MENISAL RPR SYS 0

Facility

$2,475.00

Hospital Charge Code	270688718
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

NOVOSTIT PRO MENISAL RPR SYS 0

Facility

$2,475.00

Hospital Charge Code	270688718
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

NPH (U100)

Facility

$10.90

Hospital Charge Code	6008353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

NPH (U100)

Facility

$10.90

Hospital Charge Code	6008353
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

NPLATE 250MCG

Facility

$5,850.00

Hospital Charge Code	60635713
Hospital Revenue Code	250
Min. Negotiated Rate	$140.99
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$2,223.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$1,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50
Rate for Payer: UnitedHealthcare Commercial	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$140.99
Rate for Payer: Wellpoint Medicaid Managed Care	$155.03

NPLATE 250MCG

Facility

$5,850.00

Hospital Charge Code	60635713
Hospital Revenue Code	250
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$877.50
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

NPWT < 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97607
Hospital Charge Code	9808331
Hospital Revenue Code	361
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.26
Rate for Payer: Qualcare PPO/HMO/WC	$130.13
Rate for Payer: UnitedHealthcare Community & State	$20.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$22.99

NPWT < 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97607
Hospital Charge Code	9808331
Hospital Revenue Code	361
Min. Negotiated Rate	$130.13
Max. Negotiated Rate	$130.13
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT > 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97608
Hospital Charge Code	9808332
Hospital Revenue Code	361
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.26
Rate for Payer: Qualcare PPO/HMO/WC	$130.13
Rate for Payer: UnitedHealthcare Community & State	$20.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$22.99

NPWT > 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97608
Hospital Charge Code	9808332
Hospital Revenue Code	361
Min. Negotiated Rate	$130.13
Max. Negotiated Rate	$130.13
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT TWO DRESSING KIT 10X20CM

Facility

$572.00

Hospital Charge Code	270693967
Hospital Revenue Code	270
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$85.80

NPWT TWO DRESSING KIT 10X20CM

Facility

$572.00

Hospital Charge Code	270693967
Hospital Revenue Code	270
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$286.00
Rate for Payer: Aetna Commercial	$217.36
Rate for Payer: Aetna Medicare Advantage	$171.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.86
Rate for Payer: Cigna Commercial	$286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.60
Rate for Payer: Oxford Commercial	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$85.80
Rate for Payer: UnitedHealthcare Commercial	$114.40
Rate for Payer: UnitedHealthcare Community & State	$13.79
Rate for Payer: Wellpoint Medicaid Managed Care	$15.16

Know your out-of-pocket cost for care.

All Charges