Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NITROFURANTOIN NITROF CAP100MG

Facility

$114.70

Service Code	NDC 52427028501
Hospital Charge Code	60627353
Hospital Revenue Code	251
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.20

NITROFURANTOIN NITROF CAP100MG

Facility

$114.70

Service Code	NDC 52427028501
Hospital Charge Code	60627353
Hospital Revenue Code	251
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$57.35
Rate for Payer: Aetna Commercial	$43.59
Rate for Payer: Aetna Medicare Advantage	$34.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.25
Rate for Payer: Cigna Commercial	$57.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.41
Rate for Payer: Oxford Commercial	$22.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.20
Rate for Payer: UnitedHealthcare Commercial	$22.94
Rate for Payer: UnitedHealthcare Community & State	$2.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

NITROFURAZONE CRM 0.2%

Facility

$142.75

Hospital Charge Code	60628352
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.83
Rate for Payer: Oxford Commercial	$28.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$28.55
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

NITROFURAZONE CRM 0.2%

Facility

$142.75

Hospital Charge Code	60628352
Hospital Revenue Code	250
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

NITROFURAZONE TOP .2% 56GM

Facility

$122.25

Hospital Charge Code	6003941
Hospital Revenue Code	252
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

NITROFURAZONE TOP .2% 56GM

Facility

$122.25

Hospital Charge Code	6003941
Hospital Revenue Code	252
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

NITROGEN K CYLINGER

Facility

$37.25

Hospital Charge Code	270658091
Hospital Revenue Code	270
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$5.59

NITROGEN K CYLINGER

Facility

$37.25

Hospital Charge Code	270658091
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.62
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: Aetna Medicare Advantage	$11.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.50
Rate for Payer: Cigna Commercial	$18.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.18
Rate for Payer: Oxford Commercial	$7.45
Rate for Payer: Qualcare PPO/HMO/WC	$5.59
Rate for Payer: UnitedHealthcare Commercial	$7.45
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

NITROGEN K TANK 230 C.T. PRE

Facility

$39.85

Hospital Charge Code	270658090
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.93
Rate for Payer: Aetna Commercial	$15.14
Rate for Payer: Aetna Medicare Advantage	$11.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.16
Rate for Payer: Cigna Commercial	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$7.97
Rate for Payer: Qualcare PPO/HMO/WC	$5.98
Rate for Payer: UnitedHealthcare Commercial	$7.97
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

NITROGEN K TANK 230 C.T. PRE

Facility

$39.85

Hospital Charge Code	270658090
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$5.98
Rate for Payer: Qualcare PPO/HMO/WC	$5.98

NITROGEN K TANK 230 CU FT

Facility

$61.05

Hospital Charge Code	270653906
Hospital Revenue Code	272
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$9.16
Rate for Payer: Qualcare PPO/HMO/WC	$9.16

NITROGEN K TANK 230 CU FT

Facility

$61.05

Hospital Charge Code	270653906
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.52
Rate for Payer: Aetna Commercial	$23.20
Rate for Payer: Aetna Medicare Advantage	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.57
Rate for Payer: Cigna Commercial	$30.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.32
Rate for Payer: Oxford Commercial	$12.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.16
Rate for Payer: UnitedHealthcare Commercial	$12.21
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

NITROGLYCERIN 0.4 MG TAB

Facility

$4.00

Service Code	NDC 71041813
Hospital Charge Code	6013049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NITROGLYCERIN 0.4 MG TAB

Facility

$4.00

Service Code	NDC 71041813
Hospital Charge Code	6013049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NITROGLYCERIN 2%/30GM

Facility

$15.00

Hospital Charge Code	60633536
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

NITROGLYCERIN 2%/30GM

Facility

$15.00

Hospital Charge Code	60633536
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633534
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

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633530
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

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN 2.5 MG ER CAP

Facility

$4.62

Service Code	NDC 904064360
Hospital Charge Code	60627658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$0.92
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

NITROGLYCERIN 2.5 MG ER CAP

Facility

$4.62

Service Code	NDC 904064360
Hospital Charge Code	60627658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

NITROGLYCERIN 2% OINTMENT UD

Facility

$20.30

Service Code	NDC 281032608
Hospital Charge Code	60627657
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.15
Rate for Payer: Aetna Commercial	$7.71
Rate for Payer: Aetna Medicare Advantage	$6.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.18
Rate for Payer: Cigna Commercial	$10.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.09
Rate for Payer: Oxford Commercial	$4.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$4.06
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

NITROGLYCERIN 2% OINTMENT UD

Facility

$20.30

Service Code	NDC 281032608
Hospital Charge Code	60627657
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

NITROGLYCERIN 2% OINTMENT UD

Facility

$12.55

Hospital Charge Code	60627657R
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.77
Rate for Payer: Oxford Commercial	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.51
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

Know your out-of-pocket cost for care.

All Charges