Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUPROPION 150 MG CR TAB

Facility

$11.25

Hospital Charge Code	60628579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

BUPROPION 150 MG SR TAB

Facility

$40.00

Service Code	NDC 173013555
Hospital Charge Code	60627757
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

BUPROPION 150 MG SR TAB

Facility

$40.00

Service Code	NDC 173013555
Hospital Charge Code	60627757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

BUPROPION 75 MG TAB UD

Facility

$10.39

Service Code	NDC 51079094320
Hospital Charge Code	60627758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$3.95
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$2.08
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

BUPROPION 75 MG TAB UD

Facility

$10.39

Service Code	NDC 51079094320
Hospital Charge Code	60627758
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

BUPROPION TAB 75MG

Facility

$3.85

Hospital Charge Code	6027049
Hospital Revenue Code	252
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

BUPROPION TAB 75MG

Facility

$3.85

Hospital Charge Code	6027049
Hospital Revenue Code	252
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

BUPROPION XL 300MG

Facility

$19.07

Hospital Charge Code	60635738
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$2.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.86

BUPROPION XL 300MG

Facility

$19.07

Hospital Charge Code	60635738
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.54
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: Aetna Medicare Advantage	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.86
Rate for Payer: Cigna Commercial	$9.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.86
Rate for Payer: UnitedHealthcare Commercial	$3.81
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BUPROPION XL(WELLBUTRIN)300

Facility

$204.02

Service Code	NDC 904657304
Hospital Charge Code	60630150
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$102.01
Rate for Payer: Aetna Commercial	$77.53
Rate for Payer: Aetna Medicare Advantage	$61.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.03
Rate for Payer: Cigna Commercial	$102.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.21
Rate for Payer: Oxford Commercial	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$40.80
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

BUPROPION XL(WELLBUTRIN)300

Facility

$204.02

Service Code	NDC 904657304
Hospital Charge Code	60630150
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

BUR 1.6MMX9CM MIDAS REX MR8

Facility

$1,660.00

Hospital Charge Code	270696446
Hospital Revenue Code	272
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$249.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00

BUR 1.6MMX9CM MIDAS REX MR8

Facility

$1,660.00

Hospital Charge Code	270696446
Hospital Revenue Code	272
Min. Negotiated Rate	$40.01
Max. Negotiated Rate	$830.00
Rate for Payer: Aetna Commercial	$630.80
Rate for Payer: Aetna Medicare Advantage	$498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.30
Rate for Payer: Cigna Commercial	$830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$498.00
Rate for Payer: Oxford Commercial	$332.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00
Rate for Payer: UnitedHealthcare Commercial	$332.00
Rate for Payer: UnitedHealthcare Community & State	$40.01
Rate for Payer: Wellpoint Medicaid Managed Care	$43.99

BUR 2.3 MM TAPERED ROUTER

Facility

$577.55

Hospital Charge Code	270683609
Hospital Revenue Code	272
Min. Negotiated Rate	$86.63
Max. Negotiated Rate	$86.63
Rate for Payer: Qualcare PPO/HMO/WC	$86.63

BUR 2.3 MM TAPERED ROUTER

Facility

$577.55

Hospital Charge Code	270683609
Hospital Revenue Code	272
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$288.77
Rate for Payer: Aetna Commercial	$219.47
Rate for Payer: Aetna Medicare Advantage	$173.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.28
Rate for Payer: Cigna Commercial	$288.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.26
Rate for Payer: Oxford Commercial	$115.51
Rate for Payer: Qualcare PPO/HMO/WC	$86.63
Rate for Payer: UnitedHealthcare Commercial	$115.51
Rate for Payer: UnitedHealthcare Community & State	$13.92
Rate for Payer: Wellpoint Medicaid Managed Care	$15.31

BUR 25.4MMX9CM MIDAS REX MR8

Facility

$1,385.00

Hospital Charge Code	270696447
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$692.50
Rate for Payer: Aetna Commercial	$526.30
Rate for Payer: Aetna Medicare Advantage	$415.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.18
Rate for Payer: Cigna Commercial	$692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$415.50
Rate for Payer: Oxford Commercial	$277.00
Rate for Payer: Qualcare PPO/HMO/WC	$207.75
Rate for Payer: UnitedHealthcare Commercial	$277.00
Rate for Payer: UnitedHealthcare Community & State	$33.38
Rate for Payer: Wellpoint Medicaid Managed Care	$36.70

BUR 25.4MMX9CM MIDAS REX MR8

Facility

$1,385.00

Hospital Charge Code	270696447
Hospital Revenue Code	272
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$207.75
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

BUR 3MMX9CM MIDAS REX MR8

Facility

$1,660.00

Hospital Charge Code	270696448
Hospital Revenue Code	272
Min. Negotiated Rate	$40.01
Max. Negotiated Rate	$830.00
Rate for Payer: Aetna Commercial	$630.80
Rate for Payer: Aetna Medicare Advantage	$498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.30
Rate for Payer: Cigna Commercial	$830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$498.00
Rate for Payer: Oxford Commercial	$332.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00
Rate for Payer: UnitedHealthcare Commercial	$332.00
Rate for Payer: UnitedHealthcare Community & State	$40.01
Rate for Payer: Wellpoint Medicaid Managed Care	$43.99

BUR 3MMX9CM MIDAS REX MR8

Facility

$1,660.00

Hospital Charge Code	270696448
Hospital Revenue Code	272
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$249.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00

BUR 4.0MM ROUND CUTTING

Facility

$274.00

Hospital Charge Code	270696474
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$137.00
Rate for Payer: Aetna Commercial	$104.12
Rate for Payer: Aetna Medicare Advantage	$82.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.87
Rate for Payer: Cigna Commercial	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.20
Rate for Payer: Oxford Commercial	$54.80
Rate for Payer: Qualcare PPO/HMO/WC	$41.10
Rate for Payer: UnitedHealthcare Commercial	$54.80
Rate for Payer: UnitedHealthcare Community & State	$6.60
Rate for Payer: Wellpoint Medicaid Managed Care	$7.26

BUR 4.0MM ROUND CUTTING

Facility

$274.00

Hospital Charge Code	270696474
Hospital Revenue Code	272
Min. Negotiated Rate	$41.10
Max. Negotiated Rate	$41.10
Rate for Payer: Qualcare PPO/HMO/WC	$41.10

BUR 4mm CUTTING 31314065UE

Facility

$175.00

Hospital Charge Code	270639699
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

BUR 4mm CUTTING 31314065UE

Facility

$175.00

Hospital Charge Code	270639699
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

BUR 6.0 ACORN MM

Facility

$1,125.00

Hospital Charge Code	270683985
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BUR 6.0 ACORN MM

Facility

$1,125.00

Hospital Charge Code	270683985
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

Know your out-of-pocket cost for care.

All Charges