Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DANTROLENE 25 MG CAP

Facility

$10.45

Hospital Charge Code	60627484
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

DANTROLENE 25 MG CAP

Facility

$10.45

Hospital Charge Code	60627484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

DANTROLENE SOD INJ 20MG

Facility

$449.95

Hospital Charge Code	6001614
Hospital Revenue Code	250
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$67.49
Rate for Payer: Qualcare PPO/HMO/WC	$67.49

DANTROLENE SOD INJ 20MG

Facility

$449.95

Hospital Charge Code	6001614
Hospital Revenue Code	250
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$224.97
Rate for Payer: Aetna Commercial	$170.98
Rate for Payer: Aetna Medicare Advantage	$134.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.74
Rate for Payer: Cigna Commercial	$224.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.99
Rate for Payer: Oxford Commercial	$89.99
Rate for Payer: Qualcare PPO/HMO/WC	$67.49
Rate for Payer: UnitedHealthcare Commercial	$89.99
Rate for Payer: UnitedHealthcare Community & State	$10.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.92

DAPAGLIFLOZIN 10MG TABLET

Facility

$95.14

Service Code	NDC 310621030
Hospital Charge Code	606390425
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$14.27

DAPAGLIFLOZIN 10MG TABLET

Facility

$95.14

Service Code	NDC 310621030
Hospital Charge Code	606390425
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.57
Rate for Payer: Aetna Commercial	$36.15
Rate for Payer: Aetna Medicare Advantage	$28.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.26
Rate for Payer: Cigna Commercial	$47.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.54
Rate for Payer: Oxford Commercial	$19.03
Rate for Payer: Qualcare PPO/HMO/WC	$14.27
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

DAPAGLIFLOZIN 5MG TABLET

Facility

$95.14

Service Code	NDC 310620530
Hospital Charge Code	606390424
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.57
Rate for Payer: Aetna Commercial	$36.15
Rate for Payer: Aetna Medicare Advantage	$28.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.26
Rate for Payer: Cigna Commercial	$47.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.54
Rate for Payer: Oxford Commercial	$19.03
Rate for Payer: Qualcare PPO/HMO/WC	$14.27
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

DAPAGLIFLOZIN 5MG TABLET

Facility

$95.14

Service Code	NDC 310620530
Hospital Charge Code	606390424
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$14.27

DAPSONE

Facility

$3.00

Hospital Charge Code	60635107
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

DAPSONE

Facility

$3.00

Hospital Charge Code	60635107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DAPSONE 100 MG TAB

Facility

$22.51

Service Code	NDC 49938010130
Hospital Charge Code	60628600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.26
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DAPSONE 100 MG TAB

Facility

$22.51

Service Code	NDC 49938010130
Hospital Charge Code	60628600
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DAPSONE,25MG,TAB

Facility

$18.36

Service Code	NDC 49938010230
Hospital Charge Code	60635435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$6.98
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.51
Rate for Payer: Oxford Commercial	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$3.67
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

DAPSONE,25MG,TAB

Facility

$18.36

Service Code	NDC 49938010230
Hospital Charge Code	60635435
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

DAPTOMYCIN 500MG INJ (CUBICIN)

Facility

$3,048.77

Service Code	HCPCS J0878
Hospital Charge Code	60629365
Hospital Revenue Code	636
Min. Negotiated Rate	$73.48
Max. Negotiated Rate	$1,524.38
Rate for Payer: Aetna Commercial	$1,158.53
Rate for Payer: Aetna Medicare Advantage	$914.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.44
Rate for Payer: Cigna Commercial	$1,524.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.80
Rate for Payer: Qualcare PPO/HMO/WC	$457.32
Rate for Payer: UnitedHealthcare Community & State	$73.48
Rate for Payer: Wellpoint Medicaid Managed Care	$80.79

DAPTOMYCIN 500MG INJ (CUBICIN)

Facility

$3,048.77

Service Code	HCPCS J0878
Hospital Charge Code	60629365
Hospital Revenue Code	636
Min. Negotiated Rate	$457.32
Max. Negotiated Rate	$737.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.80
Rate for Payer: Qualcare PPO/HMO/WC	$457.32

DARAPRIM

Facility

$109.01

Service Code	NDC 69413033010
Hospital Charge Code	60634464
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

DARAPRIM

Facility

$109.01

Service Code	NDC 69413033010
Hospital Charge Code	60634464
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.51
Rate for Payer: Aetna Commercial	$41.42
Rate for Payer: Aetna Medicare Advantage	$32.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.80
Rate for Payer: Cigna Commercial	$54.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.70
Rate for Payer: Oxford Commercial	$21.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$21.80
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

DARBEPOETIN ALF 1MCG INJ RENAL

Facility

$46.90

Hospital Charge Code	60629839
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.45
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$14.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.96
Rate for Payer: Cigna Commercial	$23.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.04
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

DARBEPOETIN ALF 1MCG INJ RENAL

Facility

$46.90

Hospital Charge Code	60629839
Hospital Revenue Code	636
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$11.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.04

DARFENACIN 15MG TAB

Facility

$65.12

Service Code	NDC 430017115
Hospital Charge Code	6063943091
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.54
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

DARFENACIN 15MG TAB

Facility

$65.12

Service Code	NDC 430017115
Hospital Charge Code	6063943091
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

DARFENACIN 7.5MG TAB

Facility

$65.12

Service Code	NDC 430017015
Hospital Charge Code	6063943092
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

DARFENACIN 7.5MG TAB

Facility

$65.12

Service Code	NDC 430017015
Hospital Charge Code	6063943092
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.54
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

DART ATX CHONDRAL 18 AR4005B18

Facility

$865.00

Hospital Charge Code	270627255
Hospital Revenue Code	272
Min. Negotiated Rate	$129.75
Max. Negotiated Rate	$129.75
Rate for Payer: Qualcare PPO/HMO/WC	$129.75

Know your out-of-pocket cost for care.

All Charges