Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEMADEX 5 MG U/D TAB

Facility

$3.00

Hospital Charge Code	60635307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEMADEX 5 MG U/D TAB

Facility

$3.00

Hospital Charge Code	60635307
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

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna Medicare Advantage	$21.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.16
Rate for Payer: Cigna Commercial	$35.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.37
Rate for Payer: Oxford Commercial	$14.24
Rate for Payer: Qualcare PPO/HMO/WC	$10.68
Rate for Payer: UnitedHealthcare Commercial	$14.24
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$10.68
Rate for Payer: Qualcare PPO/HMO/WC	$10.68

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

DEMEROL 25MGINJ CARPUJECT

Facility

$7.00

Hospital Charge Code	60635304
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DEMEROL 25MGINJ CARPUJECT

Facility

$7.00

Hospital Charge Code	60635304
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

DEMEROL/75MG/1ML

Facility

$42.00

Hospital Charge Code	60632793
Hospital Revenue Code	636
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

DEMEROL/75MG/1ML

Facility

$42.00

Hospital Charge Code	60632793
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$10.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

DEMEROL BLISTER PACK HOSP

Facility

$4.00

Hospital Charge Code	60632795
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

DEMEROL BLISTER PACK HOSP

Facility

$4.00

Hospital Charge Code	60632795
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEMEROL SYR 50MG/ML P-F

Facility

$122.25

Hospital Charge Code	6008031
Hospital Revenue Code	250
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

DEMEROL SYR 50MG/ML P-F

Facility

$122.25

Hospital Charge Code	6008031
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

DEMINERALISED BONE MATRIX 10cc

Facility

$7,725.00

Hospital Charge Code	270645739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

DEMINERALISED BONE MATRIX 10cc

Facility

$7,725.00

Hospital Charge Code	270645739
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

DEMINERALISED BONE MATRIX 5cc

Facility

$5,050.00

Hospital Charge Code	270645738
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$1,222.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.00
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

DEMINERALISED BONE MATRIX 5cc

Facility

$5,050.00

Hospital Charge Code	270645738
Hospital Revenue Code	278
Min. Negotiated Rate	$121.70
Max. Negotiated Rate	$2,525.00
Rate for Payer: Aetna Commercial	$1,919.00
Rate for Payer: Aetna Medicare Advantage	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.75
Rate for Payer: Cigna Commercial	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.00
Rate for Payer: Qualcare PPO/HMO/WC	$757.50
Rate for Payer: UnitedHealthcare Community & State	$121.70
Rate for Payer: Wellpoint Medicaid Managed Care	$133.82

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.99
Max. Negotiated Rate	$3,329.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,027.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$331.61
Max. Negotiated Rate	$6,879.98
Rate for Payer: Aetna Commercial	$5,228.78
Rate for Payer: Aetna Medicare Advantage	$4,127.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,508.79
Rate for Payer: Cigna Commercial	$6,879.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,027.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99
Rate for Payer: UnitedHealthcare Community & State	$331.61
Rate for Payer: Wellpoint Medicaid Managed Care	$364.64

DEMIREGOTAN/TAB

Facility

$3.00

Hospital Charge Code	60634365
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

DEMIREGOTAN/TAB

Facility

$3.00

Hospital Charge Code	60634365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEMI-REGROTON

Facility

$3.00

Hospital Charge Code	60634465
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges