Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEFOXITIN 1G PREMIX

Facility

$82.41

Service Code	HCPCS J0694
Hospital Charge Code	60635576
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.32
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.94
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

CEFOXITIN 2GM VIAL

Facility

$150.75

Service Code	HCPCS J0694
Hospital Charge Code	60632211
Hospital Revenue Code	636
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$36.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61

CEFOXITIN 2GM VIAL

Facility

$150.75

Service Code	HCPCS J0694
Hospital Charge Code	60632211
Hospital Revenue Code	636
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$75.38
Rate for Payer: Aetna Commercial	$57.28
Rate for Payer: Aetna Medicare Advantage	$45.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.44
Rate for Payer: Cigna Commercial	$75.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

CEFOXITIN 2G PREMIX

Facility

$164.89

Service Code	HCPCS J0694
Hospital Charge Code	60635575
Hospital Revenue Code	636
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$82.44
Rate for Payer: Aetna Commercial	$62.66
Rate for Payer: Aetna Medicare Advantage	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.05
Rate for Payer: Cigna Commercial	$82.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Community & State	$3.97
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

CEFOXITIN 2G PREMIX

Facility

$164.89

Service Code	HCPCS J0694
Hospital Charge Code	60635575
Hospital Revenue Code	636
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$39.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

CEFOXITIN INJ 1GM

Facility

$113.30

Hospital Charge Code	6001002
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

CEFOXITIN INJ 1GM

Facility

$113.30

Hospital Charge Code	6001002
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$43.05
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.99
Rate for Payer: Oxford Commercial	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.66
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

CEFOXITIN INJ 2GM

Facility

$185.00

Hospital Charge Code	6001010
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

CEFOXITIN INJ 2GM

Facility

$185.00

Hospital Charge Code	6001010
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.34
Rate for Payer: Aetna Commercial	$21.54
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.00
Rate for Payer: Oxford Commercial	$11.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

CEFTAZIDIME 2 GM VIAL

Facility

$222.45

Hospital Charge Code	6007272
Hospital Revenue Code	636
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$53.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.37

CEFTAZIDIME 2 GM VIAL

Facility

$222.45

Hospital Charge Code	6007272
Hospital Revenue Code	636
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$111.22
Rate for Payer: Aetna Commercial	$84.53
Rate for Payer: Aetna Medicare Advantage	$66.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.72
Rate for Payer: Cigna Commercial	$111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.37
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: Wellpoint Medicaid Managed Care	$5.89

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$256.50
Rate for Payer: Qualcare PPO/HMO/WC	$256.50

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna Commercial	$649.80
Rate for Payer: Aetna Medicare Advantage	$513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.05
Rate for Payer: Cigna Commercial	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.00
Rate for Payer: Oxford Commercial	$342.00
Rate for Payer: Qualcare PPO/HMO/WC	$256.50
Rate for Payer: UnitedHealthcare Commercial	$342.00
Rate for Payer: UnitedHealthcare Community & State	$41.21
Rate for Payer: Wellpoint Medicaid Managed Care	$45.31

CEFTAZIDIME (FORTAZ) 1 G INJ

Facility

$111.25

Hospital Charge Code	6007124
Hospital Revenue Code	636
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$26.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

CEFTAZIDIME (FORTAZ) 1 G INJ

Facility

$111.25

Hospital Charge Code	6007124
Hospital Revenue Code	636
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$42.27
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

CEFTAZIDIME IVPB ODD DOSE >1G

Facility

$177.95

Hospital Charge Code	60627260
Hospital Revenue Code	250
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$26.69
Rate for Payer: Qualcare PPO/HMO/WC	$26.69

CEFTAZIDIME IVPB ODD DOSE >1G

Facility

$177.95

Hospital Charge Code	60627260
Hospital Revenue Code	250
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$88.97
Rate for Payer: Aetna Commercial	$67.62
Rate for Payer: Aetna Medicare Advantage	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.38
Rate for Payer: Cigna Commercial	$88.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.38
Rate for Payer: Oxford Commercial	$35.59
Rate for Payer: Qualcare PPO/HMO/WC	$26.69
Rate for Payer: UnitedHealthcare Commercial	$35.59
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

CEFTIN/125MG

Facility

$6.00

Hospital Charge Code	60634657
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CEFTIN/125MG

Facility

$6.00

Hospital Charge Code	60634657
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CEFTIN/125MG/UD

Facility

$6.00

Hospital Charge Code	60634658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CEFTIN/125MG/UD

Facility

$6.00

Hospital Charge Code	60634658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CEFTIN/200ML

Facility

$95.00

Hospital Charge Code	60635001
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIN/200ML

Facility

$95.00

Hospital Charge Code	60635001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

Know your out-of-pocket cost for care.

All Charges