Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IOPIDINE 1% OPHTH SOLN

Facility

$43.00

Hospital Charge Code	60634812
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

IOPODINE 0.5L OPHTH 5ML

Facility

$127.00

Hospital Charge Code	60635103
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

IOPODINE 0.5L OPHTH 5ML

Facility

$127.00

Hospital Charge Code	60635103
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

IOSOSORBIDE DINITRATE TAB 5MG

Facility

$3.20

Hospital Charge Code	6012702
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

IOSOSORBIDE DINITRATE TAB 5MG

Facility

$3.20

Hospital Charge Code	6012702
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

IOTHALAMATE INJ 17.2%

Facility

$1.95

Hospital Charge Code	60627879
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

IOTHALAMATE INJ 17.2%

Facility

$1.95

Hospital Charge Code	60627879
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

IOTHALAMATE INJ 30%

Facility

$1.95

Hospital Charge Code	60627880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

IOTHALAMATE INJ 30%

Facility

$1.95

Hospital Charge Code	60627880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

IOTHALAMATE INJ 60%

Facility

$25.60

Hospital Charge Code	60627881
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

IOTHALAMATE INJ 60%

Facility

$25.60

Hospital Charge Code	60627881
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

IOTHALAMATE MEGLUMINE 500 ML

Facility

$160.65

Hospital Charge Code	6012686
Hospital Revenue Code	250
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Qualcare PPO/HMO/WC	$24.10

IOTHALAMATE MEGLUMINE 500 ML

Facility

$160.65

Hospital Charge Code	6012686
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$80.33
Rate for Payer: Aetna Commercial	$61.05
Rate for Payer: Aetna Medicare Advantage	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.97
Rate for Payer: Cigna Commercial	$80.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.20
Rate for Payer: Oxford Commercial	$32.13
Rate for Payer: Qualcare PPO/HMO/WC	$24.10
Rate for Payer: UnitedHealthcare Commercial	$32.13
Rate for Payer: UnitedHealthcare Community & State	$3.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

IOTHALAMATE MEGLUM SOL 17.2%

Facility

$290.60

Hospital Charge Code	6003156
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$145.30
Rate for Payer: Aetna Commercial	$110.43
Rate for Payer: Aetna Medicare Advantage	$87.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.10
Rate for Payer: Cigna Commercial	$145.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.18
Rate for Payer: Oxford Commercial	$58.12
Rate for Payer: Qualcare PPO/HMO/WC	$43.59
Rate for Payer: UnitedHealthcare Commercial	$58.12
Rate for Payer: UnitedHealthcare Community & State	$7.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.70

IOTHALAMATE MEGLUM SOL 17.2%

Facility

$290.60

Hospital Charge Code	6003156
Hospital Revenue Code	250
Min. Negotiated Rate	$43.59
Max. Negotiated Rate	$43.59
Rate for Payer: Qualcare PPO/HMO/WC	$43.59

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$71.82
Max. Negotiated Rate	$1,490.00
Rate for Payer: Aetna Commercial	$1,132.40
Rate for Payer: Aetna Medicare Advantage	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.90
Rate for Payer: Cigna Commercial	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.00
Rate for Payer: Oxford Commercial	$596.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00
Rate for Payer: UnitedHealthcare Commercial	$596.00
Rate for Payer: UnitedHealthcare Community & State	$71.82
Rate for Payer: Wellpoint Medicaid Managed Care	$78.97

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

IPECAC/30CC

Facility

$7.00

Hospital Charge Code	60634576
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

IPECAC/30CC

Facility

$7.00

Hospital Charge Code	60634576
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

IPECAC/30ML

Facility

$8.00

Hospital Charge Code	60633192
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

IPECAC/30ML

Facility

$8.00

Hospital Charge Code	60633192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

IPECAC SYRUP

Facility

$13.45

Hospital Charge Code	60628140
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

IPECAC SYRUP

Facility

$13.45

Hospital Charge Code	60628140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.04
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

IPECAC SYRUP 30ML

Facility

$37.80

Hospital Charge Code	6003164
Hospital Revenue Code	251
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

IPECAC SYRUP 30ML

Facility

$37.80

Hospital Charge Code	6003164
Hospital Revenue Code	251
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

Know your out-of-pocket cost for care.

All Charges