Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVOFLOXACIN(LEVAQUIN)250 IVPB

Facility

$154.64

Service Code	NDC 25021013281
Hospital Charge Code	60630153
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

LEVOFLOXACIN(LEVAQUIN)250 IVPB

Facility

$154.64

Service Code	NDC 25021013281
Hospital Charge Code	60630153
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.32
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna Medicare Advantage	$46.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.43
Rate for Payer: Cigna Commercial	$77.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.39
Rate for Payer: Oxford Commercial	$30.93
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$30.93
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

LEVOFLOXACIN(LEVAQUIN)500 IVPB

Facility

$154.64

Service Code	NDC 25021013282
Hospital Charge Code	60630152
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

LEVOFLOXACIN(LEVAQUIN)500 IVPB

Facility

$154.64

Service Code	NDC 25021013282
Hospital Charge Code	60630152
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.32
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna Medicare Advantage	$46.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.43
Rate for Payer: Cigna Commercial	$77.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.39
Rate for Payer: Oxford Commercial	$30.93
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$30.93
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

LEVOFLOXACIN(LEVAQUIN)500 TAB

Facility

$129.24

Service Code	NDC 93729253
Hospital Charge Code	60630154
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.39

LEVOFLOXACIN(LEVAQUIN)500 TAB

Facility

$129.24

Service Code	NDC 93729253
Hospital Charge Code	60630154
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.62
Rate for Payer: Aetna Commercial	$49.11
Rate for Payer: Aetna Medicare Advantage	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.96
Rate for Payer: Cigna Commercial	$64.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.77
Rate for Payer: Oxford Commercial	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$19.39
Rate for Payer: UnitedHealthcare Commercial	$25.85
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

LEVOFLOXACIN(LEVAQUIN)750 IVPB

Facility

$37.45

Service Code	NDC 25021013283
Hospital Charge Code	60630151
Hospital Revenue Code	250
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

LEVOFLOXACIN(LEVAQUIN)750 IVPB

Facility

$37.45

Service Code	NDC 25021013283
Hospital Charge Code	60630151
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$14.23
Rate for Payer: Aetna Medicare Advantage	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.55
Rate for Payer: Cigna Commercial	$18.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$7.49
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

LEVOFLOXACIN(LEVAQUIN)750 TAB

Facility

$237.18

Service Code	NDC 68084048301
Hospital Charge Code	60630155
Hospital Revenue Code	250
Min. Negotiated Rate	$35.58
Max. Negotiated Rate	$35.58
Rate for Payer: Qualcare PPO/HMO/WC	$35.58

LEVOFLOXACIN(LEVAQUIN)750 TAB

Facility

$237.18

Service Code	NDC 68084048301
Hospital Charge Code	60630155
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$118.59
Rate for Payer: Aetna Commercial	$90.13
Rate for Payer: Aetna Medicare Advantage	$71.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.48
Rate for Payer: Cigna Commercial	$118.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.15
Rate for Payer: Oxford Commercial	$47.44
Rate for Payer: Qualcare PPO/HMO/WC	$35.58
Rate for Payer: UnitedHealthcare Commercial	$47.44
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

LEVOFLOXACIN TAB 500MG

Facility

$46.75

Hospital Charge Code	60628635
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$9.35
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

LEVOFLOXACIN TAB 500MG

Facility

$46.75

Hospital Charge Code	60628635
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

LEVOFLOXAC IVPB 500MG/NS 100ML

Facility

$304.85

Hospital Charge Code	60628828
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$152.43
Rate for Payer: Aetna Commercial	$115.84
Rate for Payer: Aetna Medicare Advantage	$91.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.74
Rate for Payer: Cigna Commercial	$152.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$60.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.73
Rate for Payer: UnitedHealthcare Commercial	$60.97
Rate for Payer: UnitedHealthcare Community & State	$7.35
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

LEVOFLOXAC IVPB 500MG/NS 100ML

Facility

$304.85

Hospital Charge Code	60628828
Hospital Revenue Code	250
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$45.73
Rate for Payer: Qualcare PPO/HMO/WC	$45.73

LEVOFLOXALIN IV BAG 500MG

Facility

$405.65

Hospital Charge Code	60628759
Hospital Revenue Code	250
Min. Negotiated Rate	$60.85
Max. Negotiated Rate	$60.85
Rate for Payer: Qualcare PPO/HMO/WC	$60.85

LEVOFLOXALIN IV BAG 500MG

Facility

$405.65

Hospital Charge Code	60628759
Hospital Revenue Code	250
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$202.82
Rate for Payer: Aetna Commercial	$154.15
Rate for Payer: Aetna Medicare Advantage	$121.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.44
Rate for Payer: Cigna Commercial	$202.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.69
Rate for Payer: Oxford Commercial	$81.13
Rate for Payer: Qualcare PPO/HMO/WC	$60.85
Rate for Payer: UnitedHealthcare Commercial	$81.13
Rate for Payer: UnitedHealthcare Community & State	$9.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.75

LEVONORGESTREL 1.5 MG TAB

Facility

$272.15

Service Code	NDC 51285014619
Hospital Charge Code	6063943212
Hospital Revenue Code	250
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$40.82
Rate for Payer: Qualcare PPO/HMO/WC	$40.82

LEVONORGESTREL 1.5 MG TAB

Facility

$272.15

Service Code	NDC 51285014619
Hospital Charge Code	6063943212
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$136.07
Rate for Payer: Aetna Commercial	$103.42
Rate for Payer: Aetna Medicare Advantage	$81.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.40
Rate for Payer: Cigna Commercial	$136.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$54.43
Rate for Payer: Qualcare PPO/HMO/WC	$40.82
Rate for Payer: UnitedHealthcare Commercial	$54.43
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

LEVONORGESTREL 52MG

Facility

$1,272.44

Service Code	HCPCS J7298
Hospital Charge Code	606494324
Hospital Revenue Code	636
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$636.22
Rate for Payer: Aetna Commercial	$483.53
Rate for Payer: Aetna Medicare Advantage	$381.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.47
Rate for Payer: Cigna Commercial	$636.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.93
Rate for Payer: Qualcare PPO/HMO/WC	$190.87
Rate for Payer: UnitedHealthcare Community & State	$30.67
Rate for Payer: Wellpoint Medicaid Managed Care	$33.72

LEVONORGESTREL 52MG

Facility

$1,272.44

Service Code	HCPCS J7298
Hospital Charge Code	606494324
Hospital Revenue Code	636
Min. Negotiated Rate	$190.87
Max. Negotiated Rate	$307.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.93
Rate for Payer: Qualcare PPO/HMO/WC	$190.87

LEVOPHED BITARTRATE 0.1%

Facility

$34.00

Hospital Charge Code	60633283
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

LEVOPHED BITARTRATE 0.1%

Facility

$34.00

Hospital Charge Code	60633283
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

LEVORPHANOL 2MG/ML

Facility

$19.20

Hospital Charge Code	6012090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.88

LEVORPHANOL 2MG/ML

Facility

$19.20

Hospital Charge Code	6012090
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.90
Rate for Payer: Cigna Commercial	$9.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.76
Rate for Payer: Oxford Commercial	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.88
Rate for Payer: UnitedHealthcare Commercial	$3.84
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

LEVORPHANOL TARTRATE/2MG

Facility

$3.00

Hospital Charge Code	60633284
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

Know your out-of-pocket cost for care.

All Charges