Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN OINT 1GM TUBE

Facility

$3.20

Hospital Charge Code	6023113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

NITROGLYCERIN OINT 1GM TUBE

Facility

$3.20

Hospital Charge Code	6023113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

NITROGLYCERIN OINT TOP 2% 20GM

Facility

$65.65

Hospital Charge Code	6003974
Hospital Revenue Code	251
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

NITROGLYCERIN OINT TOP 2% 20GM

Facility

$65.65

Hospital Charge Code	6003974
Hospital Revenue Code	251
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$13.13
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

NITROGLYCERIN PATCH 0.1MG/HR

Facility

$12.46

Service Code	NDC 378910293
Hospital Charge Code	60627660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

NITROGLYCERIN PATCH 0.1MG/HR

Facility

$12.46

Service Code	NDC 378910293
Hospital Charge Code	60627660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.18
Rate for Payer: Cigna Commercial	$6.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

NITROGLYCERIN PATCH 0.3MG/HR

Facility

$36.58

Service Code	NDC 85331530
Hospital Charge Code	60627654
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

NITROGLYCERIN PATCH 0.3MG/HR

Facility

$36.58

Service Code	NDC 85331530
Hospital Charge Code	60627654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.29
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$10.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.97
Rate for Payer: Oxford Commercial	$7.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

NITROGLYCERIN PATCH 0.4MG/HR

Facility

$12.46

Service Code	NDC 85332030
Hospital Charge Code	60627655
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

NITROGLYCERIN PATCH 0.4MG/HR

Facility

$12.46

Service Code	NDC 85332030
Hospital Charge Code	60627655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.18
Rate for Payer: Cigna Commercial	$6.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

NITROGLYCERIN PATCH 0.6MG/HR

Facility

$16.08

Service Code	NDC 378911693
Hospital Charge Code	60627656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.04
Rate for Payer: Aetna Commercial	$6.11
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.10
Rate for Payer: Cigna Commercial	$8.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.82
Rate for Payer: Oxford Commercial	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$3.22
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

NITROGLYCERIN PATCH 0.6MG/HR

Facility

$16.08

Service Code	NDC 378911693
Hospital Charge Code	60627656
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

NITROGLYCERIN TAB SL 0.6MG

Facility

$41.60

Hospital Charge Code	6013056
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

NITROGLYCERIN TAB SL 0.6MG

Facility

$41.60

Hospital Charge Code	6013056
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

NITROGLYCERIN TOP PATCH 0.4MG

Facility

$1.95

Hospital Charge Code	6023105
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

NITROGLYCERIN TOP PATCH 0.4MG

Facility

$1.95

Hospital Charge Code	6023105
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

NITROPRUSSIDE 50MG/2ML VIAL

Facility

$1,727.26

Service Code	NDC 187430202
Hospital Charge Code	60630163
Hospital Revenue Code	250
Min. Negotiated Rate	$41.63
Max. Negotiated Rate	$863.63
Rate for Payer: Aetna Commercial	$656.36
Rate for Payer: Aetna Medicare Advantage	$518.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$440.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$440.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$440.45
Rate for Payer: Cigna Commercial	$863.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$518.18
Rate for Payer: Oxford Commercial	$345.45
Rate for Payer: Qualcare PPO/HMO/WC	$259.09
Rate for Payer: UnitedHealthcare Commercial	$345.45
Rate for Payer: UnitedHealthcare Community & State	$41.63
Rate for Payer: Wellpoint Medicaid Managed Care	$45.77

NITROPRUSSIDE 50MG/2ML VIAL

Facility

$1,727.26

Service Code	NDC 187430202
Hospital Charge Code	60630163
Hospital Revenue Code	250
Min. Negotiated Rate	$259.09
Max. Negotiated Rate	$259.09
Rate for Payer: Qualcare PPO/HMO/WC	$259.09

NITROPRUSSIDE SOD INJ 50MG

Facility

$174.75

Hospital Charge Code	6003982
Hospital Revenue Code	250
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

NITROPRUSSIDE SOD INJ 50MG

Facility

$174.75

Hospital Charge Code	6003982
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

NITROSTAT 0.03MG/SL/TAB

Facility

$4.00

Hospital Charge Code	60634330
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NITROSTAT 0.03MG/SL/TAB

Facility

$4.00

Hospital Charge Code	60634330
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

NITROSTAT/0.15MG/TAB

Facility

$3.00

Hospital Charge Code	60633538
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

NITROSTAT/0.15MG/TAB

Facility

$3.00

Hospital Charge Code	60633538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROSTAT/0.4MG/TAB

Facility

$4.00

Hospital Charge Code	60633537
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

Know your out-of-pocket cost for care.

All Charges