Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEFTIN/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632661
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CEFTIN/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CEFTIN/250MG/UD

Facility

$18.00

Hospital Charge Code	60634659
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CEFTIN/250MG/UD

Facility

$18.00

Hospital Charge Code	60634659
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

CEFTIN/500MG/TAB

Facility

$28.00

Hospital Charge Code	60632662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

CEFTIN/500MG/TAB

Facility

$28.00

Hospital Charge Code	60632662
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CEFTIN/500MG/UD

Facility

$13.00

Hospital Charge Code	60634660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CEFTIN/500MG/UD

Facility

$13.00

Hospital Charge Code	60634660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CEFTIN SUSP/100ML

Facility

$95.00

Hospital Charge Code	60635000
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIN SUSP/100ML

Facility

$95.00

Hospital Charge Code	60635000
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

CEFTIN SUSP/50ML

Facility

$95.00

Hospital Charge Code	60634999
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

CEFTIN SUSP/50ML

Facility

$95.00

Hospital Charge Code	60634999
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIZOXIME VL 1GM

Facility

$32.00

Hospital Charge Code	6001051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

CEFTIZOXIME VL 1GM

Facility

$32.00

Hospital Charge Code	6001051
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$246.83
Rate for Payer: Aetna Commercial	$187.59
Rate for Payer: Aetna Medicare Advantage	$148.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.88
Rate for Payer: Cigna Commercial	$246.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05
Rate for Payer: UnitedHealthcare Community & State	$11.90
Rate for Payer: Wellpoint Medicaid Managed Care	$13.08

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$119.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05

CEFTRIAXONE 250MG MINIBAG

Facility

$65.00

Hospital Charge Code	60635867
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CEFTRIAXONE 250MG MINIBAG

Facility

$65.00

Hospital Charge Code	60635867
Hospital Revenue Code	636
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$15.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$97.99
Max. Negotiated Rate	$158.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$326.62
Rate for Payer: Aetna Commercial	$248.24
Rate for Payer: Aetna Medicare Advantage	$195.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.58
Rate for Payer: Cigna Commercial	$326.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99
Rate for Payer: UnitedHealthcare Community & State	$15.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.31

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$47.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$75.24
Rate for Payer: Aetna Medicare Advantage	$59.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.49
Rate for Payer: Cigna Commercial	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70
Rate for Payer: UnitedHealthcare Community & State	$4.77
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$53.40
Rate for Payer: Aetna Commercial	$40.58
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.23
Rate for Payer: Cigna Commercial	$53.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02
Rate for Payer: UnitedHealthcare Community & State	$2.57
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$25.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

CEFTRIAXONE INJ 500MG

Facility

$264.68

Service Code	HCPCS J0696
Hospital Charge Code	6007140
Hospital Revenue Code	636
Min. Negotiated Rate	$39.70
Max. Negotiated Rate	$64.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$39.70

Know your out-of-pocket cost for care.

All Charges