Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BICARBONATE (CARBON DIOXIDE)

Facility

$52.85

Service Code	HCPCS 82374
Hospital Charge Code	8200305RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

BICARBONATE LIQ

Facility

$43.25

Hospital Charge Code	8200313
Hospital Revenue Code	279
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.62
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$12.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.03
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.97
Rate for Payer: Oxford Commercial	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$8.65
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

BICARBONATE LIQ

Facility

$43.25

Hospital Charge Code	8200313
Hospital Revenue Code	279
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

BICARBONATE LIQ BC-1-L

Facility

$29.65

Hospital Charge Code	270605142
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

BICARBONATE LIQ BC-1-L

Facility

$29.65

Hospital Charge Code	270605142
Hospital Revenue Code	270
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BICARBONATE SODIUM

Facility

$69.65

Hospital Charge Code	270604384
Hospital Revenue Code	270
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$10.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.45

BICARBONATE SODIUM

Facility

$69.65

Hospital Charge Code	270604384
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$34.83
Rate for Payer: Aetna Commercial	$26.47
Rate for Payer: Aetna Medicare Advantage	$20.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.76
Rate for Payer: Cigna Commercial	$34.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.89
Rate for Payer: Oxford Commercial	$13.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.45
Rate for Payer: UnitedHealthcare Commercial	$13.93
Rate for Payer: UnitedHealthcare Community & State	$1.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$5.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.04

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$16.80
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.04
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Medicare Advantage	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

BICILLIN C-R/1.2MU/2ML

Facility

$43.00

Hospital Charge Code	60632563
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

BICILLIN C-R/1.2MU/2ML

Facility

$43.00

Hospital Charge Code	60632563
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

BICILLIN C-R/600KU/1ML

Facility

$23.00

Hospital Charge Code	60632562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

BICILLIN C-R/600KU/1ML

Facility

$23.00

Hospital Charge Code	60632562
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

BICILLIN LA/1.2MU/2ML

Facility

$66.00

Hospital Charge Code	60632566
Hospital Revenue Code	636
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

BICILLIN LA/1.2MU/2ML

Facility

$66.00

Hospital Charge Code	60632566
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

BICILLIN L-A/2.4MU/4ML

Facility

$131.00

Hospital Charge Code	60632565
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$31.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

BICILLIN L-A/2.4MU/4ML

Facility

$131.00

Hospital Charge Code	60632565
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.76
Rate for Payer: Aetna Commercial	$39.34
Rate for Payer: Aetna Medicare Advantage	$31.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.40
Rate for Payer: Cigna Commercial	$51.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$25.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$5.12
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.04
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$111.13
Max. Negotiated Rate	$111.13
Rate for Payer: Qualcare PPO/HMO/WC	$111.13

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$370.44
Rate for Payer: Aetna Commercial	$281.54
Rate for Payer: Aetna Medicare Advantage	$222.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.93
Rate for Payer: Cigna Commercial	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.27
Rate for Payer: Oxford Commercial	$148.18
Rate for Payer: Qualcare PPO/HMO/WC	$111.13
Rate for Payer: UnitedHealthcare Commercial	$148.18
Rate for Payer: UnitedHealthcare Community & State	$17.86
Rate for Payer: Wellpoint Medicaid Managed Care	$19.63

Know your out-of-pocket cost for care.

All Charges