Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BEN 30/KAO 30/EMYL 30ML

Facility

$41.00

Hospital Charge Code	60634886
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

BEN 30/KAO 30/EMYL 30ML

Facility

$41.00

Hospital Charge Code	60634886
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$8.20
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

BENADRYL 1%/30GM

Facility

$8.00

Hospital Charge Code	60632540
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

BENADRYL 1%/30GM

Facility

$8.00

Hospital Charge Code	60632540
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

BENADRYL 1 % CREAM

Facility

$27.00

Service Code	NDC 12547017162
Hospital Charge Code	606350977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

BENADRYL 1 % CREAM

Facility

$27.00

Service Code	NDC 12547017162
Hospital Charge Code	606350977
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

BENADRYL ELIX 12.5MG/5CC

Facility

$1.00

Hospital Charge Code	60634767
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BENADRYL ELIX 12.5MG/5CC

Facility

$1.00

Hospital Charge Code	60634767
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BENADRYL ELIXER/5ML

Facility

$93.00

Hospital Charge Code	60634970
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$46.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.90
Rate for Payer: Oxford Commercial	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.95
Rate for Payer: UnitedHealthcare Commercial	$18.60
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

BENADRYL ELIXER/5ML

Facility

$93.00

Hospital Charge Code	60634970
Hospital Revenue Code	250
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

BENADRYL/KAO/TETRACYCLINE

Facility

$43.00

Hospital Charge Code	60634866
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

BENADRYL/KAO/TETRACYCLINE

Facility

$43.00

Hospital Charge Code	60634866
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

BENAZEPRIL 10 MG TAB

Facility

$7.25

Hospital Charge Code	60628570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

BENAZEPRIL 10 MG TAB

Facility

$7.25

Hospital Charge Code	60628570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

BENAZEPRIL 20 MG TAB

Facility

$7.25

Hospital Charge Code	60628571
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

BENAZEPRIL 20 MG TAB

Facility

$7.25

Hospital Charge Code	60628571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

BENAZEPRIL HYDROCHLORIDE 5 MG

Facility

$6.06

Hospital Charge Code	6063943184
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

BENAZEPRIL HYDROCHLORIDE 5 MG

Facility

$6.06

Hospital Charge Code	6063943184
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.30
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

BENCE-JONES PROTEIN***

Facility

$69.00

Hospital Charge Code	3010402
Hospital Revenue Code	301
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

BENCE-JONES PROTEIN***

Facility

$69.00

Hospital Charge Code	3010402
Hospital Revenue Code	301
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

BENCE JONES,SCREEN

Facility

$399.00

Service Code	HCPCS 86320
Hospital Charge Code	38477029
Hospital Revenue Code	302
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$81.38
Rate for Payer: Aetna Medicare Advantage	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.00
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: Cigna Medicare Advantage	$29.92
Rate for Payer: Clover Medicare Advantage	$28.42
Rate for Payer: EmblemHealth Commercial	$89.76
Rate for Payer: Humana Medicare Advantage	$30.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.92
Rate for Payer: Wellcare Medicare Advantage	$29.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.57

BENCE JONES,SCREEN

Facility

$399.00

Service Code	HCPCS 86320
Hospital Charge Code	38477029
Hospital Revenue Code	302
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$59.85
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065N
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065S
Hospital Revenue Code	272
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,492.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065N
Hospital Revenue Code	272
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,492.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

Know your out-of-pocket cost for care.

All Charges