Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DAKIN'S TOPICAL 0.5% SOL

Facility

$115.58

Service Code	NDC 436094616
Hospital Charge Code	60629896
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Qualcare PPO/HMO/WC	$17.34

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$1,796.94
Max. Negotiated Rate	$2,899.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$2,899.06
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.15
Rate for Payer: Cigna Medicare Advantage	$15.00
Rate for Payer: Clover Medicare Advantage	$14.25
Rate for Payer: EmblemHealth Commercial	$45.00
Rate for Payer: Humana Medicare Advantage	$15.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94
Rate for Payer: UnitedHealthcare Community & State	$288.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.00
Rate for Payer: Wellcare Medicare Advantage	$15.00
Rate for Payer: Wellpoint Medicaid Managed Care	$317.46

DALIRESP 500MCG

Facility

$828.00

Hospital Charge Code	60635808
Hospital Revenue Code	250
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna Commercial	$314.64
Rate for Payer: Aetna Medicare Advantage	$248.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.14
Rate for Payer: Cigna Commercial	$414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.40
Rate for Payer: Oxford Commercial	$165.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.20
Rate for Payer: UnitedHealthcare Commercial	$165.60
Rate for Payer: UnitedHealthcare Community & State	$19.95
Rate for Payer: Wellpoint Medicaid Managed Care	$21.94

DALIRESP 500MCG

Facility

$828.00

Hospital Charge Code	60635808
Hospital Revenue Code	250
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$124.20
Rate for Payer: Qualcare PPO/HMO/WC	$124.20

DALTEPARIN INJ 10,000U/1 ML

Facility

$405.00

Hospital Charge Code	60628985
Hospital Revenue Code	250
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

DALTEPARIN INJ 10,000U/1 ML

Facility

$405.00

Hospital Charge Code	60628985
Hospital Revenue Code	250
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

DALTEPARIN INJ 10000U/1ML

Facility

$201.00

Hospital Charge Code	60629253
Hospital Revenue Code	250
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$76.38
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.30
Rate for Payer: Oxford Commercial	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$40.20
Rate for Payer: UnitedHealthcare Community & State	$4.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.33

DALTEPARIN INJ 10000U/1ML

Facility

$201.00

Hospital Charge Code	60629253
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

DALTEPARIN INJ 2500U/0.2ML

Facility

$1,070.00

Hospital Charge Code	60629158
Hospital Revenue Code	250
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.00
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

DALTEPARIN INJ 2500U/0.2ML

Facility

$1,070.00

Hospital Charge Code	60629158
Hospital Revenue Code	250
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

DALTEPARIN INJ 5,000U/0.2 ML

Facility

$202.50

Hospital Charge Code	60628984
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare Advantage	$60.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.64
Rate for Payer: Cigna Commercial	$101.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.75
Rate for Payer: Oxford Commercial	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$30.38
Rate for Payer: UnitedHealthcare Commercial	$40.50
Rate for Payer: UnitedHealthcare Community & State	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

DALTEPARIN INJ 5,000U/0.2 ML

Facility

$202.50

Hospital Charge Code	60628984
Hospital Revenue Code	250
Min. Negotiated Rate	$30.38
Max. Negotiated Rate	$30.38
Rate for Payer: Qualcare PPO/HMO/WC	$30.38

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.94
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$7.29
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DANOCRINE

Facility

$13.00

Hospital Charge Code	60634473
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DANOCRINE

Facility

$13.00

Hospital Charge Code	60634473
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.57
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

DANTRIUM IV

Facility

$324.00

Hospital Charge Code	60635122
Hospital Revenue Code	250
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$64.80
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

DANTRIUM IV

Facility

$324.00

Hospital Charge Code	60635122
Hospital Revenue Code	250
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$106.90
Max. Negotiated Rate	$106.90
Rate for Payer: Qualcare PPO/HMO/WC	$106.90

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$356.34
Rate for Payer: Aetna Commercial	$270.82
Rate for Payer: Aetna Medicare Advantage	$213.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.73
Rate for Payer: Cigna Commercial	$356.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.80
Rate for Payer: Oxford Commercial	$142.54
Rate for Payer: Qualcare PPO/HMO/WC	$106.90
Rate for Payer: UnitedHealthcare Commercial	$142.54
Rate for Payer: UnitedHealthcare Community & State	$17.18
Rate for Payer: Wellpoint Medicaid Managed Care	$18.89

Know your out-of-pocket cost for care.

All Charges