Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETIC ACID 0.25% IRRIG SOL

Facility

$19.30

Service Code	NDC 990614309
Hospital Charge Code	60627980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

ACETIC ACID 10% / 500ML

Facility

$66.00

Hospital Charge Code	60635589
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

ACETIC ACID 10% / 500ML

Facility

$66.00

Hospital Charge Code	60635589
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

ACETIC ACID 1/2% SOLN

Facility

$61.00

Hospital Charge Code	60634793
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

ACETIC ACID 1/2% SOLN

Facility

$61.00

Hospital Charge Code	60634793
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

ACETIC ACID 1/4% SOLN

Facility

$61.00

Hospital Charge Code	60634792
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

ACETIC ACID 1/4% SOLN

Facility

$61.00

Hospital Charge Code	60634792
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

ACETIC ACID 1% SOLN

Facility

$44.00

Hospital Charge Code	60634791
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

ACETIC ACID 1% SOLN

Facility

$44.00

Hospital Charge Code	60634791
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

ACETIC ACID 2% HC 1% OTIC

Facility

$245.80

Hospital Charge Code	6005789
Hospital Revenue Code	251
Min. Negotiated Rate	$36.87
Max. Negotiated Rate	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$36.87

ACETIC ACID 2% HC 1% OTIC

Facility

$245.80

Hospital Charge Code	6005789
Hospital Revenue Code	251
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.90
Rate for Payer: Aetna Commercial	$93.40
Rate for Payer: Aetna Medicare Advantage	$73.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.68
Rate for Payer: Cigna Commercial	$122.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.74
Rate for Payer: Oxford Commercial	$49.16
Rate for Payer: Qualcare PPO/HMO/WC	$36.87
Rate for Payer: UnitedHealthcare Commercial	$49.16
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

ACETIC ACID 2% OTIC

Facility

$122.25

Hospital Charge Code	6005771
Hospital Revenue Code	251
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

ACETIC ACID 2% OTIC

Facility

$122.25

Hospital Charge Code	6005771
Hospital Revenue Code	251
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

ACETIC ACID 2% OTIC SOLUTION

Facility

$267.93

Service Code	NDC 603703841
Hospital Charge Code	60631016
Hospital Revenue Code	250
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$133.97
Rate for Payer: Aetna Commercial	$101.81
Rate for Payer: Aetna Medicare Advantage	$80.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.32
Rate for Payer: Cigna Commercial	$133.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.38
Rate for Payer: Oxford Commercial	$53.59
Rate for Payer: Qualcare PPO/HMO/WC	$40.19
Rate for Payer: UnitedHealthcare Commercial	$53.59
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

ACETIC ACID 2% OTIC SOLUTION

Facility

$267.93

Service Code	NDC 603703841
Hospital Charge Code	60631016
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$40.19
Rate for Payer: Qualcare PPO/HMO/WC	$40.19

ACETIC ACID 5% 473 ML

Facility

$28.21

Service Code	NDC 51552005506
Hospital Charge Code	606350937
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

ACETIC ACID 5% 473 ML

Facility

$28.21

Service Code	NDC 51552005506
Hospital Charge Code	606350937
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.11
Rate for Payer: Aetna Commercial	$10.72
Rate for Payer: Aetna Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.19
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.46
Rate for Payer: Oxford Commercial	$5.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$5.64
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

ACETIC ACID GLACIAL

Facility

$3.00

Hospital Charge Code	60634468
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

ACETIC ACID GLACIAL

Facility

$3.00

Hospital Charge Code	60634468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ACETIC ACID HYDROCORT SOL OTIC

Facility

$33.50

Hospital Charge Code	60628032
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.05
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$6.70
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

ACETIC ACID HYDROCORT SOL OTIC

Facility

$33.50

Hospital Charge Code	60628032
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

ACETIC ACID SOL IRRIG 500ML

Facility

$101.80

Hospital Charge Code	6005763
Hospital Revenue Code	251
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$50.90
Rate for Payer: Aetna Commercial	$38.68
Rate for Payer: Aetna Medicare Advantage	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.96
Rate for Payer: Cigna Commercial	$50.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.54
Rate for Payer: Oxford Commercial	$20.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.27
Rate for Payer: UnitedHealthcare Commercial	$20.36
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

ACETIC ACID SOL IRRIG 500ML

Facility

$101.80

Hospital Charge Code	6005763
Hospital Revenue Code	251
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$15.27
Rate for Payer: Qualcare PPO/HMO/WC	$15.27

ACETIC ACID SOL OTIC 2%

Facility

$35.85

Hospital Charge Code	60628031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.93
Rate for Payer: Aetna Commercial	$13.62
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.76
Rate for Payer: Oxford Commercial	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

ACETIC ACID SOL OTIC 2%

Facility

$35.85

Hospital Charge Code	60628031
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

Know your out-of-pocket cost for care.

All Charges