Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DISIPAL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634369
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$829.46
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$754.05
Rate for Payer: Qualcare PPO/HMO/WC	$514.12
Rate for Payer: UnitedHealthcare Community & State	$82.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$90.83

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$514.12
Max. Negotiated Rate	$829.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$754.05
Rate for Payer: Qualcare PPO/HMO/WC	$514.12

DISK MAGNETIC OPTICAL

Facility

$47.50

Hospital Charge Code	270657782
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

DISK MAGNETIC OPTICAL

Facility

$47.50

Hospital Charge Code	270657782
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$12.17
Rate for Payer: Aetna Medicare Advantage	$9.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.17
Rate for Payer: Cigna Commercial	$16.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.61
Rate for Payer: Oxford Commercial	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.41
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$1.92
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna Commercial	$8.61
Rate for Payer: Aetna Medicare Advantage	$6.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.78
Rate for Payer: Cigna Commercial	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.79
Rate for Payer: Oxford Commercial	$4.53
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$4.53
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare Advantage	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.54
Rate for Payer: Oxford Commercial	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

DISOPYRAMIDE, SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3007374
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

DISOPYRAMIDE, SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3007374
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$10,475.41

Service Code	APR-DRG 2842
Min. Negotiated Rate	$10,270.01
Max. Negotiated Rate	$10,475.41
Rate for Payer: UnitedHealthcare Community & State	$10,270.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,475.41
Rate for Payer: Wellpoint Medicaid Managed Care	$10,270.01

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$24,977.57

Service Code	APR-DRG 2844
Min. Negotiated Rate	$24,487.81
Max. Negotiated Rate	$24,977.57
Rate for Payer: UnitedHealthcare Community & State	$24,487.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,977.57
Rate for Payer: Wellpoint Medicaid Managed Care	$24,487.81

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$8,039.46

Service Code	APR-DRG 2841
Min. Negotiated Rate	$7,881.82
Max. Negotiated Rate	$8,039.46
Rate for Payer: UnitedHealthcare Community & State	$7,881.82
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,039.46
Rate for Payer: Wellpoint Medicaid Managed Care	$7,881.82

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$14,671.97

Service Code	APR-DRG 2843
Min. Negotiated Rate	$14,384.28
Max. Negotiated Rate	$14,671.97
Rate for Payer: UnitedHealthcare Community & State	$14,384.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,671.97
Rate for Payer: Wellpoint Medicaid Managed Care	$14,384.28

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$5,618.79

Service Code	APR-DRG 7582
Min. Negotiated Rate	$5,508.62
Max. Negotiated Rate	$5,618.79
Rate for Payer: UnitedHealthcare Community & State	$5,508.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,618.79
Rate for Payer: Wellpoint Medicaid Managed Care	$5,508.62

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$9,825.54

Service Code	APR-DRG 7583
Min. Negotiated Rate	$9,632.88
Max. Negotiated Rate	$9,825.54
Rate for Payer: UnitedHealthcare Community & State	$9,632.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,825.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9,632.88

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$12,933.07

Service Code	APR-DRG 7584
Min. Negotiated Rate	$12,679.48
Max. Negotiated Rate	$12,933.07
Rate for Payer: UnitedHealthcare Community & State	$12,679.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,933.07
Rate for Payer: Wellpoint Medicaid Managed Care	$12,679.48

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$4,404.61

Service Code	APR-DRG 7581
Min. Negotiated Rate	$4,318.25
Max. Negotiated Rate	$4,404.61
Rate for Payer: UnitedHealthcare Community & State	$4,318.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,404.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4,318.25

Know your out-of-pocket cost for care.

All Charges