Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.21

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.34
Rate for Payer: Aetna Commercial	$12.42
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.34
Rate for Payer: Cigna Commercial	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.81
Rate for Payer: Oxford Commercial	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$6.54
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.25

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

BORDETELLA PERTUSSIS ANTIBODY

Facility

$309.65

Service Code	HCPCS 87265
Hospital Charge Code	3009784
Hospital Revenue Code	309
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$46.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BORDETELLA PERTUSSIS ANTIBODY

Facility

$309.65

Service Code	HCPCS 87265
Hospital Charge Code	3009784
Hospital Revenue Code	309
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BORIC ACID OINT 5%

Facility

$53.80

Hospital Charge Code	6000723
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

BORIC ACID OINT 5%

Facility

$53.80

Hospital Charge Code	6000723
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$310.60
Max. Negotiated Rate	$6,444.06
Rate for Payer: Aetna Commercial	$4,897.49
Rate for Payer: Aetna Medicare Advantage	$3,866.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,286.47
Rate for Payer: Cigna Commercial	$6,444.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22
Rate for Payer: UnitedHealthcare Community & State	$310.60
Rate for Payer: Wellpoint Medicaid Managed Care	$341.54

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$1,933.22
Max. Negotiated Rate	$3,118.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22

BOSENTAN (TRACLEER) 125MG TAB

Facility

$666.00

Hospital Charge Code	60630185
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna Commercial	$253.08
Rate for Payer: Aetna Medicare Advantage	$199.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.83
Rate for Payer: Cigna Commercial	$333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.80
Rate for Payer: Oxford Commercial	$133.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.90
Rate for Payer: UnitedHealthcare Commercial	$133.20
Rate for Payer: UnitedHealthcare Community & State	$16.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.65

BOSENTAN (TRACLEER) 125MG TAB

Facility

$666.00

Hospital Charge Code	60630185
Hospital Revenue Code	250
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$99.90
Rate for Payer: Qualcare PPO/HMO/WC	$99.90

BOTLE DEVIBISS CLEAR 1OZ

Facility

$42.80

Hospital Charge Code	270655906
Hospital Revenue Code	270
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.40
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Medicare Advantage	$12.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.91
Rate for Payer: Cigna Commercial	$21.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.84
Rate for Payer: Oxford Commercial	$8.56
Rate for Payer: Qualcare PPO/HMO/WC	$6.42
Rate for Payer: UnitedHealthcare Commercial	$8.56
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

BOTLE DEVIBISS CLEAR 1OZ

Facility

$42.80

Hospital Charge Code	270655906
Hospital Revenue Code	270
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.42

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$1,345.90
Max. Negotiated Rate	$2,171.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$2,171.38
Rate for Payer: Aetna Commercial	$17.71
Rate for Payer: Aetna Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.50
Rate for Payer: Cigna Medicare Advantage	$6.51
Rate for Payer: Clover Medicare Advantage	$6.18
Rate for Payer: EmblemHealth Commercial	$19.53
Rate for Payer: Humana Medicare Advantage	$6.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90
Rate for Payer: UnitedHealthcare Community & State	$216.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.51
Rate for Payer: Wellcare Medicare Advantage	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$237.77

BOTTLE CLEANSING 8OZ

Facility

$5.65

Hospital Charge Code	270600534
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

BOTTLE CLEANSING 8OZ

Facility

$5.65

Hospital Charge Code	270600534
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

BOTTLE EVENFLO 8 OZ

Facility

$233.00

Hospital Charge Code	270654313
Hospital Revenue Code	270
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

BOTTLE EVENFLO 8 OZ

Facility

$233.00

Hospital Charge Code	270654313
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.50
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$46.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$46.60
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

Know your out-of-pocket cost for care.

All Charges