Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN IV 100MG/100ML NS

Facility

$28.07

Service Code	HCPCS J1580
Hospital Charge Code	60629864
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.04
Rate for Payer: Aetna Commercial	$10.67
Rate for Payer: Aetna Medicare Advantage	$8.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.16
Rate for Payer: Cigna Commercial	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$4.21
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

GENTAMICIN IV 100MG/100ML NS

Facility

$28.07

Service Code	HCPCS J1580
Hospital Charge Code	60629864
Hospital Revenue Code	636
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$6.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$4.21

GENTAMICIN PEAK

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.55
Rate for Payer: Aetna Medicare Advantage	$53.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$85.22
Rate for Payer: Cigna Medicare Advantage	$16.38
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Medicare Advantage	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

GENTAMICIN PEAK

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004016
Hospital Revenue Code	301
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

GENTAMICIN SULFATE 0.1%/1

Facility

$8.00

Hospital Charge Code	60633045
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

GENTAMICIN SULFATE 0.1%/1

Facility

$8.00

Hospital Charge Code	60633045
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

GENTAMICIN SULFATE 0.1 % CRE

Facility

$330.85

Service Code	NDC 45802005635
Hospital Charge Code	6002596
Hospital Revenue Code	251
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$49.63

GENTAMICIN SULFATE 0.1 % CRE

Facility

$330.85

Service Code	NDC 45802005635
Hospital Charge Code	6002596
Hospital Revenue Code	251
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$165.43
Rate for Payer: Aetna Commercial	$125.72
Rate for Payer: Aetna Medicare Advantage	$99.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.37
Rate for Payer: Cigna Commercial	$165.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.25
Rate for Payer: Oxford Commercial	$66.17
Rate for Payer: Qualcare PPO/HMO/WC	$49.63
Rate for Payer: UnitedHealthcare Commercial	$66.17
Rate for Payer: UnitedHealthcare Community & State	$7.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.77

GENTAMICIN SULFATE 0.1 % OIN

Facility

$330.78

Service Code	NDC 45802004635
Hospital Charge Code	6002604
Hospital Revenue Code	251
Min. Negotiated Rate	$49.62
Max. Negotiated Rate	$49.62
Rate for Payer: Qualcare PPO/HMO/WC	$49.62

GENTAMICIN SULFATE 0.1 % OIN

Facility

$330.78

Service Code	NDC 45802004635
Hospital Charge Code	6002604
Hospital Revenue Code	251
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$165.39
Rate for Payer: Aetna Commercial	$125.70
Rate for Payer: Aetna Medicare Advantage	$99.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.35
Rate for Payer: Cigna Commercial	$165.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.23
Rate for Payer: Oxford Commercial	$66.16
Rate for Payer: Qualcare PPO/HMO/WC	$49.62
Rate for Payer: UnitedHealthcare Commercial	$66.16
Rate for Payer: UnitedHealthcare Community & State	$7.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.77

GENTAMICIN SULFATE/40MG/1

Facility

$13.00

Hospital Charge Code	60633041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GENTAMICIN SULFATE/40MG/1

Facility

$13.00

Hospital Charge Code	60633041
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

GENTAMICIN SULFATE/40MG/1

Facility

$7.00

Hospital Charge Code	60633042
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

GENTAMICIN SULFATE/40MG/1

Facility

$7.00

Hospital Charge Code	60633042
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

GENTAMICIN SULFATE PEDIAT

Facility

$3.00

Hospital Charge Code	60633043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GENTAMICIN SULFATE PEDIAT

Facility

$3.00

Hospital Charge Code	60633043
Hospital Revenue Code	250
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	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
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	$2.19
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.67
Rate for Payer: Aetna Commercial	$10.39
Rate for Payer: Aetna Medicare Advantage	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.97
Rate for Payer: Cigna Commercial	$13.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

GENTAMYCIN 90MG PM

Facility

$48.00

Hospital Charge Code	60635045
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

GENTAMYCIN 90MG PM

Facility

$48.00

Hospital Charge Code	60635045
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GENTAMYCIN ADDVANT/100MG

Facility

$6.00

Hospital Charge Code	60634290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

GENTAMYCIN ADDVANT/100MG

Facility

$6.00

Hospital Charge Code	60634290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

GENTAMYCIN INJ 20MG

Facility

$10.90

Hospital Charge Code	6009211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

Know your out-of-pocket cost for care.

All Charges