Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BRETHINE/1MG/1ML

Facility

$12.00

Hospital Charge Code	60632577
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

BRETHINE/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60632579
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

BRETHINE/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60632579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BRETHINE/5MG/TAB

Facility

$44.56

Service Code	NDC 527131101
Hospital Charge Code	60632578
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.28
Rate for Payer: Aetna Commercial	$16.93
Rate for Payer: Aetna Medicare Advantage	$13.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.36
Rate for Payer: Cigna Commercial	$22.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.37
Rate for Payer: Oxford Commercial	$8.91
Rate for Payer: Qualcare PPO/HMO/WC	$6.68
Rate for Payer: UnitedHealthcare Commercial	$8.91
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

BRETHINE/5MG/TAB

Facility

$4.00

Hospital Charge Code	60632576
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

BRETHINE/5MG/TAB

Facility

$4.00

Hospital Charge Code	60632576
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BRETHINE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632580
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

BRETHINE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BRETHINE/5MG/TAB

Facility

$44.56

Service Code	NDC 527131101
Hospital Charge Code	60632578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$6.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.68

BRETYLIUM 50 MG/ML INJ

Facility

$237.65

Hospital Charge Code	60627548
Hospital Revenue Code	250
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$35.65
Rate for Payer: Qualcare PPO/HMO/WC	$35.65

BRETYLIUM 50 MG/ML INJ

Facility

$237.65

Hospital Charge Code	60627548
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$118.83
Rate for Payer: Aetna Commercial	$90.31
Rate for Payer: Aetna Medicare Advantage	$71.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.60
Rate for Payer: Cigna Commercial	$118.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.30
Rate for Payer: Oxford Commercial	$47.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.65
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: UnitedHealthcare Community & State	$5.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.30

BRETYLIUM INJ TOSY 50MG/ML

Facility

$213.80

Hospital Charge Code	6000731
Hospital Revenue Code	250
Min. Negotiated Rate	$32.07
Max. Negotiated Rate	$32.07
Rate for Payer: Qualcare PPO/HMO/WC	$32.07

BRETYLIUM INJ TOSY 50MG/ML

Facility

$213.80

Hospital Charge Code	6000731
Hospital Revenue Code	250
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$106.90
Rate for Payer: Aetna Commercial	$81.24
Rate for Payer: Aetna Medicare Advantage	$64.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.52
Rate for Payer: Cigna Commercial	$106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.14
Rate for Payer: Oxford Commercial	$42.76
Rate for Payer: Qualcare PPO/HMO/WC	$32.07
Rate for Payer: UnitedHealthcare Commercial	$42.76
Rate for Payer: UnitedHealthcare Community & State	$5.15
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

BRETYLIUM TOSYLATE/1000MG

Facility

$333.00

Hospital Charge Code	60634711
Hospital Revenue Code	250
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$126.54
Rate for Payer: Aetna Medicare Advantage	$99.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.92
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.90
Rate for Payer: Oxford Commercial	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Commercial	$66.60
Rate for Payer: UnitedHealthcare Community & State	$8.03
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

BRETYLIUM TOSYLATE/1000MG

Facility

$333.00

Hospital Charge Code	60634711
Hospital Revenue Code	250
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

BRETYLIUM TOSYLATE/500MG

Facility

$167.00

Hospital Charge Code	60634712
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

BRETYLIUM TOSYLATE/500MG

Facility

$167.00

Hospital Charge Code	60634712
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

BRETYLOL/500MG/10ML

Facility

$155.00

Hospital Charge Code	60632581
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.50
Rate for Payer: Oxford Commercial	$31.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Commercial	$31.00
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

BRETYLOL/500MG/10ML

Facility

$155.00

Hospital Charge Code	60632581
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

BREVIBLOC 2500MG PREMIXED

Facility

$185.00

Hospital Charge Code	60635504
Hospital Revenue Code	250
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

BREVIBLOC 2500MG PREMIXED

Facility

$185.00

Hospital Charge Code	60635504
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

BREVIBLOC 250MG/ML AMP

Facility

$185.00

Hospital Charge Code	60635503
Hospital Revenue Code	250
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

BREVIBLOC 250MG/ML AMP

Facility

$185.00

Hospital Charge Code	60635503
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

BREVIBLOC AMP 250GM/1ML

Facility

$531.85

Hospital Charge Code	6006605
Hospital Revenue Code	250
Min. Negotiated Rate	$79.78
Max. Negotiated Rate	$79.78
Rate for Payer: Qualcare PPO/HMO/WC	$79.78

BREVIBLOC AMP 250GM/1ML

Facility

$531.85

Hospital Charge Code	6006605
Hospital Revenue Code	250
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$265.93
Rate for Payer: Aetna Commercial	$202.10
Rate for Payer: Aetna Medicare Advantage	$159.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.62
Rate for Payer: Cigna Commercial	$265.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.56
Rate for Payer: Oxford Commercial	$106.37
Rate for Payer: Qualcare PPO/HMO/WC	$79.78
Rate for Payer: UnitedHealthcare Commercial	$106.37
Rate for Payer: UnitedHealthcare Community & State	$12.82
Rate for Payer: Wellpoint Medicaid Managed Care	$14.09

Know your out-of-pocket cost for care.

All Charges