Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIVALPROEX CAP 125MG SPRINKLE

Facility

$12.06

Service Code	NDC 74611411
Hospital Charge Code	60627747
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.26
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.93

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$15.02
Rate for Payer: Aetna Medicare Advantage	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.08
Rate for Payer: Cigna Commercial	$19.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Oxford Commercial	$7.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.93
Rate for Payer: UnitedHealthcare Commercial	$7.91
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

DIVALPROEX TAB 250MG

Facility

$7.70

Hospital Charge Code	6017503
Hospital Revenue Code	252
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

DIVALPROEX TAB 250MG

Facility

$7.70

Hospital Charge Code	6017503
Hospital Revenue Code	252
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$22,479.00

Service Code	APR-DRG 2444
Min. Negotiated Rate	$22,038.24
Max. Negotiated Rate	$22,479.00
Rate for Payer: UnitedHealthcare Community & State	$22,038.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,479.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22,038.24

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$6,472.89

Service Code	APR-DRG 2441
Min. Negotiated Rate	$6,345.97
Max. Negotiated Rate	$6,472.89
Rate for Payer: UnitedHealthcare Community & State	$6,345.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,472.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6,345.97

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$8,473.52

Service Code	APR-DRG 2442
Min. Negotiated Rate	$8,307.37
Max. Negotiated Rate	$8,473.52
Rate for Payer: UnitedHealthcare Community & State	$8,307.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,473.52
Rate for Payer: Wellpoint Medicaid Managed Care	$8,307.37

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$12,819.44

Service Code	APR-DRG 2443
Min. Negotiated Rate	$12,568.08
Max. Negotiated Rate	$12,819.44
Rate for Payer: UnitedHealthcare Community & State	$12,568.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,819.44
Rate for Payer: Wellpoint Medicaid Managed Care	$12,568.08

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$409.71
Max. Negotiated Rate	$409.71
Rate for Payer: Qualcare PPO/HMO/WC	$409.71

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$65.83
Max. Negotiated Rate	$1,365.68
Rate for Payer: Aetna Commercial	$1,037.92
Rate for Payer: Aetna Medicare Advantage	$819.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.50
Rate for Payer: Cigna Commercial	$1,365.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$819.41
Rate for Payer: Oxford Commercial	$546.27
Rate for Payer: Qualcare PPO/HMO/WC	$409.71
Rate for Payer: UnitedHealthcare Commercial	$546.27
Rate for Payer: UnitedHealthcare Community & State	$65.83
Rate for Payer: Wellpoint Medicaid Managed Care	$72.38

D-LACTATE

Facility

$1,057.50

Hospital Charge Code	3035126
Hospital Revenue Code	301
Min. Negotiated Rate	$158.62
Max. Negotiated Rate	$158.62
Rate for Payer: Qualcare PPO/HMO/WC	$158.62

D-LACTATE

Facility

$1,057.50

Hospital Charge Code	3035126
Hospital Revenue Code	301
Min. Negotiated Rate	$25.49
Max. Negotiated Rate	$528.75
Rate for Payer: Aetna Commercial	$401.85
Rate for Payer: Aetna Medicare Advantage	$317.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.66
Rate for Payer: Cigna Commercial	$528.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$25.49
Rate for Payer: Wellpoint Medicaid Managed Care	$28.02

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$317.30
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
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	$41.76
Rate for Payer: Cigna Commercial	$317.30
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$16.82

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$95.19
Rate for Payer: Qualcare PPO/HMO/WC	$95.19

DLU ENDO GIA 30 2.5 30805L

Facility

$1,172.85

Hospital Charge Code	270600119
Hospital Revenue Code	272
Min. Negotiated Rate	$175.93
Max. Negotiated Rate	$175.93
Rate for Payer: Qualcare PPO/HMO/WC	$175.93

DLU ENDO GIA 30 2.5 30805L

Facility

$1,172.85

Hospital Charge Code	270600119
Hospital Revenue Code	272
Min. Negotiated Rate	$28.27
Max. Negotiated Rate	$586.42
Rate for Payer: Aetna Commercial	$445.68
Rate for Payer: Aetna Medicare Advantage	$351.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.08
Rate for Payer: Cigna Commercial	$586.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.86
Rate for Payer: Oxford Commercial	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$175.93
Rate for Payer: UnitedHealthcare Commercial	$234.57
Rate for Payer: UnitedHealthcare Community & State	$28.27
Rate for Payer: Wellpoint Medicaid Managed Care	$31.08

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$248.74
Rate for Payer: Aetna Commercial	$189.04
Rate for Payer: Aetna Medicare Advantage	$149.24
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	$248.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.24
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

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

DLU ENDO GIA 60 2.5 030314

Facility

$1,986.45

Hospital Charge Code	270600125
Hospital Revenue Code	272
Min. Negotiated Rate	$297.97
Max. Negotiated Rate	$297.97
Rate for Payer: Qualcare PPO/HMO/WC	$297.97

DLU ENDO GIA 60 2.5 030314

Facility

$1,986.45

Hospital Charge Code	270600125
Hospital Revenue Code	272
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$993.23
Rate for Payer: Aetna Commercial	$754.85
Rate for Payer: Aetna Medicare Advantage	$595.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.54
Rate for Payer: Cigna Commercial	$993.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.93
Rate for Payer: Oxford Commercial	$397.29
Rate for Payer: Qualcare PPO/HMO/WC	$297.97
Rate for Payer: UnitedHealthcare Commercial	$397.29
Rate for Payer: UnitedHealthcare Community & State	$47.87
Rate for Payer: Wellpoint Medicaid Managed Care	$52.64

DLU ENDO GIA 60 3.5 30312L

Facility

$816.85

Hospital Charge Code	270600123
Hospital Revenue Code	272
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$408.43
Rate for Payer: Aetna Commercial	$310.40
Rate for Payer: Aetna Medicare Advantage	$245.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.30
Rate for Payer: Cigna Commercial	$408.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.06
Rate for Payer: Oxford Commercial	$163.37
Rate for Payer: Qualcare PPO/HMO/WC	$122.53
Rate for Payer: UnitedHealthcare Commercial	$163.37
Rate for Payer: UnitedHealthcare Community & State	$19.69
Rate for Payer: Wellpoint Medicaid Managed Care	$21.65

DLU ENDO GIA 60 3.5 30312L

Facility

$816.85

Hospital Charge Code	270600123
Hospital Revenue Code	272
Min. Negotiated Rate	$122.53
Max. Negotiated Rate	$122.53
Rate for Payer: Qualcare PPO/HMO/WC	$122.53

Know your out-of-pocket cost for care.

All Charges