Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

SULFAMETHOXA/TRIMETHOPRIM

Facility

$4.00

Hospital Charge Code	60633928
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

SULFAMETHOXA/TRIMETHOPRIM

Facility

$4.00

Hospital Charge Code	60633928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETHOXA/TRIMETHOPRIM

Facility

$3.00

Hospital Charge Code	60633927
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFAMETHOXA/TRIMETHOPRIM

Facility

$3.00

Hospital Charge Code	60633927
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

SULFAMETHOXAZOLE/TRIMETHO

Facility

$3.00

Hospital Charge Code	60633929
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

SULFAMETHOXAZOLE/TRIMETHO

Facility

$3.00

Hospital Charge Code	60633929
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFAMETHOX+TRIMETH 10ML

Facility

$4.00

Hospital Charge Code	60635081
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

SULFAMETHOX+TRIMETH 10ML

Facility

$4.00

Hospital Charge Code	60635081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
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

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$3.56
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.81
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.74

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna Commercial	$1.88
Rate for Payer: Aetna Medicare Advantage	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.26
Rate for Payer: Cigna Commercial	$2.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.49
Rate for Payer: Oxford Commercial	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.74
Rate for Payer: UnitedHealthcare Commercial	$0.99
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$2,016.70
Rate for Payer: Aetna Commercial	$1,532.69
Rate for Payer: Aetna Medicare Advantage	$1,210.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.52
Rate for Payer: Cigna Commercial	$2,016.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.02
Rate for Payer: Oxford Commercial	$806.68
Rate for Payer: Qualcare PPO/HMO/WC	$605.01
Rate for Payer: UnitedHealthcare Commercial	$806.68
Rate for Payer: UnitedHealthcare Community & State	$97.20
Rate for Payer: Wellpoint Medicaid Managed Care	$106.89

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$605.01
Max. Negotiated Rate	$605.01
Rate for Payer: Qualcare PPO/HMO/WC	$605.01

SULFANETHOXAZOLE/TAB

Facility

$1.00

Hospital Charge Code	60634706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SULFANETHOXAZOLE/TAB

Facility

$1.00

Hospital Charge Code	60634706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$29.01
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare Advantage	$17.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.80
Rate for Payer: Cigna Commercial	$29.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.41
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$108.78
Rate for Payer: Aetna Commercial	$82.67
Rate for Payer: Aetna Medicare Advantage	$65.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.48
Rate for Payer: Cigna Commercial	$108.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.27
Rate for Payer: Oxford Commercial	$43.51
Rate for Payer: Qualcare PPO/HMO/WC	$32.63
Rate for Payer: UnitedHealthcare Commercial	$43.51
Rate for Payer: UnitedHealthcare Community & State	$5.24
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$32.63
Rate for Payer: Qualcare PPO/HMO/WC	$32.63

SULFANILAMIDE CMPO VAG 15%

Facility

$234.25

Hospital Charge Code	6005136
Hospital Revenue Code	251
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.28
Rate for Payer: Oxford Commercial	$46.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Commercial	$46.85
Rate for Payer: UnitedHealthcare Community & State	$5.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.21

SULFANILAMIDE CMPO VAG 15%

Facility

$234.25

Hospital Charge Code	6005136
Hospital Revenue Code	251
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$35.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

Know your out-of-pocket cost for care.

All Charges