Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BETHANECHOL CHLORIDE/10MG

Facility

$3.00

Hospital Charge Code	60632557
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

BETHANECHOL CHLORIDE/25MG

Facility

$4.00

Hospital Charge Code	60632559
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BETHANECHOL CHLORIDE/25MG

Facility

$4.00

Hospital Charge Code	60632559
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

BETHANECHOL CHLORIDE/50MG

Facility

$3.00

Hospital Charge Code	60632558
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETHANECHOL CHLORIDE/50MG

Facility

$3.00

Hospital Charge Code	60632558
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

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.73
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$3.82
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

BETHANECHOL CHLORIDE/5MG

Facility

$3.00

Hospital Charge Code	60632556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETHANECHOL CHLORIDE/5MG

Facility

$3.00

Hospital Charge Code	60632556
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

BETHANECHOL INJ 5MG/ML

Facility

$43.55

Hospital Charge Code	6008932
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

BETHANECHOL INJ 5MG/ML

Facility

$43.55

Hospital Charge Code	6008932
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

BETOPTIC 0.5% OPHTH/10ML

Facility

$167.00

Hospital Charge Code	60632561
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

BETOPTIC 0.5% OPHTH/10ML

Facility

$167.00

Hospital Charge Code	60632561
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$33.40
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.43
Rate for Payer: Aetna Commercial	$161.44
Rate for Payer: Aetna Medicare Advantage	$127.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.34
Rate for Payer: Cigna Commercial	$212.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.45
Rate for Payer: Oxford Commercial	$84.97
Rate for Payer: Qualcare PPO/HMO/WC	$63.73
Rate for Payer: UnitedHealthcare Commercial	$84.97
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$63.73
Max. Negotiated Rate	$63.73
Rate for Payer: Qualcare PPO/HMO/WC	$63.73

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$42.26
Max. Negotiated Rate	$876.76
Rate for Payer: Aetna Commercial	$666.34
Rate for Payer: Aetna Medicare Advantage	$526.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.15
Rate for Payer: Cigna Commercial	$876.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.06
Rate for Payer: Oxford Commercial	$350.70
Rate for Payer: Qualcare PPO/HMO/WC	$263.03
Rate for Payer: UnitedHealthcare Commercial	$350.70
Rate for Payer: UnitedHealthcare Community & State	$42.26
Rate for Payer: Wellpoint Medicaid Managed Care	$46.47

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$263.03
Max. Negotiated Rate	$263.03
Rate for Payer: Qualcare PPO/HMO/WC	$263.03

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.00
Rate for Payer: Oxford Commercial	$134.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Commercial	$134.00
Rate for Payer: UnitedHealthcare Community & State	$16.15
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$635.80
Rate for Payer: Qualcare PPO/HMO/WC	$433.50

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$69.65
Max. Negotiated Rate	$1,445.00
Rate for Payer: Aetna Commercial	$1,098.20
Rate for Payer: Aetna Medicare Advantage	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$736.95
Rate for Payer: Cigna Commercial	$1,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$635.80
Rate for Payer: Qualcare PPO/HMO/WC	$433.50
Rate for Payer: UnitedHealthcare Community & State	$69.65
Rate for Payer: Wellpoint Medicaid Managed Care	$76.58

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$162.53
Max. Negotiated Rate	$162.53
Rate for Payer: Qualcare PPO/HMO/WC	$162.53

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$541.77
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$541.77
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$28.71

Know your out-of-pocket cost for care.

All Charges