Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRED MILD 0.12% OPHTH/5ML

Facility

$89.00

Hospital Charge Code	60633698
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

PREDNISOLONE 1% EYE DROP 15ML

Facility

$365.48

Hospital Charge Code	606350920
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$182.74
Rate for Payer: Aetna Commercial	$138.88
Rate for Payer: Aetna Medicare Advantage	$109.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.20
Rate for Payer: Cigna Commercial	$182.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.64
Rate for Payer: Oxford Commercial	$73.10
Rate for Payer: Qualcare PPO/HMO/WC	$54.82
Rate for Payer: UnitedHealthcare Commercial	$73.10
Rate for Payer: UnitedHealthcare Community & State	$8.81
Rate for Payer: Wellpoint Medicaid Managed Care	$9.69

PREDNISOLONE 1% EYE DROP 15ML

Facility

$365.48

Hospital Charge Code	606350920
Hospital Revenue Code	250
Min. Negotiated Rate	$54.82
Max. Negotiated Rate	$54.82
Rate for Payer: Qualcare PPO/HMO/WC	$54.82

PREDNISOLONE 5MG/5ML

Facility

$70.40

Hospital Charge Code	6017081
Hospital Revenue Code	251
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

PREDNISOLONE 5MG/5ML

Facility

$70.40

Hospital Charge Code	6017081
Hospital Revenue Code	251
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

PREDNISOLONE 5MG/5ML SYR 120ML

Facility

$96.00

Hospital Charge Code	60628782
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PREDNISOLONE 5MG/5ML SYR 120ML

Facility

$96.00

Hospital Charge Code	60628782
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$36.48
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.80
Rate for Payer: Oxford Commercial	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$19.20
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

PREDNISOLONE 5MG/5ML SYRUP

Facility

$131.25

Hospital Charge Code	60629118
Hospital Revenue Code	636
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$31.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.76
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

PREDNISOLONE 5MG/5ML SYRUP

Facility

$131.25

Hospital Charge Code	60629118
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$49.88
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.76
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

PREDNISOLONE ACETATE 1% EYE

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	60628041
Hospital Revenue Code	250
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$55.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.60

PREDNISOLONE ACETATE 1% EYE

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	60628041
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$185.32
Rate for Payer: Aetna Commercial	$140.84
Rate for Payer: Aetna Medicare Advantage	$111.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.51
Rate for Payer: Cigna Commercial	$185.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.19
Rate for Payer: Oxford Commercial	$74.13
Rate for Payer: Qualcare PPO/HMO/WC	$55.60
Rate for Payer: UnitedHealthcare Commercial	$74.13
Rate for Payer: UnitedHealthcare Community & State	$8.93
Rate for Payer: Wellpoint Medicaid Managed Care	$9.82

PREDNISOLONE ACETATE 1% OPHTH

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	6063943239
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$185.32
Rate for Payer: Aetna Commercial	$140.84
Rate for Payer: Aetna Medicare Advantage	$111.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.51
Rate for Payer: Cigna Commercial	$185.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.19
Rate for Payer: Oxford Commercial	$74.13
Rate for Payer: Qualcare PPO/HMO/WC	$55.60
Rate for Payer: UnitedHealthcare Commercial	$74.13
Rate for Payer: UnitedHealthcare Community & State	$8.93
Rate for Payer: Wellpoint Medicaid Managed Care	$9.82

PREDNISOLONE ACETATE 1% OPHTH

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	6063943239
Hospital Revenue Code	250
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$55.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.60

PREDNISOLONE ACET OPH 1% 10ML

Facility

$43.55

Hospital Charge Code	6004618
Hospital Revenue Code	251
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

PREDNISOLONE ACET OPH 1% 10ML

Facility

$43.55

Hospital Charge Code	6004618
Hospital Revenue Code	251
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

PREDNISOLONE ACET OPH .12% 5ML

Facility

$109.45

Hospital Charge Code	6004600
Hospital Revenue Code	251
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

PREDNISOLONE ACET OPH .12% 5ML

Facility

$109.45

Hospital Charge Code	6004600
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

PREDNISOLONE ACET OPH 1% 5ML

Facility

$10.90

Hospital Charge Code	6004592
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

PREDNISOLONE ACET OPH 1% 5ML

Facility

$10.90

Hospital Charge Code	6004592
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

PREDNISOLONE ACT OPH .12% 10ML

Facility

$147.85

Hospital Charge Code	6004584
Hospital Revenue Code	251
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.35
Rate for Payer: Oxford Commercial	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$29.57
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

PREDNISOLONE ACT OPH .12% 10ML

Facility

$147.85

Hospital Charge Code	6004584
Hospital Revenue Code	251
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

PREDNISOLONE NEO POLY SSP 5ML

Facility

$136.35

Hospital Charge Code	6004626
Hospital Revenue Code	251
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

PREDNISOLONE NEO POLY SSP 5ML

Facility

$136.35

Hospital Charge Code	6004626
Hospital Revenue Code	251
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.91
Rate for Payer: Oxford Commercial	$27.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$27.27
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

PREDNISOLONE OPH .125% SUS

Facility

$26.45

Hospital Charge Code	60628888
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

PREDNISOLONE OPH .125% SUS

Facility

$26.45

Hospital Charge Code	60628888
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

Know your out-of-pocket cost for care.

All Charges