Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMYCIN, PEAK***

Facility

$124.00

Service Code	HCPCS 80170
Hospital Charge Code	3031390
Hospital Revenue Code	301
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

GENTAMYCIN, PEAK***

Facility

$124.00

Service Code	HCPCS 80170
Hospital Charge Code	3031390
Hospital Revenue Code	301
Min. Negotiated Rate	$3.29
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	$62.00
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	$37.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
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	$3.29

GENTAMYCIN PM 60MG/50ML

Facility

$48.00

Hospital Charge Code	60635034
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 PM 60MG/50ML

Facility

$48.00

Hospital Charge Code	60635034
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 PM 70MG/50ML

Facility

$34.00

Hospital Charge Code	60635035
Hospital Revenue Code	636
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$8.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

GENTAMYCIN PM 70MG/50ML

Facility

$34.00

Hospital Charge Code	60635035
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

GENTAMYCIN PM 80MG/100ML

Facility

$48.00

Hospital Charge Code	60635036
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 PM 80MG/100ML

Facility

$48.00

Hospital Charge Code	60635036
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 PREDNIS OPH SSP

Facility

$72.85

Hospital Charge Code	60628014
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

GENTAMYCIN PREDNIS OPH SSP

Facility

$72.85

Hospital Charge Code	60628014
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

GENTAMYCIN, RANDOM

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004017
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

GENTAMYCIN, RANDOM

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004017
Hospital Revenue Code	301
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

GENTAMYCIN TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

GENTAMYCIN TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
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	$89.50
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	$53.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
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	$4.74

GENTAMYCIN, TROUGH***

Facility

$123.60

Service Code	HCPCS 80170
Hospital Charge Code	3031382
Hospital Revenue Code	301
Min. Negotiated Rate	$3.28
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	$61.80
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	$37.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.54
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	$3.28

GENTAMYCIN, TROUGH***

Facility

$123.60

Service Code	HCPCS 80170
Hospital Charge Code	3031382
Hospital Revenue Code	301
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$18.54
Rate for Payer: Qualcare PPO/HMO/WC	$18.54

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna Commercial	$20.67
Rate for Payer: Aetna Medicare Advantage	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.87
Rate for Payer: Cigna Commercial	$27.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.32
Rate for Payer: Oxford Commercial	$10.88
Rate for Payer: Qualcare PPO/HMO/WC	$8.16
Rate for Payer: UnitedHealthcare Commercial	$10.88
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$8.16
Rate for Payer: Qualcare PPO/HMO/WC	$8.16

GENTIAN VIOLET 2%

Facility

$13.00

Hospital Charge Code	60634493
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GENTIAN VIOLET 2%

Facility

$13.00

Hospital Charge Code	60634493
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

GENTLE TOUCH SYSTEM 100MM LOOP

Facility

$116.20

Hospital Charge Code	270655989
Hospital Revenue Code	271
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$17.43

GENTLE TOUCH SYSTEM 100MM LOOP

Facility

$116.20

Hospital Charge Code	270655989
Hospital Revenue Code	271
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$58.10
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$34.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.63
Rate for Payer: Cigna Commercial	$58.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.86
Rate for Payer: Oxford Commercial	$23.24
Rate for Payer: Qualcare PPO/HMO/WC	$17.43
Rate for Payer: UnitedHealthcare Commercial	$23.24
Rate for Payer: UnitedHealthcare Community & State	$2.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.08

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$51.32
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$30.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.17
Rate for Payer: Cigna Commercial	$51.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.79
Rate for Payer: Oxford Commercial	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.40
Rate for Payer: UnitedHealthcare Commercial	$20.53
Rate for Payer: UnitedHealthcare Community & State	$2.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.72

Know your out-of-pocket cost for care.

All Charges