Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 2% OINTMENT UD

Facility

$12.55

Hospital Charge Code	60627657R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

NITROGLYCERIN 50MG/10ML INJ

Facility

$108.88

Service Code	NDC 517481025
Hospital Charge Code	6003958
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

NITROGLYCERIN 50MG/10ML INJ

Facility

$108.88

Service Code	NDC 517481025
Hospital Charge Code	6003958
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$54.44
Rate for Payer: Aetna Commercial	$41.37
Rate for Payer: Aetna Medicare Advantage	$32.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.76
Rate for Payer: Cigna Commercial	$54.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.66
Rate for Payer: Oxford Commercial	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.33
Rate for Payer: UnitedHealthcare Commercial	$21.78
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

NITROGLYCERIN/50MG/250D5W

Facility

$27.00

Hospital Charge Code	60634989
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

NITROGLYCERIN/50MG/250D5W

Facility

$27.00

Hospital Charge Code	60634989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

NITROGLYCERIN 50MG/250ML INJ

Facility

$34.60

Hospital Charge Code	60629344
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

NITROGLYCERIN 50MG/250ML INJ

Facility

$34.60

Hospital Charge Code	60629344
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

NITROGLYCERIN 50MG/D5W 250ML

Facility

$52.57

Hospital Charge Code	606350912
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.29
Rate for Payer: Aetna Commercial	$19.98
Rate for Payer: Aetna Medicare Advantage	$15.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.41
Rate for Payer: Cigna Commercial	$26.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.77
Rate for Payer: Oxford Commercial	$10.51
Rate for Payer: Qualcare PPO/HMO/WC	$7.89
Rate for Payer: UnitedHealthcare Commercial	$10.51
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

NITROGLYCERIN 50MG/D5W 250ML

Facility

$52.57

Hospital Charge Code	606350912
Hospital Revenue Code	250
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$7.89
Rate for Payer: Qualcare PPO/HMO/WC	$7.89

NITROGLYCERIN/5MG/1ML

Facility

$43.00

Hospital Charge Code	60633533
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

NITROGLYCERIN/5MG/1ML

Facility

$43.00

Hospital Charge Code	60633533
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

NITROGLYCERIN/5MG/1ML

Facility

$9.00

Hospital Charge Code	60633528
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

NITROGLYCERIN/5MG/1ML

Facility

$9.00

Hospital Charge Code	60633528
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

NITROGLYCERIN/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633532
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/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633531
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/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633535
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/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633535
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN/6.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN 6.5 MG ER CAP

Facility

$4.00

Hospital Charge Code	60627659
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NITROGLYCERIN 6.5 MG ER CAP

Facility

$4.00

Hospital Charge Code	60627659
Hospital Revenue Code	250
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/9MG/CAP

Facility

$3.00

Hospital Charge Code	60633529
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN/9MG/CAP

Facility

$3.00

Hospital Charge Code	60633529
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 IN D5W 50MG/250M

Facility

$51.26

Service Code	NDC 409148202
Hospital Charge Code	60630162
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

NITROGLYCERIN IN D5W 50MG/250M

Facility

$51.26

Service Code	NDC 409148202
Hospital Charge Code	60630162
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.63
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.38
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

Know your out-of-pocket cost for care.

All Charges