Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DECALCIFICATION

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	38474058
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005221
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005220
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005220
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005221
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECAL STAT 1212A

Facility

$1,276.85

Hospital Charge Code	270602210
Hospital Revenue Code	272
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

DECAL STAT 1212A

Facility

$1,276.85

Hospital Charge Code	270602210
Hospital Revenue Code	272
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

DECASPRAY/25GM

Facility

$75.00

Hospital Charge Code	60634216
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

DECASPRAY/25GM

Facility

$75.00

Hospital Charge Code	60634216
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DECELL PLACENTAL MEMBRANE 5X5C

Facility

$6,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704474
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

DECELL PLACENTAL MEMBRANE 5X5C

Facility

$6,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704474
Hospital Revenue Code	278
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$2,451.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,419.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50
Rate for Payer: UnitedHealthcare Community & State	$155.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.93

DECITABINE 50MG INJ

Facility

$13,756.44

Service Code	HCPCS J0894
Hospital Charge Code	6063943093
Hospital Revenue Code	636
Min. Negotiated Rate	$331.53
Max. Negotiated Rate	$6,878.22
Rate for Payer: Aetna Commercial	$5,227.45
Rate for Payer: Aetna Medicare Advantage	$4,126.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,507.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,507.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,507.89
Rate for Payer: Cigna Commercial	$6,878.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.47
Rate for Payer: UnitedHealthcare Community & State	$331.53
Rate for Payer: Wellpoint Medicaid Managed Care	$364.55

DECITABINE 50MG INJ

Facility

$13,756.44

Service Code	HCPCS J0894
Hospital Charge Code	6063943093
Hospital Revenue Code	636
Min. Negotiated Rate	$2,063.47
Max. Negotiated Rate	$3,329.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.47

DECITABINE 50 MG REC

Facility

$8,874.00

Hospital Charge Code	60629939
Hospital Revenue Code	636
Min. Negotiated Rate	$1,331.10
Max. Negotiated Rate	$2,147.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.10

DECITABINE 50 MG REC

Facility

$8,874.00

Hospital Charge Code	60629939
Hospital Revenue Code	636
Min. Negotiated Rate	$213.86
Max. Negotiated Rate	$4,437.00
Rate for Payer: Aetna Commercial	$3,372.12
Rate for Payer: Aetna Medicare Advantage	$2,662.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,262.87
Rate for Payer: Cigna Commercial	$4,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.10
Rate for Payer: UnitedHealthcare Community & State	$213.86
Rate for Payer: Wellpoint Medicaid Managed Care	$235.16

DECITABINE PER 1 MG INJ 50MG

Facility

$11,862.16

Hospital Charge Code	6063943015
Hospital Revenue Code	636
Min. Negotiated Rate	$1,779.32
Max. Negotiated Rate	$2,870.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,779.32

DECITABINE PER 1 MG INJ 50MG

Facility

$11,862.16

Hospital Charge Code	6063943015
Hospital Revenue Code	636
Min. Negotiated Rate	$285.88
Max. Negotiated Rate	$5,931.08
Rate for Payer: Aetna Commercial	$4,507.62
Rate for Payer: Aetna Medicare Advantage	$3,558.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,024.85
Rate for Payer: Cigna Commercial	$5,931.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,779.32
Rate for Payer: UnitedHealthcare Community & State	$285.88
Rate for Payer: Wellpoint Medicaid Managed Care	$314.35

DECLOMYCIN/150MG/CAP

Facility

$18.00

Hospital Charge Code	60632785
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DECLOMYCIN/150MG/CAP

Facility

$18.00

Hospital Charge Code	60632785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DECLOMYCIN/300MG/TAB

Facility

$114.37

Service Code	NDC 65162055548
Hospital Charge Code	60634319
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$17.16
Rate for Payer: Qualcare PPO/HMO/WC	$17.16

DECLOMYCIN/300MG/TAB

Facility

$114.37

Service Code	NDC 65162055548
Hospital Charge Code	60634319
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$57.19
Rate for Payer: Aetna Commercial	$43.46
Rate for Payer: Aetna Medicare Advantage	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.16
Rate for Payer: Cigna Commercial	$57.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.31
Rate for Payer: Oxford Commercial	$22.87
Rate for Payer: Qualcare PPO/HMO/WC	$17.16
Rate for Payer: UnitedHealthcare Commercial	$22.87
Rate for Payer: UnitedHealthcare Community & State	$2.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.03

DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	3400080
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

DECLOT VASCULAR DEVICE

Facility

$1,814.20

Service Code	HCPCS 36593
Hospital Charge Code	350036593
Hospital Revenue Code	361
Min. Negotiated Rate	$272.13
Max. Negotiated Rate	$272.13
Rate for Payer: Qualcare PPO/HMO/WC	$272.13

DECLOT VASCULAR DEVICE

Facility

$1,814.20

Service Code	HCPCS 36593
Hospital Charge Code	350036593
Hospital Revenue Code	361
Min. Negotiated Rate	$43.72
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$392.41
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.26
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$272.13
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$43.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$48.08

DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	3400080
Hospital Revenue Code	361
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$392.41
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$29.52

Know your out-of-pocket cost for care.

All Charges