Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIAMOX SEQ 500

Facility

$4.00

Hospital Charge Code	60634751
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIANEAL 1.50-2000*****

Facility

$23.00

Hospital Charge Code	7000359
Hospital Revenue Code	258
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

DIANEAL 1.50-2000*****

Facility

$23.00

Hospital Charge Code	7000359
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DIANEAL 4.25D-2000*****

Facility

$20.00

Hospital Charge Code	7000367
Hospital Revenue Code	258
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

DIANEAL 4.25D-2000*****

Facility

$20.00

Hospital Charge Code	7000367
Hospital Revenue Code	258
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

DIANEAL PD2 4.25% SOL

Facility

$296.94

Service Code	NDC 941042952
Hospital Charge Code	606390441
Hospital Revenue Code	270
Min. Negotiated Rate	$44.54
Max. Negotiated Rate	$44.54
Rate for Payer: Qualcare PPO/HMO/WC	$44.54

DIANEAL PD2 4.25% SOL

Facility

$296.94

Service Code	NDC 941042952
Hospital Charge Code	606390441
Hospital Revenue Code	270
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$148.47
Rate for Payer: Aetna Commercial	$112.84
Rate for Payer: Aetna Medicare Advantage	$89.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.72
Rate for Payer: Cigna Commercial	$148.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.08
Rate for Payer: Oxford Commercial	$59.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.54
Rate for Payer: UnitedHealthcare Commercial	$59.39
Rate for Payer: UnitedHealthcare Community & State	$7.16
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

DIAPER BRIEF ADULT XL

Facility

$29.76

Hospital Charge Code	270649678
Hospital Revenue Code	270
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$4.46
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

DIAPER BRIEF ADULT XL

Facility

$29.76

Hospital Charge Code	270649678
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.88
Rate for Payer: Aetna Commercial	$11.31
Rate for Payer: Aetna Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.59
Rate for Payer: Cigna Commercial	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Oxford Commercial	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.46
Rate for Payer: UnitedHealthcare Commercial	$5.95
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DIAPER PAMPERS SZ-6

Facility

$1.10

Hospital Charge Code	270633895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna Commercial	$0.42
Rate for Payer: Aetna Medicare Advantage	$0.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.28
Rate for Payer: Cigna Commercial	$0.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.33
Rate for Payer: Oxford Commercial	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.17
Rate for Payer: UnitedHealthcare Commercial	$0.22
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

DIAPER PAMPERS SZ-6

Facility

$1.10

Hospital Charge Code	270633895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.17

DIAPERS ADULT

Facility

$16.35

Hospital Charge Code	270300850
Hospital Revenue Code	270
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.45

DIAPERS ADULT

Facility

$16.35

Hospital Charge Code	270300850
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna Commercial	$6.21
Rate for Payer: Aetna Medicare Advantage	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.17
Rate for Payer: Cigna Commercial	$8.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.45
Rate for Payer: UnitedHealthcare Commercial	$3.27
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

DIAPERS ADULT PKG*****

Facility

$10.00

Hospital Charge Code	8001257
Hospital Revenue Code	279
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DIAPERS ADULT PKG*****

Facility

$10.00

Hospital Charge Code	8001257
Hospital Revenue Code	279
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

DIAPERS HUGGIES NEWBORN

Facility

$4.85

Hospital Charge Code	270130135
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DIAPERS HUGGIES NEWBORN

Facility

$4.85

Hospital Charge Code	270130135
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DIAPERS HUGGIES TODDLER

Facility

$4.00

Hospital Charge Code	270301335
Hospital Revenue Code	270
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

DIAPERS HUGGIES TODDLER

Facility

$4.00

Hospital Charge Code	270301335
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIAPERS PHASES NEWBORN

Facility

$0.32

Hospital Charge Code	270649470
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: Aetna Medicare Advantage	$0.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.08
Rate for Payer: Cigna Commercial	$0.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.10
Rate for Payer: Oxford Commercial	$0.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.06
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

DIAPERS PHASES NEWBORN

Facility

$0.32

Hospital Charge Code	270649470
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

DIAPHYSIS SH HUMER CEMENTLS 12

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

DIAPHYSIS SH HUMER CEMENTLS 12

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699210
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

DIATRIZOATE MEG 50ML

Facility

$105.00

Hospital Charge Code	6012454
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

DIATRIZOATE MEG 50ML

Facility

$105.00

Hospital Charge Code	6012454
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

Know your out-of-pocket cost for care.

All Charges