Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704582
Hospital Revenue Code	278
Min. Negotiated Rate	$64.66
Max. Negotiated Rate	$1,341.58
Rate for Payer: Aetna Commercial	$1,019.60
Rate for Payer: Aetna Medicare Advantage	$804.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.20
Rate for Payer: Cigna Commercial	$1,341.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.29
Rate for Payer: Qualcare PPO/HMO/WC	$402.47
Rate for Payer: UnitedHealthcare Community & State	$64.66
Rate for Payer: Wellpoint Medicaid Managed Care	$71.10

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704582
Hospital Revenue Code	278
Min. Negotiated Rate	$402.47
Max. Negotiated Rate	$649.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.29
Rate for Payer: Qualcare PPO/HMO/WC	$402.47

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704583
Hospital Revenue Code	278
Min. Negotiated Rate	$64.66
Max. Negotiated Rate	$1,341.58
Rate for Payer: Aetna Commercial	$1,019.60
Rate for Payer: Aetna Medicare Advantage	$804.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.20
Rate for Payer: Cigna Commercial	$1,341.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.29
Rate for Payer: Qualcare PPO/HMO/WC	$402.47
Rate for Payer: UnitedHealthcare Community & State	$64.66
Rate for Payer: Wellpoint Medicaid Managed Care	$71.10

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704583
Hospital Revenue Code	278
Min. Negotiated Rate	$402.47
Max. Negotiated Rate	$649.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.29
Rate for Payer: Qualcare PPO/HMO/WC	$402.47

DARTFIRE EDGE INSTRUMENT PACK

Facility

$8,224.55

Service Code	HCPCS C1713
Hospital Charge Code	270699041
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.68
Max. Negotiated Rate	$1,990.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,809.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.68

DARTFIRE EDGE INSTRUMENT PACK

Facility

$8,224.55

Service Code	HCPCS C1713
Hospital Charge Code	270699041
Hospital Revenue Code	278
Min. Negotiated Rate	$198.21
Max. Negotiated Rate	$4,112.27
Rate for Payer: Aetna Commercial	$3,125.33
Rate for Payer: Aetna Medicare Advantage	$2,467.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.26
Rate for Payer: Cigna Commercial	$4,112.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,809.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.68
Rate for Payer: UnitedHealthcare Community & State	$198.21
Rate for Payer: Wellpoint Medicaid Managed Care	$217.95

DARTFIRE EDGE SCRDVR S 2-2.7MM

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	270702547
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.70
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

DARTFIRE EDGE SCRDVR S 2-2.7MM

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	270702547
Hospital Revenue Code	278
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$44.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.70
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

DART SNP-OFF 2X13MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270704250
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

DART SNP-OFF 2X13MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270704250
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

DARUNAVIR 600MG TAB

Facility

$168.57

Service Code	NDC 59676056201
Hospital Charge Code	60632210
Hospital Revenue Code	250
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$84.28
Rate for Payer: Aetna Commercial	$64.06
Rate for Payer: Aetna Medicare Advantage	$50.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.99
Rate for Payer: Cigna Commercial	$84.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.57
Rate for Payer: Oxford Commercial	$33.71
Rate for Payer: Qualcare PPO/HMO/WC	$25.29
Rate for Payer: UnitedHealthcare Commercial	$33.71
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

DARUNAVIR 600MG TAB

Facility

$168.57

Service Code	NDC 59676056201
Hospital Charge Code	60632210
Hospital Revenue Code	250
Min. Negotiated Rate	$25.29
Max. Negotiated Rate	$25.29
Rate for Payer: Qualcare PPO/HMO/WC	$25.29

DARUNAVIR ETHANOLATE 800 MG TA

Facility

$510.34

Service Code	NDC 54569636600
Hospital Charge Code	6063943192
Hospital Revenue Code	250
Min. Negotiated Rate	$76.55
Max. Negotiated Rate	$76.55
Rate for Payer: Qualcare PPO/HMO/WC	$76.55

DARUNAVIR ETHANOLATE 800 MG TA

Facility

$510.34

Service Code	NDC 54569636600
Hospital Charge Code	6063943192
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$255.17
Rate for Payer: Aetna Commercial	$193.93
Rate for Payer: Aetna Medicare Advantage	$153.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.14
Rate for Payer: Cigna Commercial	$255.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.10
Rate for Payer: Oxford Commercial	$102.07
Rate for Payer: Qualcare PPO/HMO/WC	$76.55
Rate for Payer: UnitedHealthcare Commercial	$102.07
Rate for Payer: UnitedHealthcare Community & State	$12.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

DARVOCET-N 100/TAB

Facility

$4.00

Hospital Charge Code	60632776
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

DARVOCET-N 100/TAB

Facility

$4.00

Hospital Charge Code	60632776
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DARVOCET-N 100/TAB

Facility

$3.00

Hospital Charge Code	60632777
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

DARVOCET-N 100/TAB

Facility

$3.00

Hospital Charge Code	60632777
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DARVON/65MG/CAP

Facility

$3.00

Hospital Charge Code	60632778
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

DARVON/65MG/CAP

Facility

$3.00

Hospital Charge Code	60632778
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DAUNORUBICIN 20 MG/4 ML INJ

Facility

$1,806.00

Hospital Charge Code	60635129
Hospital Revenue Code	636
Min. Negotiated Rate	$43.52
Max. Negotiated Rate	$903.00
Rate for Payer: Aetna Commercial	$686.28
Rate for Payer: Aetna Medicare Advantage	$541.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$460.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$460.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$460.53
Rate for Payer: Cigna Commercial	$903.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.05
Rate for Payer: Qualcare PPO/HMO/WC	$270.90
Rate for Payer: UnitedHealthcare Community & State	$43.52
Rate for Payer: Wellpoint Medicaid Managed Care	$47.86

DAUNORUBICIN 20 MG/4 ML INJ

Facility

$1,806.00

Hospital Charge Code	60635129
Hospital Revenue Code	636
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$437.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.05
Rate for Payer: Qualcare PPO/HMO/WC	$270.90

DAUNORUBICIN HCL INJ 20MG VIAL

Facility

$1,204.50

Hospital Charge Code	6001622
Hospital Revenue Code	636
Min. Negotiated Rate	$29.03
Max. Negotiated Rate	$602.25
Rate for Payer: Aetna Commercial	$457.71
Rate for Payer: Aetna Medicare Advantage	$361.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.15
Rate for Payer: Cigna Commercial	$602.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.49
Rate for Payer: Qualcare PPO/HMO/WC	$180.68
Rate for Payer: UnitedHealthcare Community & State	$29.03
Rate for Payer: Wellpoint Medicaid Managed Care	$31.92

DAUNORUBICIN HCL INJ 20MG VIAL

Facility

$1,204.50

Hospital Charge Code	6001622
Hospital Revenue Code	636
Min. Negotiated Rate	$180.68
Max. Negotiated Rate	$291.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.49
Rate for Payer: Qualcare PPO/HMO/WC	$180.68

Know your out-of-pocket cost for care.

All Charges