Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEX 5%.3% SOD CHL500ml 7925-03

Facility

$17.50

Hospital Charge Code	270649408
Hospital Revenue Code	258
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

DEX 5 TAB

Facility

$5.00

Hospital Charge Code	60630069W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

DEX 5 TAB

Facility

$5.00

Hospital Charge Code	60630069W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DEXAMETHASONE 0.1% OPHTH SOLN

Facility

$141.37

Service Code	NDC 61314029405
Hospital Charge Code	6001713
Hospital Revenue Code	251
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$21.21
Rate for Payer: Qualcare PPO/HMO/WC	$21.21

DEXAMETHASONE 0.1% OPHTH SOLN

Facility

$141.37

Service Code	NDC 61314029405
Hospital Charge Code	6001713
Hospital Revenue Code	251
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$70.69
Rate for Payer: Aetna Commercial	$53.72
Rate for Payer: Aetna Medicare Advantage	$42.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.05
Rate for Payer: Cigna Commercial	$70.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.41
Rate for Payer: Oxford Commercial	$28.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.21
Rate for Payer: UnitedHealthcare Commercial	$28.27
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

DEXAMETHASONE 0.5 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	6023055
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE 0.5 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	6023055
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632808
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEXAMETHASONE/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632808
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DEXAMETHASONE 0.75 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE 0.75 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE 10 MG/ML INJ

Facility

$32.50

Service Code	HCPCS J1100
Hospital Charge Code	60639329
Hospital Revenue Code	636
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

DEXAMETHASONE 10 MG/ML INJ

Facility

$10.45

Service Code	HCPCS J1100
Hospital Charge Code	60628188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

DEXAMETHASONE 10 MG/ML INJ

Facility

$32.50

Service Code	HCPCS J1100
Hospital Charge Code	60639329
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

DEXAMETHASONE 10 MG/ML INJ

Facility

$10.45

Service Code	HCPCS J1100
Hospital Charge Code	60628188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

DEXAMETHASONE/1.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632807
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEXAMETHASONE/1.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632807
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DEXAMETHASONE/1MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632806
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE/1MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632806
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE/2MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632809
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE/2MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632809
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE/2MG/TAB

Facility

$5.00

Hospital Charge Code	60632805
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DEXAMETHASONE/2MG/TAB

Facility

$5.00

Hospital Charge Code	60632805
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

DEXAMETHASONE 4 MG/1 ML

Facility

$7.30

Service Code	HCPCS J1100
Hospital Charge Code	60628190
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DEXAMETHASONE 4 MG/1 ML

Facility

$7.30

Service Code	HCPCS J1100
Hospital Charge Code	60628190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

Know your out-of-pocket cost for care.

All Charges