Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NITRATE, URINE***

Facility

$22.00

Service Code	HCPCS 84311
Hospital Charge Code	3031325
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

NITRAZINE PAPER W/DISPENS

Facility

$266.53

Service Code	NDC 3052620
Hospital Charge Code	60633527
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$133.26
Rate for Payer: Aetna Commercial	$101.28
Rate for Payer: Aetna Medicare Advantage	$79.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.97
Rate for Payer: Cigna Commercial	$133.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.96
Rate for Payer: Oxford Commercial	$53.31
Rate for Payer: Qualcare PPO/HMO/WC	$39.98
Rate for Payer: UnitedHealthcare Commercial	$53.31
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.06

NITRAZINE PAPER W/DISPENS

Facility

$266.53

Service Code	NDC 3052620
Hospital Charge Code	60633527
Hospital Revenue Code	250
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$39.98
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

NITRIC OXIDE PER HOUR

Facility

$1,288.05

Hospital Charge Code	31701001
Hospital Revenue Code	270
Min. Negotiated Rate	$31.04
Max. Negotiated Rate	$644.02
Rate for Payer: Aetna Commercial	$489.46
Rate for Payer: Aetna Medicare Advantage	$386.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.45
Rate for Payer: Cigna Commercial	$644.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.42
Rate for Payer: Oxford Commercial	$257.61
Rate for Payer: Qualcare PPO/HMO/WC	$193.21
Rate for Payer: UnitedHealthcare Commercial	$257.61
Rate for Payer: UnitedHealthcare Community & State	$31.04
Rate for Payer: Wellpoint Medicaid Managed Care	$34.13

NITRIC OXIDE PER HOUR

Facility

$1,288.05

Hospital Charge Code	31701001
Hospital Revenue Code	270
Min. Negotiated Rate	$193.21
Max. Negotiated Rate	$193.21
Rate for Payer: Qualcare PPO/HMO/WC	$193.21

NITRO-BID 2% OINT 30GM TB

Facility

$49.00

Hospital Charge Code	60635683
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

NITRO-BID 2% OINT 30GM TB

Facility

$49.00

Hospital Charge Code	60635683
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

NITROBID U/D

Facility

$3.00

Hospital Charge Code	60634962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROBID U/D

Facility

$3.00

Hospital Charge Code	60634962
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

NITRO-DUR 0.8 MG/HR

Facility

$13.00

Hospital Charge Code	60635230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

NITRO-DUR 0.8 MG/HR

Facility

$13.00

Hospital Charge Code	60635230
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

NITRODUR PATCH/0.1MG/HR

Facility

$5.00

Hospital Charge Code	60634507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.1MG/HR

Facility

$5.00

Hospital Charge Code	60634507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NITRODUR PATCH/0.2MG/HR

Facility

$5.00

Hospital Charge Code	60634508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.2MG/HR

Facility

$5.00

Hospital Charge Code	60634508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NITRODUR PATCH/0.3MG/HR

Facility

$5.00

Hospital Charge Code	60634509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NITRODUR PATCH/0.3MG/HR

Facility

$5.00

Hospital Charge Code	60634509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.4MG/HR

Facility

$5.00

Hospital Charge Code	60634510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NITRODUR PATCH/0.4MG/HR

Facility

$5.00

Hospital Charge Code	60634510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.6MG/HR

Facility

$5.00

Hospital Charge Code	60634511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

NITRODUR PATCH/0.6MG/HR

Facility

$5.00

Hospital Charge Code	60634511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH .2MG/1HR

Facility

$17.42

Service Code	NDC 47781029703
Hospital Charge Code	6006613
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

NITRODUR PATCH .2MG/1HR

Facility

$17.42

Service Code	NDC 47781029703
Hospital Charge Code	6006613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$6.62
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$3.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Commercial	$3.48
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

NITROFURANTOIN 25MG/5ML SUSP

Facility

$106.40

Service Code	NDC 66993047173
Hospital Charge Code	6063943149
Hospital Revenue Code	250
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$15.96
Rate for Payer: Qualcare PPO/HMO/WC	$15.96

NITROFURANTOIN 25MG/5ML SUSP

Facility

$106.40

Service Code	NDC 66993047173
Hospital Charge Code	6063943149
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$53.20
Rate for Payer: Aetna Commercial	$40.43
Rate for Payer: Aetna Medicare Advantage	$31.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.13
Rate for Payer: Cigna Commercial	$53.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Oxford Commercial	$21.28
Rate for Payer: Qualcare PPO/HMO/WC	$15.96
Rate for Payer: UnitedHealthcare Commercial	$21.28
Rate for Payer: UnitedHealthcare Community & State	$2.56
Rate for Payer: Wellpoint Medicaid Managed Care	$2.82

Know your out-of-pocket cost for care.

All Charges