Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIGOXIN 0.5MG

Facility

$10.90

Hospital Charge Code	6008130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

DIGOXIN 0.5MG

Facility

$10.90

Hospital Charge Code	6008130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$19.30

Service Code	NDC 59212024256
Hospital Charge Code	6023097
Hospital Revenue Code	251
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$14.40

Hospital Charge Code	6023097R
Hospital Revenue Code	251
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$5.47
Rate for Payer: Aetna Medicare Advantage	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.67
Rate for Payer: Cigna Commercial	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.16
Rate for Payer: UnitedHealthcare Commercial	$2.88
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$14.40

Hospital Charge Code	6023097R
Hospital Revenue Code	251
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.16

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$19.30

Service Code	NDC 59212024256
Hospital Charge Code	6023097
Hospital Revenue Code	251
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

DIGOXIN 250 MCG (0.25 MG) TAB

Facility

$19.30

Service Code	NDC 24987024956
Hospital Charge Code	6022404
Hospital Revenue Code	251
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

DIGOXIN 250 MCG (0.25 MG) TAB

Facility

$19.30

Service Code	NDC 24987024956
Hospital Charge Code	6022404
Hospital Revenue Code	251
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

DIGOXIN .25 MG/5 ML U/D LIQUID

Facility

$9.90

Hospital Charge Code	60629310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.95
Rate for Payer: Aetna Commercial	$3.76
Rate for Payer: Aetna Medicare Advantage	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.52
Rate for Payer: Cigna Commercial	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.97
Rate for Payer: Oxford Commercial	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$1.98
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

DIGOXIN .25 MG/5 ML U/D LIQUID

Facility

$9.90

Hospital Charge Code	60629310
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

DIGOXIN IMMUNE FAB 40 MG INJ

Facility

$18,258.84

Service Code	HCPCS J1162
Hospital Charge Code	60628285
Hospital Revenue Code	636
Min. Negotiated Rate	$2,738.83
Max. Negotiated Rate	$4,418.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,418.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,738.83

DIGOXIN IMMUNE FAB 40 MG INJ

Facility

$18,258.84

Service Code	HCPCS J1162
Hospital Charge Code	60628285
Hospital Revenue Code	636
Min. Negotiated Rate	$440.04
Max. Negotiated Rate	$18,651.28
Rate for Payer: Aetna Commercial	$14,054.21
Rate for Payer: Aetna Medicare Advantage	$16,741.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,651.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,651.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,477.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,651.28
Rate for Payer: Cigna Medicare Advantage	$5,166.99
Rate for Payer: Clover Medicare Advantage	$4,908.64
Rate for Payer: EmblemHealth Commercial	$15,500.97
Rate for Payer: Humana Medicare Advantage	$5,322.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,166.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,418.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,738.83
Rate for Payer: UnitedHealthcare Community & State	$440.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,166.99
Rate for Payer: Wellcare Medicare Advantage	$5,166.99
Rate for Payer: Wellpoint Medicaid Managed Care	$483.86

DIGOXIN IMMUNE FAB INJ 40MG

Facility

$3,300.50

Hospital Charge Code	6001929
Hospital Revenue Code	636
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$1,650.25
Rate for Payer: Aetna Commercial	$1,254.19
Rate for Payer: Aetna Medicare Advantage	$990.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.63
Rate for Payer: Cigna Commercial	$1,650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.72
Rate for Payer: Qualcare PPO/HMO/WC	$495.07
Rate for Payer: UnitedHealthcare Community & State	$79.54
Rate for Payer: Wellpoint Medicaid Managed Care	$87.46

DIGOXIN IMMUNE FAB INJ 40MG

Facility

$3,300.50

Hospital Charge Code	6001929
Hospital Revenue Code	636
Min. Negotiated Rate	$495.07
Max. Negotiated Rate	$798.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.72
Rate for Payer: Qualcare PPO/HMO/WC	$495.07

DIGOXIN INJ 0.5MG/2ML

Facility

$34.71

Service Code	HCPCS J1160
Hospital Charge Code	60627552
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.36
Rate for Payer: Aetna Commercial	$13.19
Rate for Payer: Aetna Medicare Advantage	$10.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.85
Rate for Payer: Cigna Commercial	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

DIGOXIN INJ 0.5MG/2ML

Facility

$34.71

Service Code	HCPCS J1160
Hospital Charge Code	60627552
Hospital Revenue Code	636
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$8.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

DIGOXIN LEVEL

Facility

$667.59

Service Code	HCPCS 80162
Hospital Charge Code	3001096
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

DIGOXIN LEVEL

Facility

$667.59

Service Code	HCPCS 80162
Hospital Charge Code	3001096
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.12
Rate for Payer: Aetna Medicare Advantage	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.28
Rate for Payer: Clover Medicare Advantage	$12.62
Rate for Payer: EmblemHealth Commercial	$39.84
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.28
Rate for Payer: Wellcare Medicare Advantage	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

DIGOXIN LIQ .05MG/ML 60CC

Facility

$27.25

Hospital Charge Code	6001911
Hospital Revenue Code	251
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

DIGOXIN LIQ .05MG/ML 60CC

Facility

$27.25

Hospital Charge Code	6001911
Hospital Revenue Code	251
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

DIHYDROERGOTAMINE 1 MG/ML INJ

Facility

$661.05

Hospital Charge Code	60627474
Hospital Revenue Code	636
Min. Negotiated Rate	$99.16
Max. Negotiated Rate	$159.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.97
Rate for Payer: Qualcare PPO/HMO/WC	$99.16

DIHYDROERGOTAMINE 1 MG/ML INJ

Facility

$661.05

Hospital Charge Code	60627474
Hospital Revenue Code	636
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.52
Rate for Payer: Aetna Commercial	$251.20
Rate for Payer: Aetna Medicare Advantage	$198.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.57
Rate for Payer: Cigna Commercial	$330.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.97
Rate for Payer: Qualcare PPO/HMO/WC	$99.16
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.52

DIHYDROERGOTAMINE INJ 1MG/1ML

Facility

$117.00

Hospital Charge Code	6001937
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$23.40
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

DIHYDROERGOTAMINE INJ 1MG/1ML

Facility

$117.00

Hospital Charge Code	6001937
Hospital Revenue Code	250
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

DIHYDROTERTOSTERONE 1-2

Facility

$179.00

Service Code	HCPCS 80327
Hospital Charge Code	3000602
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

Know your out-of-pocket cost for care.

All Charges