Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIEGO POWERED DISSECTOR BLADE

Facility

$567.45

Hospital Charge Code	270659523
Hospital Revenue Code	270
Min. Negotiated Rate	$85.12
Max. Negotiated Rate	$85.12
Rate for Payer: Qualcare PPO/HMO/WC	$85.12

DIEGO POWERED DISSECTOR BLADE

Facility

$567.45

Hospital Charge Code	270659523
Hospital Revenue Code	270
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$283.73
Rate for Payer: Aetna Commercial	$215.63
Rate for Payer: Aetna Medicare Advantage	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.70
Rate for Payer: Cigna Commercial	$283.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.24
Rate for Payer: Oxford Commercial	$113.49
Rate for Payer: Qualcare PPO/HMO/WC	$85.12
Rate for Payer: UnitedHealthcare Commercial	$113.49
Rate for Payer: UnitedHealthcare Community & State	$13.68
Rate for Payer: Wellpoint Medicaid Managed Care	$15.04

DIEGO PWR DISSECTOR BLADE 4.2M

Facility

$827.44

Hospital Charge Code	270652847
Hospital Revenue Code	272
Min. Negotiated Rate	$19.94
Max. Negotiated Rate	$413.72
Rate for Payer: Aetna Commercial	$314.43
Rate for Payer: Aetna Medicare Advantage	$248.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.00
Rate for Payer: Cigna Commercial	$413.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.23
Rate for Payer: Oxford Commercial	$165.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.12
Rate for Payer: UnitedHealthcare Commercial	$165.49
Rate for Payer: UnitedHealthcare Community & State	$19.94
Rate for Payer: Wellpoint Medicaid Managed Care	$21.93

DIEGO PWR DISSECTOR BLADE 4.2M

Facility

$827.44

Hospital Charge Code	270652847
Hospital Revenue Code	272
Min. Negotiated Rate	$124.12
Max. Negotiated Rate	$124.12
Rate for Payer: Qualcare PPO/HMO/WC	$124.12

DIETHYLSTILBESTROL 1MG

Facility

$3.00

Hospital Charge Code	60634367
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIETHYLSTILBESTROL 1MG

Facility

$3.00

Hospital Charge Code	60634367
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

DIETHYLSTILBESTROL 250MG

Facility

$259.00

Hospital Charge Code	60633920
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$129.50
Rate for Payer: Aetna Commercial	$98.42
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.70
Rate for Payer: Oxford Commercial	$51.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$51.80
Rate for Payer: UnitedHealthcare Community & State	$6.24
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

DIETHYLSTILBESTROL 250MG

Facility

$259.00

Hospital Charge Code	60633920
Hospital Revenue Code	250
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

DIETHYLSTILBSTRL 250MG/5ML

Facility

$113.30

Hospital Charge Code	6000335
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$43.05
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.99
Rate for Payer: Oxford Commercial	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.66
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

DIETHYLSTILBSTRL 250MG/5ML

Facility

$113.30

Hospital Charge Code	6000335
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

DIETHYLSTILBSTRL INJ 250MG/5ML

Facility

$112.00

Hospital Charge Code	60628215
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

DIETHYLSTILBSTRL INJ 250MG/5ML

Facility

$112.00

Hospital Charge Code	60628215
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$22.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$22.40
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

DIFF/AUTO ADS OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86978
Hospital Charge Code	3100182
Hospital Revenue Code	300
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$252.97
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
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	$124.00
Rate for Payer: UnitedHealthcare Community & State	$35.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DIFF/AUTO ADS OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86978
Hospital Charge Code	3100182
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIFFERENTIAL

Facility

$70.00

Service Code	HCPCS 85007
Hospital Charge Code	38473006
Hospital Revenue Code	305
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: Cigna Medicare Advantage	$3.80
Rate for Payer: Clover Medicare Advantage	$3.61
Rate for Payer: EmblemHealth Commercial	$11.40
Rate for Payer: Humana Medicare Advantage	$3.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.80
Rate for Payer: Wellcare Medicare Advantage	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

DIFFERENTIAL

Facility

$70.00

Service Code	HCPCS 85007
Hospital Charge Code	38473006
Hospital Revenue Code	305
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

DIFFERENTIAL, MANUAL

Facility

$390.00

Service Code	HCPCS 85007
Hospital Charge Code	3005428
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIFFERENTIAL, MANUAL

Facility

$390.00

Service Code	HCPCS 85007
Hospital Charge Code	3005428
Hospital Revenue Code	305
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.80
Rate for Payer: Clover Medicare Advantage	$3.61
Rate for Payer: EmblemHealth Commercial	$11.40
Rate for Payer: Humana Medicare Advantage	$3.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.80
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	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.80
Rate for Payer: Wellcare Medicare Advantage	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DIFFUSER MAESTRO

Facility

$62.10

Hospital Charge Code	270672675
Hospital Revenue Code	272
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

DIFFUSER MAESTRO

Facility

$62.10

Hospital Charge Code	270672675
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

DIFLORASONE 0.05% OINT

Facility

$341.65

Hospital Charge Code	60628378
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$170.82
Rate for Payer: Aetna Commercial	$129.83
Rate for Payer: Aetna Medicare Advantage	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.12
Rate for Payer: Cigna Commercial	$170.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.50
Rate for Payer: Oxford Commercial	$68.33
Rate for Payer: Qualcare PPO/HMO/WC	$51.25
Rate for Payer: UnitedHealthcare Commercial	$68.33
Rate for Payer: UnitedHealthcare Community & State	$8.23
Rate for Payer: Wellpoint Medicaid Managed Care	$9.05

DIFLORASONE 0.05% OINT

Facility

$341.65

Hospital Charge Code	60628378
Hospital Revenue Code	250
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$51.25
Rate for Payer: Qualcare PPO/HMO/WC	$51.25

DIFLORASONE OINT 0.05%

Facility

$379.25

Hospital Charge Code	60628379
Hospital Revenue Code	250
Min. Negotiated Rate	$56.89
Max. Negotiated Rate	$56.89
Rate for Payer: Qualcare PPO/HMO/WC	$56.89

DIFLORASONE OINT 0.05%

Facility

$379.25

Hospital Charge Code	60628379
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$189.62
Rate for Payer: Aetna Commercial	$144.12
Rate for Payer: Aetna Medicare Advantage	$113.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.71
Rate for Payer: Cigna Commercial	$189.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.78
Rate for Payer: Oxford Commercial	$75.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.89
Rate for Payer: UnitedHealthcare Commercial	$75.85
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

DIFLUCAN/100MG/TAB

Facility

$48.00

Hospital Charge Code	60632839
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

Know your out-of-pocket cost for care.

All Charges