Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BETAGAN 0.5% OPHTH/2ML

Facility

$84.76

Service Code	NDC 23438505
Hospital Charge Code	60632549
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.38
Rate for Payer: Aetna Commercial	$32.21
Rate for Payer: Aetna Medicare Advantage	$25.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.61
Rate for Payer: Cigna Commercial	$42.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.43
Rate for Payer: Oxford Commercial	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$12.71
Rate for Payer: UnitedHealthcare Commercial	$16.95
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

BETAGAN 0.5% OPHTH/2ML

Facility

$84.76

Service Code	NDC 23438505
Hospital Charge Code	60632549
Hospital Revenue Code	250
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$12.71
Rate for Payer: Qualcare PPO/HMO/WC	$12.71

BETA HYDROXYBUTYRATE

Facility

$390.00

Service Code	HCPCS 82010
Hospital Charge Code	39900031
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BETA HYDROXYBUTYRATE

Facility

$390.00

Service Code	HCPCS 82010
Hospital Charge Code	39900031
Hospital Revenue Code	307
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038080
Hospital Revenue Code	307
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038130
Hospital Revenue Code	300
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038130
Hospital Revenue Code	300
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038080
Hospital Revenue Code	307
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

BETAMETHASONE CLOTRI CRM 15OZ

Facility

$109.45

Hospital Charge Code	6000681
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

BETAMETHASONE CLOTRI CRM 15OZ

Facility

$109.45

Hospital Charge Code	6000681
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

BETAMETHASONE/CLOTRIMAZOLE

Facility

$995.35

Service Code	NDC 168025815
Hospital Charge Code	60628337
Hospital Revenue Code	250
Min. Negotiated Rate	$23.99
Max. Negotiated Rate	$497.68
Rate for Payer: Aetna Commercial	$378.23
Rate for Payer: Aetna Medicare Advantage	$298.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.81
Rate for Payer: Cigna Commercial	$497.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.61
Rate for Payer: Oxford Commercial	$199.07
Rate for Payer: Qualcare PPO/HMO/WC	$149.30
Rate for Payer: UnitedHealthcare Commercial	$199.07
Rate for Payer: UnitedHealthcare Community & State	$23.99
Rate for Payer: Wellpoint Medicaid Managed Care	$26.38

BETAMETHASONE/CLOTRIMAZOLE

Facility

$995.35

Service Code	NDC 168025815
Hospital Charge Code	60628337
Hospital Revenue Code	250
Min. Negotiated Rate	$149.30
Max. Negotiated Rate	$149.30
Rate for Payer: Qualcare PPO/HMO/WC	$149.30

BETAMETHASONE CRM 0.05%

Facility

$86.40

Hospital Charge Code	60628369
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

BETAMETHASONE CRM 0.05%

Facility

$86.40

Hospital Charge Code	60628369
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

BETAMETHASONE CRM 0.05% AF 15G

Facility

$254.27

Service Code	NDC 51672131001
Hospital Charge Code	606285574
Hospital Revenue Code	250
Min. Negotiated Rate	$38.14
Max. Negotiated Rate	$38.14
Rate for Payer: Qualcare PPO/HMO/WC	$38.14

BETAMETHASONE CRM 0.05% AF 15G

Facility

$254.27

Service Code	NDC 51672131001
Hospital Charge Code	606285574
Hospital Revenue Code	250
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$127.14
Rate for Payer: Aetna Commercial	$96.62
Rate for Payer: Aetna Medicare Advantage	$76.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.84
Rate for Payer: Cigna Commercial	$127.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.28
Rate for Payer: Oxford Commercial	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.14
Rate for Payer: UnitedHealthcare Commercial	$50.85
Rate for Payer: UnitedHealthcare Community & State	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.74

BETAMETHASONE CRM 15GM DIP

Facility

$122.90

Hospital Charge Code	6000665
Hospital Revenue Code	251
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Oxford Commercial	$24.58
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$24.58
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

BETAMETHASONE CRM 15GM DIP

Facility

$122.90

Hospital Charge Code	6000665
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

BETAMETHASONE CRM 15GM VAL

Facility

$34.60

Hospital Charge Code	6000632
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

BETAMETHASONE CRM 15GM VAL

Facility

$34.60

Hospital Charge Code	6000632
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

BETAMETHASONE CRM VAL 1% 45GM

Facility

$53.80

Hospital Charge Code	6007199
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

BETAMETHASONE CRM VAL 1% 45GM

Facility

$53.80

Hospital Charge Code	6007199
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

BETAMETHASONE DIP 0.05% OINT

Facility

$187.40

Service Code	NDC 168004015
Hospital Charge Code	6063943315
Hospital Revenue Code	250
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$28.11
Rate for Payer: Qualcare PPO/HMO/WC	$28.11

BETAMETHASONE DIP 0.05% OINT

Facility

$187.40

Service Code	NDC 168004015
Hospital Charge Code	6063943315
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$93.70
Rate for Payer: Aetna Commercial	$71.21
Rate for Payer: Aetna Medicare Advantage	$56.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$93.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.22
Rate for Payer: Oxford Commercial	$37.48
Rate for Payer: Qualcare PPO/HMO/WC	$28.11
Rate for Payer: UnitedHealthcare Commercial	$37.48
Rate for Payer: UnitedHealthcare Community & State	$4.52
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

BETAMETHASONE DIP 0.05%ONT 15G

Facility

$228.79

Hospital Charge Code	6063943372
Hospital Revenue Code	251
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$34.32
Rate for Payer: Qualcare PPO/HMO/WC	$34.32

Know your out-of-pocket cost for care.

All Charges