Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GABAPENTIN 250MG/5ML SOL

Facility

$20.23

Service Code	NDC 71201247
Hospital Charge Code	60632259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna Medicare Advantage	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.16
Rate for Payer: Cigna Commercial	$10.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.07
Rate for Payer: Oxford Commercial	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.03
Rate for Payer: UnitedHealthcare Commercial	$4.05
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

GABAPENTIN 300 MG CAP

Facility

$27.94

Service Code	NDC 71080540
Hospital Charge Code	6017750
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

GABAPENTIN 300 MG CAP

Facility

$27.94

Service Code	NDC 71080540
Hospital Charge Code	6017750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.97
Rate for Payer: Aetna Commercial	$10.62
Rate for Payer: Aetna Medicare Advantage	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.38
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$5.59
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

GABAPENTIN 400 MG CAP

Facility

$32.43

Service Code	NDC 71080640
Hospital Charge Code	6017768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.21
Rate for Payer: Aetna Commercial	$12.32
Rate for Payer: Aetna Medicare Advantage	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.27
Rate for Payer: Cigna Commercial	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Oxford Commercial	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$6.49
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

GABAPENTIN 400 MG CAP

Facility

$32.43

Service Code	NDC 71080640
Hospital Charge Code	6017768
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

GABAPENTIN CAP 100MG

Facility

$26.90

Hospital Charge Code	6017743
Hospital Revenue Code	252
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

GABAPENTIN CAP 100MG

Facility

$26.90

Hospital Charge Code	6017743
Hospital Revenue Code	252
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

GABAPENTIN (NEURONTIN)

Facility

$239.00

Service Code	HCPCS 80299
Hospital Charge Code	38473126
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

GABAPENTIN (NEURONTIN)

Facility

$239.00

Service Code	HCPCS 80299
Hospital Charge Code	38473126
Hospital Revenue Code	301
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

GABAPENTIN (NEURONTIN) 600MG T

Facility

$16.95

Service Code	NDC 59762502301
Hospital Charge Code	60630132
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.54

GABAPENTIN (NEURONTIN) 600MG T

Facility

$16.95

Service Code	NDC 59762502301
Hospital Charge Code	60630132
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.47
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.32
Rate for Payer: Cigna Commercial	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Oxford Commercial	$3.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.54
Rate for Payer: UnitedHealthcare Commercial	$3.39
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

GAD-65 AB

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900515
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.08
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

GAD-65 AB

Facility

$112.00

Service Code	HCPCS 83519
Hospital Charge Code	38477008
Hospital Revenue Code	301
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

GAD-65 AB

Facility

$112.00

Service Code	HCPCS 83519
Hospital Charge Code	38477008
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

GAD-65 AB

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900515
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GAD65 NEURO SYNDROME AB

Facility

$815.50

Service Code	HCPCS 83516
Hospital Charge Code	3038554
Hospital Revenue Code	301
Min. Negotiated Rate	$122.33
Max. Negotiated Rate	$122.33
Rate for Payer: Qualcare PPO/HMO/WC	$122.33

GAD65 NEURO SYNDROME AB

Facility

$815.50

Service Code	HCPCS 83516
Hospital Charge Code	3038554
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$407.75
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$407.75
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.33
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$21.61

GADODIAMIDE 287MG/ML 15ML VIAL

Facility

$596.37

Service Code	NDC 407069005
Hospital Charge Code	60630242
Hospital Revenue Code	255
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$298.19
Rate for Payer: Aetna Commercial	$226.62
Rate for Payer: Aetna Medicare Advantage	$178.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.07
Rate for Payer: Cigna Commercial	$298.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.91
Rate for Payer: Oxford Commercial	$119.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.46
Rate for Payer: UnitedHealthcare Commercial	$119.27
Rate for Payer: UnitedHealthcare Community & State	$14.37
Rate for Payer: Wellpoint Medicaid Managed Care	$15.80

GADODIAMIDE 287MG/ML 15ML VIAL

Facility

$596.37

Service Code	NDC 407069005
Hospital Charge Code	60630242
Hospital Revenue Code	255
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$89.46
Rate for Payer: Qualcare PPO/HMO/WC	$89.46

GADOLINIUM/OMNISCAN/ MRI C AGN

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	2008075
Hospital Revenue Code	636
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$351.75
Rate for Payer: Aetna Commercial	$267.33
Rate for Payer: Aetna Medicare Advantage	$211.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.39
Rate for Payer: Cigna Commercial	$351.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$105.53
Rate for Payer: UnitedHealthcare Community & State	$16.95
Rate for Payer: Wellpoint Medicaid Managed Care	$18.64

GADOLINIUM/OMNISCAN/ MRI C AGN

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	2008075
Hospital Revenue Code	636
Min. Negotiated Rate	$105.53
Max. Negotiated Rate	$170.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$105.53

GADOTERIDOL 15ML

Facility

$247.70

Service Code	NDC 270111102
Hospital Charge Code	606390368
Hospital Revenue Code	255
Min. Negotiated Rate	$37.16
Max. Negotiated Rate	$37.16
Rate for Payer: Qualcare PPO/HMO/WC	$37.16

GADOTERIDOL 15ML

Facility

$247.70

Service Code	NDC 270111102
Hospital Charge Code	606390368
Hospital Revenue Code	255
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$123.85
Rate for Payer: Aetna Commercial	$94.13
Rate for Payer: Aetna Medicare Advantage	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.16
Rate for Payer: Cigna Commercial	$123.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.31
Rate for Payer: Oxford Commercial	$49.54
Rate for Payer: Qualcare PPO/HMO/WC	$37.16
Rate for Payer: UnitedHealthcare Commercial	$49.54
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$6.56

GADOTERIDOL 20ML

Facility

$330.31

Service Code	NDC 270111103
Hospital Charge Code	606390369
Hospital Revenue Code	255
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$165.16
Rate for Payer: Aetna Commercial	$125.52
Rate for Payer: Aetna Medicare Advantage	$99.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.23
Rate for Payer: Cigna Commercial	$165.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.09
Rate for Payer: Oxford Commercial	$66.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.55
Rate for Payer: UnitedHealthcare Commercial	$66.06
Rate for Payer: UnitedHealthcare Community & State	$7.96
Rate for Payer: Wellpoint Medicaid Managed Care	$8.75

GADOTERIDOL 20ML

Facility

$330.31

Service Code	NDC 270111103
Hospital Charge Code	606390369
Hospital Revenue Code	255
Min. Negotiated Rate	$49.55
Max. Negotiated Rate	$49.55
Rate for Payer: Qualcare PPO/HMO/WC	$49.55

Know your out-of-pocket cost for care.

All Charges