Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NICOTINE

Facility

$308.00

Service Code	HCPCS 80323
Hospital Charge Code	38473082
Hospital Revenue Code	301
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$8.16

NICOTINE 14 MG/24 HR ER

Facility

$32.43

Service Code	NDC 135019503
Hospital Charge Code	60627594
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

NICOTINE 14 MG/24 HR ER

Facility

$32.43

Service Code	NDC 135019503
Hospital Charge Code	60627594
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.21
Rate for Payer: Aetna Commercial	$12.32
Rate for Payer: Aetna Medicare Advantage	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.27
Rate for Payer: Cigna Commercial	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Oxford Commercial	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$6.49
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

NICOTINE 21 MG/24 HR ER

Facility

$22.45

Service Code	NDC 766145020
Hospital Charge Code	60627496
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

NICOTINE 21 MG/24 HR ER

Facility

$22.45

Service Code	NDC 766145020
Hospital Charge Code	60627496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

NICOTINE 7 MG/24 HR ER

Facility

$42.08

Service Code	NDC 67512407
Hospital Charge Code	60628797
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.04
Rate for Payer: Aetna Commercial	$15.99
Rate for Payer: Aetna Medicare Advantage	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.73
Rate for Payer: Cigna Commercial	$21.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.62
Rate for Payer: Oxford Commercial	$8.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.31
Rate for Payer: UnitedHealthcare Commercial	$8.42
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

NICOTINE 7 MG/24 HR ER

Facility

$42.08

Service Code	NDC 67512407
Hospital Charge Code	60628797
Hospital Revenue Code	250
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$6.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.31

NICOTINE & COTININE, LC/MS/MS

Facility

$434.65

Service Code	HCPCS 80323
Hospital Charge Code	39990242
Hospital Revenue Code	301
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$217.32
Rate for Payer: Aetna Commercial	$165.17
Rate for Payer: Aetna Medicare Advantage	$130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.84
Rate for Payer: Cigna Commercial	$217.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$11.52

NICOTINE & COTININE, LC/MS/MS

Facility

$434.65

Service Code	HCPCS 80323
Hospital Charge Code	39990242
Hospital Revenue Code	301
Min. Negotiated Rate	$65.20
Max. Negotiated Rate	$65.20
Rate for Payer: Qualcare PPO/HMO/WC	$65.20

NICOTINE & EXPANDED METABOLITE

Facility

$390.00

Service Code	HCPCS 80323
Hospital Charge Code	3000377
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

NICOTINE & EXPANDED METABOLITE

Facility

$390.00

Service Code	HCPCS 80323
Hospital Charge Code	3000377
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

NICOTINE GUM 2MG

Facility

$7.25

Hospital Charge Code	60627495
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

NICOTINE GUM 2MG

Facility

$7.25

Hospital Charge Code	60627495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

NICOTINE METABOLITE SCREEN (UA

Facility

$116.00

Service Code	HCPCS 80307
Hospital Charge Code	401380307
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

NICOTINE METABOLITE SCREEN (UA

Facility

$116.00

Service Code	HCPCS 80307
Hospital Charge Code	401380307
Hospital Revenue Code	301
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.31
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$62.14
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

NICOTINE PATCH 11MG

Facility

$28.80

Hospital Charge Code	60727493
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

NICOTINE PATCH 11MG

Facility

$37.80

Hospital Charge Code	60627493
Hospital Revenue Code	250
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

NICOTINE PATCH 11MG

Facility

$37.80

Hospital Charge Code	60627493
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

NICOTINE PATCH 11MG

Facility

$28.80

Hospital Charge Code	60727493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$5.76
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$5.76
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

NICOTINE PATCH 22MG/DAY

Facility

$30.75

Hospital Charge Code	6016307
Hospital Revenue Code	251
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.84
Rate for Payer: Cigna Commercial	$15.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.22
Rate for Payer: Oxford Commercial	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.61
Rate for Payer: UnitedHealthcare Commercial	$6.15
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

NICOTINE PATCH 22MG/DAY

Facility

$30.75

Hospital Charge Code	6016307
Hospital Revenue Code	251
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: Qualcare PPO/HMO/WC	$4.61

NIFEDIPINE 10 MG CAP

Facility

$7.17

Service Code	NDC 228249710
Hospital Charge Code	60627589
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

NIFEDIPINE 10 MG CAP

Facility

$7.17

Service Code	NDC 228249710
Hospital Charge Code	60627589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.43
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

NIFEDIPINE 30 MG ER TAB

Facility

$8.84

Service Code	NDC 51079040020
Hospital Charge Code	6009815
Hospital Revenue Code	250
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	$2.65
Rate for Payer: Oxford Commercial	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Commercial	$1.77
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

NIFEDIPINE 30 MG ER TAB

Facility

$8.84

Service Code	NDC 51079040020
Hospital Charge Code	6009815
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

Know your out-of-pocket cost for care.

All Charges