Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$12.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.87

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$42.91
Rate for Payer: Aetna Commercial	$32.62
Rate for Payer: Aetna Medicare Advantage	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.89
Rate for Payer: Cigna Commercial	$42.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.75
Rate for Payer: Oxford Commercial	$17.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.87
Rate for Payer: UnitedHealthcare Commercial	$17.17
Rate for Payer: UnitedHealthcare Community & State	$2.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

CHLORAMBUCIL TAB 2MG

Facility

$15.40

Hospital Charge Code	6009583
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

CHLORAMBUCIL TAB 2MG

Facility

$15.40

Hospital Charge Code	6009583
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

CHLORAMPHENICOL 1.67MG/1ML OPS

Facility

$128.00

Hospital Charge Code	60629177
Hospital Revenue Code	250
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CHLORAMPHENICOL 1.67MG/1ML OPS

Facility

$128.00

Hospital Charge Code	60629177
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CHLORAMPHENICOL 1 % OPHT. OIN

Facility

$141.65

Hospital Charge Code	60628010
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

CHLORAMPHENICOL 1 % OPHT. OIN

Facility

$141.65

Hospital Charge Code	60628010
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$70.83
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$28.33
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$28.33
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

CHLORAMPHENICOL INJ 1G

Facility

$33.65

Hospital Charge Code	60629178
Hospital Revenue Code	636
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

CHLORAMPHENICOL INJ 1G

Facility

$33.65

Hospital Charge Code	60629178
Hospital Revenue Code	636
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$8.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

CHLORAMPHENIC OPHT 0.5% SOLN

Facility

$4.85

Hospital Charge Code	6001085
Hospital Revenue Code	252
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CHLORAMPHENIC OPHT 0.5% SOLN

Facility

$4.85

Hospital Charge Code	6001085
Hospital Revenue Code	252
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.26
Rate for Payer: Oxford Commercial	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.26
Rate for Payer: Oxford Commercial	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.09
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.63
Rate for Payer: Cigna Commercial	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.45
Rate for Payer: Oxford Commercial	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$3.63
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$55.81
Rate for Payer: Qualcare PPO/HMO/WC	$55.81

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.05
Rate for Payer: Aetna Commercial	$141.40
Rate for Payer: Aetna Medicare Advantage	$111.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.89
Rate for Payer: Cigna Commercial	$186.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.63
Rate for Payer: Oxford Commercial	$74.42
Rate for Payer: Qualcare PPO/HMO/WC	$55.81
Rate for Payer: UnitedHealthcare Commercial	$74.42
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$15.99
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	$15.99
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

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CHLORAPREP ORNG TINT APPL 26ml

Facility

$778.75

Hospital Charge Code	270301990
Hospital Revenue Code	270
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$389.38
Rate for Payer: Aetna Commercial	$295.93
Rate for Payer: Aetna Medicare Advantage	$233.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.58
Rate for Payer: Cigna Commercial	$389.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.62
Rate for Payer: Oxford Commercial	$155.75
Rate for Payer: Qualcare PPO/HMO/WC	$116.81
Rate for Payer: UnitedHealthcare Commercial	$155.75
Rate for Payer: UnitedHealthcare Community & State	$18.77
Rate for Payer: Wellpoint Medicaid Managed Care	$20.64

Know your out-of-pocket cost for care.

All Charges