Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BISMUTH MAGMA SSP 8 OZ

Facility

$21.15

Hospital Charge Code	6000707
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012280
Hospital Revenue Code	250
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$221.45
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Aetna Medicare Advantage	$132.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.94
Rate for Payer: Cigna Commercial	$221.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.87
Rate for Payer: Oxford Commercial	$88.58
Rate for Payer: Qualcare PPO/HMO/WC	$66.44
Rate for Payer: UnitedHealthcare Commercial	$88.58
Rate for Payer: UnitedHealthcare Community & State	$10.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.74

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012272
Hospital Revenue Code	250
Min. Negotiated Rate	$66.44
Max. Negotiated Rate	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.44

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012272
Hospital Revenue Code	250
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$221.45
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Aetna Medicare Advantage	$132.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.94
Rate for Payer: Cigna Commercial	$221.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.87
Rate for Payer: Oxford Commercial	$88.58
Rate for Payer: Qualcare PPO/HMO/WC	$66.44
Rate for Payer: UnitedHealthcare Commercial	$88.58
Rate for Payer: UnitedHealthcare Community & State	$10.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.74

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012280
Hospital Revenue Code	250
Min. Negotiated Rate	$66.44
Max. Negotiated Rate	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.44

BISMUTH SUBGALLATE POWDER

Facility

$967.25

Hospital Charge Code	60628514
Hospital Revenue Code	250
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$483.62
Rate for Payer: Aetna Commercial	$367.56
Rate for Payer: Aetna Medicare Advantage	$290.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.65
Rate for Payer: Cigna Commercial	$483.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.18
Rate for Payer: Oxford Commercial	$193.45
Rate for Payer: Qualcare PPO/HMO/WC	$145.09
Rate for Payer: UnitedHealthcare Commercial	$193.45
Rate for Payer: UnitedHealthcare Community & State	$23.31
Rate for Payer: Wellpoint Medicaid Managed Care	$25.63

BISMUTH SUBGALLATE POWDER

Facility

$967.25

Hospital Charge Code	60628514
Hospital Revenue Code	250
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$145.09
Rate for Payer: Qualcare PPO/HMO/WC	$145.09

BISMUTH SUBSALICYLATE

Facility

$4.00

Service Code	NDC 37000003204
Hospital Charge Code	60628109
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

BISMUTH SUBSALICYLATE

Facility

$4.00

Service Code	NDC 37000003204
Hospital Charge Code	60628109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISMUTH SUBSALICYLATE CHEW TAB

Facility

$2.45

Hospital Charge Code	60628108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

BISMUTH SUBSALICYLATE CHEW TAB

Facility

$2.45

Hospital Charge Code	60628108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

BISOPROLOL 5 MG TAB

Facility

$9.38

Service Code	NDC 29300012613
Hospital Charge Code	60630005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

BISOPROLOL 5 MG TAB

Facility

$9.38

Service Code	NDC 29300012613
Hospital Charge Code	60630005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$3.56
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.81
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

BIT AMD DRILL CANN AT-7032

Facility

$932.50

Hospital Charge Code	270621019
Hospital Revenue Code	272
Min. Negotiated Rate	$139.88
Max. Negotiated Rate	$139.88
Rate for Payer: Qualcare PPO/HMO/WC	$139.88

BIT AMD DRILL CANN AT-7032

Facility

$932.50

Hospital Charge Code	270621019
Hospital Revenue Code	272
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$466.25
Rate for Payer: Aetna Commercial	$354.35
Rate for Payer: Aetna Medicare Advantage	$279.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.79
Rate for Payer: Cigna Commercial	$466.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.75
Rate for Payer: Oxford Commercial	$186.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.88
Rate for Payer: UnitedHealthcare Commercial	$186.50
Rate for Payer: UnitedHealthcare Community & State	$22.47
Rate for Payer: Wellpoint Medicaid Managed Care	$24.71

BIT BMT DR 2.8 20 25-424505

Facility

$386.95

Hospital Charge Code	270628131
Hospital Revenue Code	272
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$147.04
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.08
Rate for Payer: Oxford Commercial	$77.39
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Commercial	$77.39
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.25

BIT BMT DR 2.8 20 25-424505

Facility

$386.95

Hospital Charge Code	270628131
Hospital Revenue Code	272
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$58.04
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

BIT BMT DR 3.2 20 25-424508

Facility

$639.90

Hospital Charge Code	270615800
Hospital Revenue Code	272
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$319.95
Rate for Payer: Aetna Commercial	$243.16
Rate for Payer: Aetna Medicare Advantage	$191.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.17
Rate for Payer: Cigna Commercial	$319.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.97
Rate for Payer: Oxford Commercial	$127.98
Rate for Payer: Qualcare PPO/HMO/WC	$95.98
Rate for Payer: UnitedHealthcare Commercial	$127.98
Rate for Payer: UnitedHealthcare Community & State	$15.42
Rate for Payer: Wellpoint Medicaid Managed Care	$16.96

BIT BMT DR 3.2 20 25-424508

Facility

$639.90

Hospital Charge Code	270615800
Hospital Revenue Code	272
Min. Negotiated Rate	$95.98
Max. Negotiated Rate	$95.98
Rate for Payer: Qualcare PPO/HMO/WC	$95.98

BIT BMT DR 3.2 40 25-424510

Facility

$500.00

Hospital Charge Code	270617803
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

BIT BMT DR 3.2 40 25-424510

Facility

$500.00

Hospital Charge Code	270617803
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BIT BMT DR 3.2 5.5 35463018

Facility

$610.00

Hospital Charge Code	270612878
Hospital Revenue Code	272
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

BIT BMT DR 3.2 5.5 35463018

Facility

$610.00

Hospital Charge Code	270612878
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

BIT BMT DR 4.5 5.0 35463020

Facility

$420.85

Hospital Charge Code	270625700
Hospital Revenue Code	272
Min. Negotiated Rate	$63.13
Max. Negotiated Rate	$63.13
Rate for Payer: Qualcare PPO/HMO/WC	$63.13

BIT BMT DR 4.5 5.0 35463020

Facility

$420.85

Hospital Charge Code	270625700
Hospital Revenue Code	272
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$210.43
Rate for Payer: Aetna Commercial	$159.92
Rate for Payer: Aetna Medicare Advantage	$126.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.32
Rate for Payer: Cigna Commercial	$210.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.25
Rate for Payer: Oxford Commercial	$84.17
Rate for Payer: Qualcare PPO/HMO/WC	$63.13
Rate for Payer: UnitedHealthcare Commercial	$84.17
Rate for Payer: UnitedHealthcare Community & State	$10.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.15

Know your out-of-pocket cost for care.

All Charges