Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$13.52
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.07
Rate for Payer: Cigna Commercial	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.67
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

CIPROFLOXACIN 750 MG TAB

Facility

$60.00

Hospital Charge Code	60627348
Hospital Revenue Code	252
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

CIPROFLOXACIN 750 MG TAB

Facility

$60.00

Hospital Charge Code	60627348
Hospital Revenue Code	252
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

CIPROFLOXACIN INJ 200MG

Facility

$70.40

Hospital Charge Code	6016364
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

CIPROFLOXACIN INJ 200MG

Facility

$70.40

Hospital Charge Code	6016364
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

CIPROFLOXACIN INJ 400MG

Facility

$136.35

Hospital Charge Code	6016372
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

CIPROFLOXACIN INJ 400MG

Facility

$136.35

Hospital Charge Code	6016372
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

CIPROFLOXACIN OPH DROPS 5ML

Facility

$204.80

Hospital Charge Code	6008569
Hospital Revenue Code	252
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna Commercial	$77.82
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.44
Rate for Payer: Oxford Commercial	$40.96
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$40.96
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

CIPROFLOXACIN OPH DROPS 5ML

Facility

$204.80

Hospital Charge Code	6008569
Hospital Revenue Code	252
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

CIPROFLOXACIN TAB 750MG

Facility

$43.55

Hospital Charge Code	6010623
Hospital Revenue Code	252
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

CIPROFLOXACIN TAB 750MG

Facility

$43.55

Hospital Charge Code	6010623
Hospital Revenue Code	252
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

CIPRO IV 400MG/VIAL 40ML

Facility

$66.00

Hospital Charge Code	60635344
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CIPRO IV 400MG/VIAL 40ML

Facility

$66.00

Hospital Charge Code	60635344
Hospital Revenue Code	636
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	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

CIRC ANES LAT FRE 188590LG40

Facility

$17.25

Hospital Charge Code	270625309
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

CIRC ANES LAT FRE 188590LG40

Facility

$17.25

Hospital Charge Code	270625309
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.40
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CIRCUIT ADULT PORT VENT

Facility

$17.62

Hospital Charge Code	270651843
Hospital Revenue Code	272
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.64

CIRCUIT ADULT PORT VENT

Facility

$17.62

Hospital Charge Code	270651843
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna Medicare Advantage	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.49
Rate for Payer: Cigna Commercial	$8.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: Oxford Commercial	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.64
Rate for Payer: UnitedHealthcare Commercial	$3.52
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

CIRCUIT ANESTHESIA 2253710-804

Facility

$16.85

Hospital Charge Code	270070041
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

CIRCUIT ANESTHESIA 2253710-804

Facility

$16.85

Hospital Charge Code	270070041
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

CIRCUIT ANESTHESIA 60 CORR, LF

Facility

$378.10

Hospital Charge Code	270645627
Hospital Revenue Code	272
Min. Negotiated Rate	$56.72
Max. Negotiated Rate	$56.72
Rate for Payer: Qualcare PPO/HMO/WC	$56.72

CIRCUIT ANESTHESIA 60 CORR, LF

Facility

$378.10

Hospital Charge Code	270645627
Hospital Revenue Code	272
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$189.05
Rate for Payer: Aetna Commercial	$143.68
Rate for Payer: Aetna Medicare Advantage	$113.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.42
Rate for Payer: Cigna Commercial	$189.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.43
Rate for Payer: Oxford Commercial	$75.62
Rate for Payer: Qualcare PPO/HMO/WC	$56.72
Rate for Payer: UnitedHealthcare Commercial	$75.62
Rate for Payer: UnitedHealthcare Community & State	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.02

CIRCUIT ANESTHESIA ADULT

Facility

$10.63

Hospital Charge Code	270649971
Hospital Revenue Code	272
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.59

CIRCUIT ANESTHESIA ADULT

Facility

$10.63

Hospital Charge Code	270649971
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.32
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare Advantage	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.71
Rate for Payer: Cigna Commercial	$5.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.19
Rate for Payer: Oxford Commercial	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.59
Rate for Payer: UnitedHealthcare Commercial	$2.13
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

Know your out-of-pocket cost for care.

All Charges