Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DISULFIRAM 250 MG TAB

Facility

$9.65

Hospital Charge Code	60628526
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

DISULFIRAM 250 MG TAB

Facility

$9.65

Hospital Charge Code	60628526
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

DITATION 10FN

Facility

$42.50

Hospital Charge Code	270663691
Hospital Revenue Code	270
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$6.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.38

DITATION 10FN

Facility

$42.50

Hospital Charge Code	270663691
Hospital Revenue Code	270
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.25
Rate for Payer: Aetna Commercial	$16.15
Rate for Payer: Aetna Medicare Advantage	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.84
Rate for Payer: Cigna Commercial	$21.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.75
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.38
Rate for Payer: UnitedHealthcare Commercial	$8.50
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

DITROPAN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632872
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DITROPAN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632872
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

DITROPAN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632873
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DITROPAN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632873
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

DITROPAN XL 10MG, TAB.

Facility

$46.57

Service Code	NDC 50458081001
Hospital Charge Code	60635438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$6.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.99

DITROPAN XL 10MG, TAB.

Facility

$46.57

Service Code	NDC 50458081001
Hospital Charge Code	60635438
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.29
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.88
Rate for Payer: Cigna Commercial	$23.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.97
Rate for Payer: Oxford Commercial	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.99
Rate for Payer: UnitedHealthcare Commercial	$9.31
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

DITROPAN XL 5MG

Facility

$4.00

Hospital Charge Code	60635401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DITROPAN XL 5MG

Facility

$4.00

Hospital Charge Code	60635401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIUPRES/250MG

Facility

$3.00

Hospital Charge Code	60634476
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

DIUPRES/250MG

Facility

$3.00

Hospital Charge Code	60634476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIUPRES/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634372
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

DIUPRES/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634372
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIUPRES/500MG

Facility

$3.00

Hospital Charge Code	60634477
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

DIUPRES/500MG

Facility

$3.00

Hospital Charge Code	60634477
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIUPRES/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634373
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

DIUPRES/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634373
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIURETICS PNL(SERUM OR PLASMA)

Facility

$157.00

Service Code	HCPCS 80375
Hospital Charge Code	401180375
Hospital Revenue Code	306
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

DIURETICS PNL(SERUM OR PLASMA)

Facility

$157.00

Service Code	HCPCS 80375
Hospital Charge Code	401180375
Hospital Revenue Code	306
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.66
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

DIURIL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634370
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

DIURIL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634370
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIVALPROEX CAP 125MG SPRINKLE

Facility

$12.06

Service Code	NDC 74611411
Hospital Charge Code	60627747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.62
Rate for Payer: Oxford Commercial	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.41
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

Know your out-of-pocket cost for care.

All Charges