Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRANISEHCLVL 1MG/ML2941490

Facility

$500.00

Hospital Charge Code	6010334
Hospital Revenue Code	636
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

GRANISETRON 1/MG 1/ML

Facility

$805.00

Hospital Charge Code	60634937
Hospital Revenue Code	250
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$120.75
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

GRANISETRON 1/MG 1/ML

Facility

$805.00

Hospital Charge Code	60634937
Hospital Revenue Code	250
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$402.50
Rate for Payer: Aetna Commercial	$305.90
Rate for Payer: Aetna Medicare Advantage	$241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.28
Rate for Payer: Cigna Commercial	$402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.50
Rate for Payer: Oxford Commercial	$161.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.75
Rate for Payer: UnitedHealthcare Commercial	$161.00
Rate for Payer: UnitedHealthcare Community & State	$19.40
Rate for Payer: Wellpoint Medicaid Managed Care	$21.33

GRANISETRON 1MG/1ML VIAL

Facility

$190.00

Hospital Charge Code	60635644
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Oxford Commercial	$38.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

GRANISETRON 1MG/1ML VIAL

Facility

$190.00

Hospital Charge Code	60635644
Hospital Revenue Code	250
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

GRANISETRON 1MG/D5W 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628141
Hospital Revenue Code	636
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$711.70
Rate for Payer: Aetna Commercial	$540.89
Rate for Payer: Aetna Medicare Advantage	$427.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.97
Rate for Payer: Cigna Commercial	$711.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51
Rate for Payer: UnitedHealthcare Community & State	$34.30
Rate for Payer: Wellpoint Medicaid Managed Care	$37.72

GRANISETRON 1MG/D5W 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628141
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$344.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1MG/NS 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628142
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$344.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1MG/NS 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628142
Hospital Revenue Code	636
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$711.70
Rate for Payer: Aetna Commercial	$540.89
Rate for Payer: Aetna Medicare Advantage	$427.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.97
Rate for Payer: Cigna Commercial	$711.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51
Rate for Payer: UnitedHealthcare Community & State	$34.30
Rate for Payer: Wellpoint Medicaid Managed Care	$37.72

GRANISETRON 1 MG TAB

Facility

$314.70

Hospital Charge Code	60628886
Hospital Revenue Code	636
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$76.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.16
Rate for Payer: Qualcare PPO/HMO/WC	$47.20

GRANISETRON 1 MG TAB

Facility

$314.70

Hospital Charge Code	60628886
Hospital Revenue Code	636
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$157.35
Rate for Payer: Aetna Commercial	$119.59
Rate for Payer: Aetna Medicare Advantage	$94.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.25
Rate for Payer: Cigna Commercial	$157.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.16
Rate for Payer: Qualcare PPO/HMO/WC	$47.20
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: Wellpoint Medicaid Managed Care	$8.34

GRANISETRON 1MG TAB

Facility

$15.00

Hospital Charge Code	60635647
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

GRANISETRON 1MG TAB

Facility

$193.00

Hospital Charge Code	60635020
Hospital Revenue Code	250
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

GRANISETRON 1MG TAB

Facility

$193.00

Hospital Charge Code	60635020
Hospital Revenue Code	250
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.50
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.90
Rate for Payer: Oxford Commercial	$38.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$38.60
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

GRANISETRON 1MG TAB

Facility

$15.00

Hospital Charge Code	60635647
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$59.31
Max. Negotiated Rate	$95.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$197.72
Rate for Payer: Aetna Commercial	$150.26
Rate for Payer: Aetna Medicare Advantage	$118.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.83
Rate for Payer: Cigna Commercial	$197.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31
Rate for Payer: UnitedHealthcare Community & State	$9.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.48

GRANULES 24MM 20CC

Facility

$14,140.00

Service Code	HCPCS C1765
Hospital Charge Code	270706183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,121.00
Max. Negotiated Rate	$3,421.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,110.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00

GRANULES 24MM 20CC

Facility

$14,140.00

Service Code	HCPCS C1765
Hospital Charge Code	270706183
Hospital Revenue Code	278
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$7,070.00
Rate for Payer: Aetna Commercial	$5,373.20
Rate for Payer: Aetna Medicare Advantage	$4,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,605.70
Rate for Payer: Cigna Commercial	$7,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,110.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00
Rate for Payer: UnitedHealthcare Community & State	$340.77
Rate for Payer: Wellpoint Medicaid Managed Care	$374.71

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$272.57
Max. Negotiated Rate	$5,655.00
Rate for Payer: Aetna Commercial	$4,297.80
Rate for Payer: Aetna Medicare Advantage	$3,393.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,884.05
Rate for Payer: Cigna Commercial	$5,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,488.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50
Rate for Payer: UnitedHealthcare Community & State	$272.57
Rate for Payer: Wellpoint Medicaid Managed Care	$299.71

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,696.50
Max. Negotiated Rate	$2,737.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,488.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50

GRANULES CANCELLOUS SPONGIOSA

Facility

$1,517.65

Hospital Charge Code	270612036
Hospital Revenue Code	270
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$758.83
Rate for Payer: Aetna Commercial	$576.71
Rate for Payer: Aetna Medicare Advantage	$455.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$387.00
Rate for Payer: Cigna Commercial	$758.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.30
Rate for Payer: Oxford Commercial	$303.53
Rate for Payer: Qualcare PPO/HMO/WC	$227.65
Rate for Payer: UnitedHealthcare Commercial	$303.53
Rate for Payer: UnitedHealthcare Community & State	$36.58
Rate for Payer: Wellpoint Medicaid Managed Care	$40.22

GRANULES CANCELLOUS SPONGIOSA

Facility

$1,517.65

Hospital Charge Code	270612036
Hospital Revenue Code	270
Min. Negotiated Rate	$227.65
Max. Negotiated Rate	$227.65
Rate for Payer: Qualcare PPO/HMO/WC	$227.65

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$69.26
Max. Negotiated Rate	$1,437.00
Rate for Payer: Aetna Commercial	$1,092.12
Rate for Payer: Aetna Medicare Advantage	$862.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.87
Rate for Payer: Cigna Commercial	$1,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.28
Rate for Payer: Qualcare PPO/HMO/WC	$431.10
Rate for Payer: UnitedHealthcare Community & State	$69.26
Rate for Payer: Wellpoint Medicaid Managed Care	$76.16

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$431.10
Max. Negotiated Rate	$695.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.28
Rate for Payer: Qualcare PPO/HMO/WC	$431.10

Know your out-of-pocket cost for care.

All Charges