Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HALOG 0.025%/15GM

Facility

$66.00

Hospital Charge Code	60633074
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

HALOG 0.1%/15GM

Facility

$69.00

Hospital Charge Code	60633075
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

HALOG 0.1%/15GM

Facility

$69.00

Hospital Charge Code	60633075
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

HALOPERIDOL 0.5 MG TAB

Facility

$4.00

Service Code	NDC 781139113
Hospital Charge Code	60627800
Hospital Revenue Code	250
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 0.5 MG TAB

Facility

$4.00

Service Code	NDC 781139113
Hospital Charge Code	60627800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HALOPERIDOL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633076
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

HALOPERIDOL 100 MG/ML INJ

Facility

$1,214.38

Service Code	HCPCS J1631
Hospital Charge Code	6011035
Hospital Revenue Code	636
Min. Negotiated Rate	$182.16
Max. Negotiated Rate	$293.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.88
Rate for Payer: Qualcare PPO/HMO/WC	$182.16

HALOPERIDOL 100 MG/ML INJ

Facility

$1,214.38

Service Code	HCPCS J1631
Hospital Charge Code	6011035
Hospital Revenue Code	636
Min. Negotiated Rate	$29.27
Max. Negotiated Rate	$607.19
Rate for Payer: Aetna Commercial	$461.46
Rate for Payer: Aetna Medicare Advantage	$364.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.67
Rate for Payer: Cigna Commercial	$607.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.88
Rate for Payer: Qualcare PPO/HMO/WC	$182.16
Rate for Payer: UnitedHealthcare Community & State	$29.27
Rate for Payer: Wellpoint Medicaid Managed Care	$32.18

HALOPERIDOL 10 MG TAB

Facility

$11.99

Service Code	NDC 781139713
Hospital Charge Code	60627801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

HALOPERIDOL 10 MG TAB

Facility

$11.99

Service Code	NDC 781139713
Hospital Charge Code	60627801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

HALOPERIDOL 1 MG TAB

Facility

$4.00

Service Code	NDC 781139213
Hospital Charge Code	60627802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL 1 MG TAB

Facility

$4.00

Service Code	NDC 781139213
Hospital Charge Code	60627802
Hospital Revenue Code	250
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 2 MG TAB

Facility

$4.02

Service Code	NDC 781139313
Hospital Charge Code	60627803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL 2 MG TAB

Facility

$4.02

Service Code	NDC 781139313
Hospital Charge Code	60627803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.03
Rate for Payer: Cigna Commercial	$2.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 5 MG/ML INJ

Facility

$8.84

Service Code	HCPCS J1630
Hospital Charge Code	60627805
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

HALOPERIDOL 5 MG/ML INJ

Facility

$8.84

Service Code	HCPCS J1630
Hospital Charge Code	60627805
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.42
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.25
Rate for Payer: Cigna Commercial	$4.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

HALOPERIDOL 5 MG TAB

Facility

$6.50

Service Code	NDC 781139613
Hospital Charge Code	6022529
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

HALOPERIDOL 5 MG TAB

Facility

$6.50

Service Code	NDC 781139613
Hospital Charge Code	6022529
Hospital Revenue Code	251
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

HALOPERIDOL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633077
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HALOPERIDOL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633077
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

HALOPERIDOL CONC LQ 2MG/ML

Facility

$4.00

Hospital Charge Code	60627806
Hospital Revenue Code	250
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL CONC LQ 2MG/ML

Facility

$4.00

Hospital Charge Code	60627806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL DECAN 50MG/ML

Facility

$163.20

Hospital Charge Code	6011019
Hospital Revenue Code	250
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

HALOPERIDOL DECAN 50MG/ML

Facility

$163.20

Hospital Charge Code	6011019
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: Aetna Medicare Advantage	$48.96
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) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.96
Rate for Payer: Oxford Commercial	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$32.64
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

Know your out-of-pocket cost for care.

All Charges