Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIPHTHER ANTITOX INJ 20,000U

Facility

$1,196.20

Hospital Charge Code	6001994
Hospital Revenue Code	250
Min. Negotiated Rate	$179.43
Max. Negotiated Rate	$179.43
Rate for Payer: Qualcare PPO/HMO/WC	$179.43

DIPHTHER ANTITOX INJ 20,000U

Facility

$1,196.20

Hospital Charge Code	6001994
Hospital Revenue Code	250
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$598.10
Rate for Payer: Aetna Commercial	$454.56
Rate for Payer: Aetna Medicare Advantage	$358.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$305.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$305.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$305.03
Rate for Payer: Cigna Commercial	$598.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.86
Rate for Payer: Oxford Commercial	$239.24
Rate for Payer: Qualcare PPO/HMO/WC	$179.43
Rate for Payer: UnitedHealthcare Commercial	$239.24
Rate for Payer: UnitedHealthcare Community & State	$28.83
Rate for Payer: Wellpoint Medicaid Managed Care	$31.70

DIPHTHERIA ANTITOXOID***

Facility

$152.00

Hospital Charge Code	3010493
Hospital Revenue Code	306
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

DIPHTHERIA ANTITOXOID***

Facility

$152.00

Hospital Charge Code	3010493
Hospital Revenue Code	306
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

DIPHTHERIA/TETANUS TOXOID

Facility

$13.00

Hospital Charge Code	60632862
Hospital Revenue Code	254
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DIPHTHERIA/TETANUS TOXOID

Facility

$13.00

Hospital Charge Code	60632862
Hospital Revenue Code	254
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

DIPHTHER TET PERT HAEM INJ

Facility

$708.00

Hospital Charge Code	60628301
Hospital Revenue Code	250
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$354.00
Rate for Payer: Aetna Commercial	$269.04
Rate for Payer: Aetna Medicare Advantage	$212.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.54
Rate for Payer: Cigna Commercial	$354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.40
Rate for Payer: Oxford Commercial	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$106.20
Rate for Payer: UnitedHealthcare Commercial	$141.60
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$18.76

DIPHTHER TET PERT HAEM INJ

Facility

$708.00

Hospital Charge Code	60628301
Hospital Revenue Code	250
Min. Negotiated Rate	$106.20
Max. Negotiated Rate	$106.20
Rate for Payer: Qualcare PPO/HMO/WC	$106.20

DIPHTHER TET PERT INJ 0.5 ML

Facility

$109.45

Hospital Charge Code	6002026
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

DIPHTHER TET PERT INJ 0.5 ML

Facility

$109.45

Hospital Charge Code	6002026
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

DIPHTHER TET TOX INJ ADULT

Facility

$26.75

Hospital Charge Code	6002000
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$4.01
Rate for Payer: Qualcare PPO/HMO/WC	$4.01

DIPHTHER TET TOX INJ ADULT

Facility

$26.75

Hospital Charge Code	6002000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.38
Rate for Payer: Aetna Commercial	$10.16
Rate for Payer: Aetna Medicare Advantage	$8.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.82
Rate for Payer: Cigna Commercial	$13.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.03
Rate for Payer: Oxford Commercial	$5.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.01
Rate for Payer: UnitedHealthcare Commercial	$5.35
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

DIPHTHER TET TOX INJ PED

Facility

$73.00

Hospital Charge Code	6002018
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

DIPHTHER TET TOX INJ PED

Facility

$73.00

Hospital Charge Code	6002018
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

DIPIVEFRIN 0.1% OPHTH SOLN

Facility

$138.45

Hospital Charge Code	60628065
Hospital Revenue Code	250
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$69.22
Rate for Payer: Aetna Commercial	$52.61
Rate for Payer: Aetna Medicare Advantage	$41.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.30
Rate for Payer: Cigna Commercial	$69.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.53
Rate for Payer: Oxford Commercial	$27.69
Rate for Payer: Qualcare PPO/HMO/WC	$20.77
Rate for Payer: UnitedHealthcare Commercial	$27.69
Rate for Payer: UnitedHealthcare Community & State	$3.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.67

DIPIVEFRIN 0.1% OPHTH SOLN

Facility

$138.45

Hospital Charge Code	60628065
Hospital Revenue Code	250
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$20.77
Rate for Payer: Qualcare PPO/HMO/WC	$20.77

DIPRIVAN/10MG/1ML

Facility

$83.00

Hospital Charge Code	60632863
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

DIPRIVAN/10MG/1ML

Facility

$83.00

Hospital Charge Code	60632863
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

DIPRIVAN 10MG/ML 100ML VI

Facility

$79.00

Hospital Charge Code	60635378
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

DIPRIVAN 10MG/ML 100ML VI

Facility

$79.00

Hospital Charge Code	60635378
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$15.80
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

DIPROLENE 0.05%/60ML

Facility

$159.00

Hospital Charge Code	60632864
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.70
Rate for Payer: Oxford Commercial	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$31.80
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

DIPROLENE 0.05%/60ML

Facility

$159.00

Hospital Charge Code	60632864
Hospital Revenue Code	250
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

DIPROLENE 0.05% GEL/15GR

Facility

$122.00

Hospital Charge Code	60634721
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

DIPROLENE 0.05% GEL/15GR

Facility

$122.00

Hospital Charge Code	60634721
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

DIPROLENE 0.05% GEL/45GM

Facility

$238.00

Hospital Charge Code	60634722
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

Know your out-of-pocket cost for care.

All Charges