Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632704
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632704
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

CIPRO/400MG/BAG

Facility

$196.00

Hospital Charge Code	60634501
Hospital Revenue Code	636
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$74.48
Rate for Payer: Aetna Medicare Advantage	$58.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.98
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

CIPRO/400MG/BAG

Facility

$196.00

Hospital Charge Code	60634501
Hospital Revenue Code	636
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$47.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

CIPRO 400MG VIAL INJ

Facility

$195.00

Hospital Charge Code	60635381
Hospital Revenue Code	636
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$47.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CIPRO 400MG VIAL INJ

Facility

$195.00

Hospital Charge Code	60635381
Hospital Revenue Code	636
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

CIPRO/500MG/TAB

Facility

$13.00

Hospital Charge Code	60632705
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

CIPRO/500MG/TAB

Facility

$13.00

Hospital Charge Code	60632705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CIPRO/500MG/TAB

Facility

$18.00

Hospital Charge Code	60632701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CIPRO/500MG/TAB

Facility

$18.00

Hospital Charge Code	60632701
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

CIPRO/750MG/TAB

Facility

$32.00

Hospital Charge Code	60632702
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CIPRO/750MG/TAB

Facility

$28.00

Hospital Charge Code	60632703
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

CIPRO/750MG/TAB

Facility

$28.00

Hospital Charge Code	60632703
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CIPRO/750MG/TAB

Facility

$32.00

Hospital Charge Code	60632702
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

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$201.58
Max. Negotiated Rate	$201.58
Rate for Payer: Qualcare PPO/HMO/WC	$201.58

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$32.39
Max. Negotiated Rate	$671.95
Rate for Payer: Aetna Commercial	$510.68
Rate for Payer: Aetna Medicare Advantage	$403.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.69
Rate for Payer: Cigna Commercial	$671.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.17
Rate for Payer: Oxford Commercial	$268.78
Rate for Payer: Qualcare PPO/HMO/WC	$201.58
Rate for Payer: UnitedHealthcare Commercial	$268.78
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$35.61

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$25.02
Max. Negotiated Rate	$25.02
Rate for Payer: Qualcare PPO/HMO/WC	$25.02

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.42
Rate for Payer: Aetna Commercial	$63.40
Rate for Payer: Aetna Medicare Advantage	$50.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.54
Rate for Payer: Cigna Commercial	$83.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.05
Rate for Payer: Oxford Commercial	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$25.02
Rate for Payer: UnitedHealthcare Commercial	$33.37
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.42

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.43

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.73
Rate for Payer: Cigna Commercial	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.86
Rate for Payer: Oxford Commercial	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.43
Rate for Payer: UnitedHealthcare Commercial	$0.58
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CIPROFLOXACIN 200MG/100ML

Facility

$104.59

Service Code	HCPCS J0744
Hospital Charge Code	60627346
Hospital Revenue Code	636
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$25.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.69

CIPROFLOXACIN 200MG/100ML

Facility

$104.59

Service Code	HCPCS J0744
Hospital Charge Code	60627346
Hospital Revenue Code	636
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.30
Rate for Payer: Aetna Commercial	$39.74
Rate for Payer: Aetna Medicare Advantage	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.67
Rate for Payer: Cigna Commercial	$52.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.69
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.08
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

CIPROFLOXACIN 400MG/200ML

Facility

$201.07

Service Code	HCPCS J0744
Hospital Charge Code	60627347
Hospital Revenue Code	636
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$48.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.66
Rate for Payer: Qualcare PPO/HMO/WC	$30.16

Know your out-of-pocket cost for care.

All Charges