Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POVIDONE IODINE 10% SOL 14 ML

Facility

$4.50

Hospital Charge Code	60628747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
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

POVIDONE IODINE 5% AEROSOL

Facility

$66.45

Hospital Charge Code	60628361
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$25.25
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.93
Rate for Payer: Oxford Commercial	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$13.29
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

POVIDONE IODINE 5% AEROSOL

Facility

$66.45

Hospital Charge Code	60628361
Hospital Revenue Code	250
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
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

POVIDONE IODINE DCHE VG 14.8ML

Facility

$19.85

Hospital Charge Code	6004576
Hospital Revenue Code	252
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

POVIDONE IODINE DCHE VG 14.8ML

Facility

$19.85

Hospital Charge Code	6004576
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

POVIDONE IODINE GEL 10%

Facility

$3.85

Hospital Charge Code	60628360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

POVIDONE IODINE GEL 10%

Facility

$3.85

Hospital Charge Code	60628360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

POVIDONE IODINE GEL VAG 5GM

Facility

$52.50

Hospital Charge Code	6004568
Hospital Revenue Code	252
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

POVIDONE IODINE GEL VAG 5GM

Facility

$52.50

Hospital Charge Code	6004568
Hospital Revenue Code	252
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$13.58

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$45.26
Rate for Payer: Aetna Commercial	$34.40
Rate for Payer: Aetna Medicare Advantage	$27.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.08
Rate for Payer: Cigna Commercial	$45.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.16
Rate for Payer: Oxford Commercial	$18.10
Rate for Payer: Qualcare PPO/HMO/WC	$13.58
Rate for Payer: UnitedHealthcare Commercial	$18.10
Rate for Payer: UnitedHealthcare Community & State	$2.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

POVIDONE IODINE SOL OPH5% 50MG

Facility

$73.00

Hospital Charge Code	6007454
Hospital Revenue Code	252
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

POVIDONE IODINE SOL OPH5% 50MG

Facility

$73.00

Hospital Charge Code	6007454
Hospital Revenue Code	252
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$16.95
Rate for Payer: Aetna Commercial	$12.88
Rate for Payer: Aetna Medicare Advantage	$10.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.64
Rate for Payer: Cigna Commercial	$16.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.17
Rate for Payer: Oxford Commercial	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$6.78
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

POVIDONE SOL 10% 120ML

Facility

$7.70

Hospital Charge Code	60628356
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

POVIDONE SOL 10% 120ML

Facility

$7.70

Hospital Charge Code	60628356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

POVIDONE SOL 10% 946ML

Facility

$32.00

Hospital Charge Code	60628357
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

POVIDONE SOL 10% 946ML

Facility

$32.00

Hospital Charge Code	60628357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

POVIDONE SOL OPH 5%

Facility

$79.40

Hospital Charge Code	60628358
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$39.70
Rate for Payer: Aetna Commercial	$30.17
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.82
Rate for Payer: Oxford Commercial	$15.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Commercial	$15.88
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

POVIDONE SOL OPH 5%

Facility

$79.40

Hospital Charge Code	60628358
Hospital Revenue Code	250
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$11.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

Know your out-of-pocket cost for care.

All Charges