Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIFLUCAN/100MG/TAB

Facility

$48.00

Hospital Charge Code	60632839
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIFLUCAN/200MG/NS 0.9%/20

Facility

$389.00

Hospital Charge Code	60632842
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.70
Rate for Payer: Oxford Commercial	$77.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$77.80
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

DIFLUCAN/200MG/NS 0.9%/20

Facility

$389.00

Hospital Charge Code	60632842
Hospital Revenue Code	250
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

DIFLUCAN/200MG/TAB

Facility

$80.00

Hospital Charge Code	60632840
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

DIFLUCAN/200MG/TAB

Facility

$80.00

Hospital Charge Code	60632840
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.20
Rate for Payer: Aetna Commercial	$30.55
Rate for Payer: Aetna Medicare Advantage	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.50
Rate for Payer: Cigna Commercial	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$19.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

DIFLUCAN PRENIRED/400MG

Facility

$645.00

Hospital Charge Code	60634707
Hospital Revenue Code	636
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$245.10
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$15.54
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

DIFLUCAN PRENIRED/400MG

Facility

$645.00

Hospital Charge Code	60634707
Hospital Revenue Code	636
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$156.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

DIFLUNISAL 500 MG TAB

Facility

$13.65

Hospital Charge Code	60628605
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

DIFLUNISAL 500 MG TAB

Facility

$13.65

Hospital Charge Code	60628605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

DIGESTIVE MALIGNANCY

Facility

$22,994.80

Service Code	APR-DRG 2404
Min. Negotiated Rate	$22,543.92
Max. Negotiated Rate	$22,994.80
Rate for Payer: UnitedHealthcare Community & State	$22,543.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,994.80
Rate for Payer: Wellpoint Medicaid Managed Care	$22,543.92

DIGESTIVE MALIGNANCY

Facility

$14,055.31

Service Code	APR-DRG 2403
Min. Negotiated Rate	$13,779.72
Max. Negotiated Rate	$14,055.31
Rate for Payer: UnitedHealthcare Community & State	$13,779.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,055.31
Rate for Payer: Wellpoint Medicaid Managed Care	$13,779.72

DIGESTIVE MALIGNANCY

Facility

$10,517.50

Service Code	APR-DRG 2402
Min. Negotiated Rate	$10,311.27
Max. Negotiated Rate	$10,517.50
Rate for Payer: UnitedHealthcare Community & State	$10,311.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,517.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10,311.27

DIGESTIVE MALIGNANCY

Facility

$8,777.42

Service Code	APR-DRG 2401
Min. Negotiated Rate	$8,605.31
Max. Negotiated Rate	$8,777.42
Rate for Payer: UnitedHealthcare Community & State	$8,605.31
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,777.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8,605.31

DIGESTIVE MALIGNANCY WITH CC

Facility

$41,230.36

Service Code	MSDRG 375
Min. Negotiated Rate	$12,554.12
Max. Negotiated Rate	$41,230.36
Rate for Payer: Aetna Commercial	$28,587.28
Rate for Payer: Aetna Medicare Advantage	$41,230.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,214.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,913.20
Rate for Payer: Cigna Commercial	$22,636.45
Rate for Payer: Cigna Medicare Advantage	$13,214.86
Rate for Payer: Clover Medicare Advantage	$12,554.12
Rate for Payer: EmblemHealth Commercial	$39,644.58
Rate for Payer: Humana Medicare Advantage	$13,611.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,214.86
Rate for Payer: Oxford Commercial	$16,269.12
Rate for Payer: UnitedHealthcare Commercial	$28,528.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,214.86
Rate for Payer: Wellcare Medicare Advantage	$13,214.86

DIGESTIVE MALIGNANCY WITH MCC

Facility

$71,260.39

Service Code	MSDRG 374
Min. Negotiated Rate	$21,697.88
Max. Negotiated Rate	$71,260.39
Rate for Payer: Aetna Commercial	$49,221.32
Rate for Payer: Aetna Medicare Advantage	$71,260.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,848.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,848.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,839.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,848.10
Rate for Payer: Cigna Commercial	$40,023.63
Rate for Payer: Cigna Medicare Advantage	$22,839.87
Rate for Payer: Clover Medicare Advantage	$21,697.88
Rate for Payer: EmblemHealth Commercial	$68,519.61
Rate for Payer: Humana Medicare Advantage	$23,525.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,839.87
Rate for Payer: Oxford Commercial	$28,765.51
Rate for Payer: UnitedHealthcare Commercial	$50,441.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,839.87
Rate for Payer: Wellcare Medicare Advantage	$22,839.87

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$32,009.02

Service Code	MSDRG 376
Min. Negotiated Rate	$9,746.33
Max. Negotiated Rate	$32,009.02
Rate for Payer: Aetna Commercial	$22,251.17
Rate for Payer: Aetna Medicare Advantage	$32,009.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,702.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,702.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,702.29
Rate for Payer: Cigna Commercial	$17,297.35
Rate for Payer: Cigna Medicare Advantage	$10,259.30
Rate for Payer: Clover Medicare Advantage	$9,746.33
Rate for Payer: EmblemHealth Commercial	$30,777.90
Rate for Payer: Humana Medicare Advantage	$10,567.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,259.30
Rate for Payer: Oxford Commercial	$12,431.83
Rate for Payer: UnitedHealthcare Commercial	$21,799.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,259.30
Rate for Payer: Wellcare Medicare Advantage	$10,259.30

DIGIBIND/40MG

Facility

$1,957.00

Hospital Charge Code	60632843
Hospital Revenue Code	636
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$978.50
Rate for Payer: Aetna Commercial	$743.66
Rate for Payer: Aetna Medicare Advantage	$587.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$499.04
Rate for Payer: Cigna Commercial	$978.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: Qualcare PPO/HMO/WC	$293.55
Rate for Payer: UnitedHealthcare Community & State	$47.16
Rate for Payer: Wellpoint Medicaid Managed Care	$51.86

DIGIBIND/40MG

Facility

$1,957.00

Hospital Charge Code	60632843
Hospital Revenue Code	636
Min. Negotiated Rate	$293.55
Max. Negotiated Rate	$473.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: Qualcare PPO/HMO/WC	$293.55

DIGIFAB 40MG VL

Facility

$2,646.00

Hospital Charge Code	60635568
Hospital Revenue Code	636
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$640.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.33
Rate for Payer: Qualcare PPO/HMO/WC	$396.90

DIGIFAB 40MG VL

Facility

$2,646.00

Hospital Charge Code	60635568
Hospital Revenue Code	636
Min. Negotiated Rate	$63.77
Max. Negotiated Rate	$1,323.00
Rate for Payer: Aetna Commercial	$1,005.48
Rate for Payer: Aetna Medicare Advantage	$793.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$674.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$674.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$674.73
Rate for Payer: Cigna Commercial	$1,323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.33
Rate for Payer: Qualcare PPO/HMO/WC	$396.90
Rate for Payer: UnitedHealthcare Community & State	$63.77
Rate for Payer: Wellpoint Medicaid Managed Care	$70.12

DIGITAL DIAG ADD VIEWS BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061455
Hospital Revenue Code	401
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$297.92
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.20
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.78

DIGITAL DIAG ADD VIEWS BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061455
Hospital Revenue Code	401
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

DIGITAL DIAG ADD VIEWS LT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061457
Hospital Revenue Code	401
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.70

Know your out-of-pocket cost for care.

All Charges