Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.17
Rate for Payer: Aetna Commercial	$16.09
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.80
Rate for Payer: Cigna Commercial	$21.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.70
Rate for Payer: Oxford Commercial	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$6.35
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.11
Rate for Payer: Aetna Commercial	$10.72
Rate for Payer: Aetna Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.19
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.46
Rate for Payer: Oxford Commercial	$5.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$5.64
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.03
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna Medicare Advantage	$15.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.28
Rate for Payer: Cigna Commercial	$26.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.62
Rate for Payer: Oxford Commercial	$10.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.81
Rate for Payer: UnitedHealthcare Commercial	$10.41
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$7.81
Rate for Payer: Qualcare PPO/HMO/WC	$7.81

AZITHROMYCIN 500 MG INJ

Facility

$132.00

Hospital Charge Code	60635548
Hospital Revenue Code	636
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$31.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.94
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

AZITHROMYCIN 500 MG INJ

Facility

$132.00

Hospital Charge Code	60635548
Hospital Revenue Code	636
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.94
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.09
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: Aetna Medicare Advantage	$31.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.57
Rate for Payer: Cigna Commercial	$52.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$25.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$179.83
Rate for Payer: Aetna Commercial	$136.67
Rate for Payer: Aetna Medicare Advantage	$107.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.71
Rate for Payer: Cigna Commercial	$179.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.90
Rate for Payer: Oxford Commercial	$71.93
Rate for Payer: Qualcare PPO/HMO/WC	$53.95
Rate for Payer: UnitedHealthcare Commercial	$71.93
Rate for Payer: UnitedHealthcare Community & State	$8.67
Rate for Payer: Wellpoint Medicaid Managed Care	$9.53

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$53.95
Max. Negotiated Rate	$53.95
Rate for Payer: Qualcare PPO/HMO/WC	$53.95

AZITHROMYCIN CAP 250MG

Facility

$46.10

Hospital Charge Code	6010649
Hospital Revenue Code	252
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

AZITHROMYCIN CAP 250MG

Facility

$46.10

Hospital Charge Code	6010649
Hospital Revenue Code	252
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.05
Rate for Payer: Aetna Commercial	$17.52
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.76
Rate for Payer: Cigna Commercial	$23.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.83
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$6.92
Rate for Payer: UnitedHealthcare Commercial	$9.22
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

AZMACORT/20GM

Facility

$207.00

Hospital Charge Code	60632520
Hospital Revenue Code	250
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

AZMACORT/20GM

Facility

$207.00

Hospital Charge Code	60632520
Hospital Revenue Code	250
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$78.66
Rate for Payer: Aetna Medicare Advantage	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.10
Rate for Payer: Oxford Commercial	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$41.40
Rate for Payer: UnitedHealthcare Community & State	$4.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

AZO-GANTANOL/TAB

Facility

$6.00

Hospital Charge Code	60632521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

AZO-GANTANOL/TAB

Facility

$6.00

Hospital Charge Code	60632521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

AZO-GANTRISIN/TAB

Facility

$3.00

Hospital Charge Code	60632522
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

AZO-GANTRISIN/TAB

Facility

$3.00

Hospital Charge Code	60632522
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AZTREONAM

Facility

$535.00

Service Code	NDC 63323040120
Hospital Charge Code	60627267
Hospital Revenue Code	250
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$203.30
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.50
Rate for Payer: Oxford Commercial	$107.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$107.00
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.18

AZTREONAM

Facility

$535.00

Service Code	NDC 63323040120
Hospital Charge Code	60627267
Hospital Revenue Code	250
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

AZTREONAM 2 GM INJ

Facility

$545.31

Service Code	NDC 3257016
Hospital Charge Code	60627269
Hospital Revenue Code	250
Min. Negotiated Rate	$81.80
Max. Negotiated Rate	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.80

AZTREONAM 2 GM INJ

Facility

$545.31

Service Code	NDC 3257016
Hospital Charge Code	60627269
Hospital Revenue Code	250
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$272.65
Rate for Payer: Aetna Commercial	$207.22
Rate for Payer: Aetna Medicare Advantage	$163.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.05
Rate for Payer: Cigna Commercial	$272.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.59
Rate for Payer: Oxford Commercial	$109.06
Rate for Payer: Qualcare PPO/HMO/WC	$81.80
Rate for Payer: UnitedHealthcare Commercial	$109.06
Rate for Payer: UnitedHealthcare Community & State	$13.14
Rate for Payer: Wellpoint Medicaid Managed Care	$14.45

AZTREONAM 500 MG INJ

Facility

$102.04

Service Code	NDC 3256016
Hospital Charge Code	60627271
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$38.78
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.61
Rate for Payer: Oxford Commercial	$20.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$20.41
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

AZTREONAM 500 MG INJ

Facility

$102.04

Service Code	NDC 3256016
Hospital Charge Code	60627271
Hospital Revenue Code	250
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

Know your out-of-pocket cost for care.

All Charges