Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVOBUNOLOL OPH SOL 0.05%

Facility

$93.65

Hospital Charge Code	60628090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$46.83
Rate for Payer: Aetna Commercial	$35.59
Rate for Payer: Aetna Medicare Advantage	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.88
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$18.73
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

LEVOBUNOLOL OPH SOL 0.25%

Facility

$265.60

Hospital Charge Code	60628091
Hospital Revenue Code	250
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

LEVOBUNOLOL OPH SOL 0.25%

Facility

$265.60

Hospital Charge Code	60628091
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna Commercial	$100.93
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.68
Rate for Payer: Oxford Commercial	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$53.12
Rate for Payer: UnitedHealthcare Community & State	$6.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.04

LEVOBUNOLOL OPHT .05% 5ML SOL

Facility

$70.40

Hospital Charge Code	6003230
Hospital Revenue Code	252
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

LEVOBUNOLOL OPHT .05% 5ML SOL

Facility

$70.40

Hospital Charge Code	6003230
Hospital Revenue Code	252
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

LEVOBUPIVACAINE 5MG/1ML INJ

Facility

$35.85

Hospital Charge Code	60629249
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.93
Rate for Payer: Aetna Commercial	$13.62
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.76
Rate for Payer: Oxford Commercial	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

LEVOBUPIVACAINE 5MG/1ML INJ

Facility

$35.85

Hospital Charge Code	60629249
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

LEVOCARNITINE 1G/5ML INJ

Facility

$151.05

Hospital Charge Code	60629183
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$75.53
Rate for Payer: Aetna Commercial	$57.40
Rate for Payer: Aetna Medicare Advantage	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.52
Rate for Payer: Cigna Commercial	$75.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.31
Rate for Payer: Oxford Commercial	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$22.66
Rate for Payer: UnitedHealthcare Commercial	$30.21
Rate for Payer: UnitedHealthcare Community & State	$3.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

LEVOCARNITINE 1G/5ML INJ

Facility

$151.05

Hospital Charge Code	60629183
Hospital Revenue Code	250
Min. Negotiated Rate	$22.66
Max. Negotiated Rate	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$22.66

LEVODOPA 500 MG TAB

Facility

$5.65

Hospital Charge Code	60627871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

LEVODOPA 500 MG TAB

Facility

$5.65

Hospital Charge Code	60627871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

LEVODOPA TAB 250MG

Facility

$3.85

Hospital Charge Code	60627870
Hospital Revenue Code	250
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

LEVODOPA TAB 250MG

Facility

$3.85

Hospital Charge Code	60627870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

LEVO-DROMORAN/2MG/1ML

Facility

$13.00

Hospital Charge Code	60633282
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

LEVO-DROMORAN/2MG/1ML

Facility

$13.00

Hospital Charge Code	60633282
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LEVOFLOXACIN 250MG/50 ML IVPB

Facility

$174.10

Hospital Charge Code	60629226
Hospital Revenue Code	258
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$26.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

LEVOFLOXACIN 250MG/50 ML IVPB

Facility

$174.10

Hospital Charge Code	60629226
Hospital Revenue Code	258
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$87.05
Rate for Payer: Aetna Commercial	$66.16
Rate for Payer: Aetna Medicare Advantage	$52.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.40
Rate for Payer: Cigna Commercial	$87.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.23
Rate for Payer: Oxford Commercial	$34.82
Rate for Payer: Qualcare PPO/HMO/WC	$26.11
Rate for Payer: UnitedHealthcare Commercial	$34.82
Rate for Payer: UnitedHealthcare Community & State	$4.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

LEVOFLOXACIN 250MG/D5W 50ML IV

Facility

$152.85

Hospital Charge Code	60628993
Hospital Revenue Code	250
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$76.42
Rate for Payer: Aetna Commercial	$58.08
Rate for Payer: Aetna Medicare Advantage	$45.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$76.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.85
Rate for Payer: Oxford Commercial	$30.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.93
Rate for Payer: UnitedHealthcare Commercial	$30.57
Rate for Payer: UnitedHealthcare Community & State	$3.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

LEVOFLOXACIN 250MG/D5W 50ML IV

Facility

$152.85

Hospital Charge Code	60628993
Hospital Revenue Code	250
Min. Negotiated Rate	$22.93
Max. Negotiated Rate	$22.93
Rate for Payer: Qualcare PPO/HMO/WC	$22.93

LEVOFLOXACIN 250 MG TAB

Facility

$191.75

Service Code	NDC 50458092010
Hospital Charge Code	60628633
Hospital Revenue Code	250
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$28.76
Rate for Payer: Qualcare PPO/HMO/WC	$28.76

LEVOFLOXACIN 250 MG TAB

Facility

$191.75

Service Code	NDC 50458092010
Hospital Charge Code	60628633
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$95.88
Rate for Payer: Aetna Commercial	$72.86
Rate for Payer: Aetna Medicare Advantage	$57.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.90
Rate for Payer: Cigna Commercial	$95.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.52
Rate for Payer: Oxford Commercial	$38.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.76
Rate for Payer: UnitedHealthcare Commercial	$38.35
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

LEVOFLOXACIN 500 MG TAB

Facility

$58.45

Hospital Charge Code	60628634
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

LEVOFLOXACIN 500 MG TAB

Facility

$58.45

Hospital Charge Code	60628634
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.23
Rate for Payer: Aetna Commercial	$22.21
Rate for Payer: Aetna Medicare Advantage	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.54
Rate for Payer: Oxford Commercial	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$11.69
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

LEVOFLOXACIN 750MG/D5W 150MLIV

Facility

$322.60

Hospital Charge Code	60629092
Hospital Revenue Code	250
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$161.30
Rate for Payer: Aetna Commercial	$122.59
Rate for Payer: Aetna Medicare Advantage	$96.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.26
Rate for Payer: Cigna Commercial	$161.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.78
Rate for Payer: Oxford Commercial	$64.52
Rate for Payer: Qualcare PPO/HMO/WC	$48.39
Rate for Payer: UnitedHealthcare Commercial	$64.52
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

LEVOFLOXACIN 750MG/D5W 150MLIV

Facility

$322.60

Hospital Charge Code	60629092
Hospital Revenue Code	250
Min. Negotiated Rate	$48.39
Max. Negotiated Rate	$48.39
Rate for Payer: Qualcare PPO/HMO/WC	$48.39

Know your out-of-pocket cost for care.

All Charges