Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ISOSORBIDE MONONIT TAB SR 30MG

Facility

$11.12

Service Code	NDC 904644961
Hospital Charge Code	60627652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna Commercial	$4.23
Rate for Payer: Aetna Medicare Advantage	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.84
Rate for Payer: Cigna Commercial	$5.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.34
Rate for Payer: Oxford Commercial	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.67
Rate for Payer: UnitedHealthcare Commercial	$2.22
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.36

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna Commercial	$3.44
Rate for Payer: Aetna Medicare Advantage	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.31
Rate for Payer: Cigna Commercial	$4.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.36
Rate for Payer: UnitedHealthcare Commercial	$1.81
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

ISOSORBIDE TAB 20MG

Facility

$3.85

Hospital Charge Code	6023139
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

ISOSORBIDE TAB 20MG

Facility

$3.85

Hospital Charge Code	6023139
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

ISOSORBIDE TAB SL 2.5MG

Facility

$3.20

Hospital Charge Code	6022586
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

ISOSORBIDE TAB SL 2.5MG

Facility

$3.20

Hospital Charge Code	6022586
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

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$213.32
Max. Negotiated Rate	$213.32
Rate for Payer: Qualcare PPO/HMO/WC	$213.32

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$711.07
Rate for Payer: Aetna Commercial	$540.41
Rate for Payer: Aetna Medicare Advantage	$426.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.65
Rate for Payer: Cigna Commercial	$711.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$426.64
Rate for Payer: Oxford Commercial	$284.43
Rate for Payer: Qualcare PPO/HMO/WC	$213.32
Rate for Payer: UnitedHealthcare Commercial	$284.43
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: Wellpoint Medicaid Managed Care	$37.69

ISOSULFAN BLUE 1% 5ML

Facility

$846.00

Hospital Charge Code	60635591
Hospital Revenue Code	250
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$423.00
Rate for Payer: Aetna Commercial	$321.48
Rate for Payer: Aetna Medicare Advantage	$253.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.73
Rate for Payer: Cigna Commercial	$423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.80
Rate for Payer: Oxford Commercial	$169.20
Rate for Payer: Qualcare PPO/HMO/WC	$126.90
Rate for Payer: UnitedHealthcare Commercial	$169.20
Rate for Payer: UnitedHealthcare Community & State	$20.39
Rate for Payer: Wellpoint Medicaid Managed Care	$22.42

ISOSULFAN BLUE 1% 5ML

Facility

$846.00

Hospital Charge Code	60635591
Hospital Revenue Code	250
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.90

ISOTOCARPINE 3%

Facility

$49.00

Hospital Charge Code	60634900
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

ISOTOCARPINE 3%

Facility

$49.00

Hospital Charge Code	60634900
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$54.35
Max. Negotiated Rate	$54.35
Rate for Payer: Qualcare PPO/HMO/WC	$54.35

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$181.17
Rate for Payer: Aetna Commercial	$137.69
Rate for Payer: Aetna Medicare Advantage	$108.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.40
Rate for Payer: Cigna Commercial	$181.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.70
Rate for Payer: Oxford Commercial	$72.47
Rate for Payer: Qualcare PPO/HMO/WC	$54.35
Rate for Payer: UnitedHealthcare Commercial	$72.47
Rate for Payer: UnitedHealthcare Community & State	$8.73
Rate for Payer: Wellpoint Medicaid Managed Care	$9.60

ISOVUE M200 10ML

Facility

$90.34

Hospital Charge Code	270653684
Hospital Revenue Code	270
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$45.17
Rate for Payer: Aetna Commercial	$34.33
Rate for Payer: Aetna Medicare Advantage	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.04
Rate for Payer: Cigna Commercial	$45.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.10
Rate for Payer: Oxford Commercial	$18.07
Rate for Payer: Qualcare PPO/HMO/WC	$13.55
Rate for Payer: UnitedHealthcare Commercial	$18.07
Rate for Payer: UnitedHealthcare Community & State	$2.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

ISOVUE M200 10ML

Facility

$90.34

Hospital Charge Code	270653684
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$13.55

ISOVUE MULTIPAC

Facility

$827.92

Hospital Charge Code	60635842
Hospital Revenue Code	255
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$413.96
Rate for Payer: Aetna Commercial	$314.61
Rate for Payer: Aetna Medicare Advantage	$248.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.12
Rate for Payer: Cigna Commercial	$413.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.38
Rate for Payer: Oxford Commercial	$165.58
Rate for Payer: Qualcare PPO/HMO/WC	$124.19
Rate for Payer: UnitedHealthcare Commercial	$165.58
Rate for Payer: UnitedHealthcare Community & State	$19.95
Rate for Payer: Wellpoint Medicaid Managed Care	$21.94

ISOVUE MULTIPAC

Facility

$827.92

Hospital Charge Code	60635842
Hospital Revenue Code	255
Min. Negotiated Rate	$124.19
Max. Negotiated Rate	$124.19
Rate for Payer: Qualcare PPO/HMO/WC	$124.19

ISRADIPINE 5mg ER

Facility

$3.30

Hospital Charge Code	60629960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.84
Rate for Payer: Cigna Commercial	$1.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: UnitedHealthcare Commercial	$0.66
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

ISRADIPINE 5mg ER

Facility

$3.30

Hospital Charge Code	60629960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

ISRADIPINE CAP 5MG

Facility

$11.15

Hospital Charge Code	60627568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.67

ISRADIPINE CAP 5MG

Facility

$11.15

Hospital Charge Code	60627568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.58
Rate for Payer: Aetna Commercial	$4.24
Rate for Payer: Aetna Medicare Advantage	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.84
Rate for Payer: Cigna Commercial	$5.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: Oxford Commercial	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$1.67
Rate for Payer: UnitedHealthcare Commercial	$2.23
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

Know your out-of-pocket cost for care.

All Charges