Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIMENHYDRINATE SOL 15MG/ML

Facility

$147.85

Hospital Charge Code	6001945
Hospital Revenue Code	251
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

DIMENHYDRINATE SOL 15MG/ML

Facility

$147.85

Hospital Charge Code	6001945
Hospital Revenue Code	251
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.35
Rate for Payer: Oxford Commercial	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$29.57
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

DIMERCAPROL INJ 100MG/ML

Facility

$497.50

Hospital Charge Code	60628176
Hospital Revenue Code	250
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$248.75
Rate for Payer: Aetna Commercial	$189.05
Rate for Payer: Aetna Medicare Advantage	$149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.86
Rate for Payer: Cigna Commercial	$248.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.25
Rate for Payer: Oxford Commercial	$99.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.62
Rate for Payer: UnitedHealthcare Commercial	$99.50
Rate for Payer: UnitedHealthcare Community & State	$11.99
Rate for Payer: Wellpoint Medicaid Managed Care	$13.18

DIMERCAPROL INJ 100MG/ML

Facility

$497.50

Hospital Charge Code	60628176
Hospital Revenue Code	250
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

DIMERCAPROL INJ 10% 3ML

Facility

$398.00

Hospital Charge Code	6001952
Hospital Revenue Code	250
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$199.00
Rate for Payer: Aetna Commercial	$151.24
Rate for Payer: Aetna Medicare Advantage	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.49
Rate for Payer: Cigna Commercial	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.40
Rate for Payer: Oxford Commercial	$79.60
Rate for Payer: Qualcare PPO/HMO/WC	$59.70
Rate for Payer: UnitedHealthcare Commercial	$79.60
Rate for Payer: UnitedHealthcare Community & State	$9.59
Rate for Payer: Wellpoint Medicaid Managed Care	$10.55

DIMERCAPROL INJ 10% 3ML

Facility

$398.00

Hospital Charge Code	6001952
Hospital Revenue Code	250
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$59.70
Rate for Payer: Qualcare PPO/HMO/WC	$59.70

DIMETANE-DX/480ML

Facility

$155.00

Hospital Charge Code	60632850
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

DIMETANE-DX/480ML

Facility

$155.00

Hospital Charge Code	60632850
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.50
Rate for Payer: Oxford Commercial	$31.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Commercial	$31.00
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

DIMETAPP/3840ML

Facility

$8.00

Hospital Charge Code	60632854
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

DIMETAPP/3840ML

Facility

$8.00

Hospital Charge Code	60632854
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

DIMETAPP/480ML

Facility

$72.00

Hospital Charge Code	60632852
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

DIMETAPP/480ML

Facility

$72.00

Hospital Charge Code	60632852
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

DIMETAPP/5ML

Facility

$6.00

Hospital Charge Code	60632853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DIMETAPP/5ML

Facility

$6.00

Hospital Charge Code	60632853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DIMETAPP EXTENTAB/TAB

Facility

$3.00

Hospital Charge Code	60632855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIMETAPP EXTENTAB/TAB

Facility

$3.00

Hospital Charge Code	60632855
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

DIMETAPP/TAB

Facility

$3.00

Hospital Charge Code	60632851
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

DIMETAPP/TAB

Facility

$3.00

Hospital Charge Code	60632851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIMRETIC PANEL, URINE

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3035115B
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

DIMRETIC PANEL, URINE

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3035115B
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

DIMRETIC PANEL, URINE

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3035115A
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

DIMRETIC PANEL, URINE

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3035115A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$59.34
Max. Negotiated Rate	$1,231.19
Rate for Payer: Aetna Commercial	$935.70
Rate for Payer: Aetna Medicare Advantage	$738.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$627.91
Rate for Payer: Cigna Commercial	$1,231.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$738.71
Rate for Payer: Oxford Commercial	$492.48
Rate for Payer: Qualcare PPO/HMO/WC	$369.36
Rate for Payer: UnitedHealthcare Commercial	$492.48
Rate for Payer: UnitedHealthcare Community & State	$59.34
Rate for Payer: Wellpoint Medicaid Managed Care	$65.25

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$369.36
Max. Negotiated Rate	$369.36
Rate for Payer: Qualcare PPO/HMO/WC	$369.36

DINOPROSTONE 20 MG SUP

Facility

$5,885.20

Hospital Charge Code	60628281
Hospital Revenue Code	250
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$2,942.60
Rate for Payer: Aetna Commercial	$2,236.38
Rate for Payer: Aetna Medicare Advantage	$1,765.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,500.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,500.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,500.73
Rate for Payer: Cigna Commercial	$2,942.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,765.56
Rate for Payer: Oxford Commercial	$1,177.04
Rate for Payer: Qualcare PPO/HMO/WC	$882.78
Rate for Payer: UnitedHealthcare Commercial	$1,177.04
Rate for Payer: UnitedHealthcare Community & State	$141.83
Rate for Payer: Wellpoint Medicaid Managed Care	$155.96

Know your out-of-pocket cost for care.

All Charges