Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARVEDILOL 6.25 MG TAB

Facility

$126.03

Service Code	NDC 80725014020
Hospital Charge Code	60628586
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL TAB 3.125MG

Facility

$10.90

Hospital Charge Code	6018006
Hospital Revenue Code	252
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

CARVEDILOL TAB 3.125MG

Facility

$10.90

Hospital Charge Code	6018006
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

CA SAIL PLUS5x40x130SAE0500401

Facility

$1,413.65

Hospital Charge Code	270635690
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CA SAIL PLUS5x40x130SAE0500401

Facility

$1,413.65

Hospital Charge Code	270635690V
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CA SAIL PLUS5x40x130SAE0500401

Facility

$1,413.65

Hospital Charge Code	270635690V
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CA SAIL PLUS5x40x130SAE0500401

Facility

$1,413.65

Hospital Charge Code	270635690
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CASCADE 910046

Facility

$750.00

Hospital Charge Code	270646505
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CASCADE 910046

Facility

$750.00

Hospital Charge Code	270646505
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CASCADE PLATELET SYST PRFM KIT

Facility

$1,750.00

Hospital Charge Code	270678210
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CASCADE PLATELET SYST PRFM KIT

Facility

$1,750.00

Hospital Charge Code	270678210
Hospital Revenue Code	272
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CASCADE PLATELET SYST PRP MEMB

Facility

$3,300.00

Hospital Charge Code	270678212
Hospital Revenue Code	272
Min. Negotiated Rate	$79.53
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$1,254.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.00
Rate for Payer: Oxford Commercial	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00
Rate for Payer: UnitedHealthcare Commercial	$660.00
Rate for Payer: UnitedHealthcare Community & State	$79.53
Rate for Payer: Wellpoint Medicaid Managed Care	$87.45

CASCADE PLATELET SYST PRP MEMB

Facility

$3,300.00

Hospital Charge Code	270678212
Hospital Revenue Code	272
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

CASCADE PLATELET SYST PRP x2

Facility

$2,625.00

Hospital Charge Code	270678211
Hospital Revenue Code	272
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

CASCADE PLATELET SYST PRP x2

Facility

$2,625.00

Hospital Charge Code	270678211
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

CASCARA AROMATIC 4 OZ

Facility

$1.95

Hospital Charge Code	6006258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CASCARA AROMATIC 4 OZ

Facility

$1.95

Hospital Charge Code	6006258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CASCARA LQ 120ML

Facility

$9.00

Hospital Charge Code	60628587
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CASCARA LQ 120ML

Facility

$9.00

Hospital Charge Code	60628587
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

CASCARA SAGRADA 5ML U/D CUP

Facility

$1.60

Hospital Charge Code	60629313
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.61
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.48
Rate for Payer: Oxford Commercial	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.32
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

CASCARA SAGRADA 5ML U/D CUP

Facility

$1.60

Hospital Charge Code	60629313
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

CASCARA SAGRADA AROMATIC

Facility

$3.00

Hospital Charge Code	60632642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CASCARA SAGRADA AROMATIC

Facility

$3.00

Hospital Charge Code	60632642
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

CASCARA SAGRADA AROMATIC

Facility

$1.00

Hospital Charge Code	60632641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CASCARA SAGRADA AROMATIC

Facility

$1.00

Hospital Charge Code	60632641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

Know your out-of-pocket cost for care.

All Charges