Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DNA & PLODY ANALYSIS

Facility

$674.00

Service Code	HCPCS 88358
Hospital Charge Code	38474150
Hospital Revenue Code	310
Min. Negotiated Rate	$101.10
Max. Negotiated Rate	$101.10
Rate for Payer: Qualcare PPO/HMO/WC	$101.10

DNA & PLODY ANALYSIS

Facility

$674.00

Service Code	HCPCS 88358
Hospital Charge Code	38474150
Hospital Revenue Code	310
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.10
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$111.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$17.86

DNASE-B AB

Facility

$91.05

Service Code	HCPCS 86215
Hospital Charge Code	39900199
Hospital Revenue Code	302
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$13.66
Rate for Payer: Qualcare PPO/HMO/WC	$13.66

DNASE-B AB

Facility

$91.05

Service Code	HCPCS 86215
Hospital Charge Code	39900199
Hospital Revenue Code	302
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$45.52
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

DOANE KNEE RETR DBL-END 5.7&6.

Facility

$290.00

Hospital Charge Code	270664597
Hospital Revenue Code	270
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

DOANE KNEE RETR DBL-END 5.7&6.

Facility

$290.00

Hospital Charge Code	270664597
Hospital Revenue Code	270
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$58.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$58.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

DOANE KNEE RETR DBL-END 6.3&7.

Facility

$290.00

Hospital Charge Code	270664598
Hospital Revenue Code	270
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$58.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$58.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

DOANE KNEE RETR DBL-END 6.3&7.

Facility

$290.00

Hospital Charge Code	270664598
Hospital Revenue Code	270
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

DOBUTAMINE 250 MG/20ML INJ

Facility

$30.95

Service Code	HCPCS J1250
Hospital Charge Code	60627445
Hospital Revenue Code	636
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$7.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.64

DOBUTAMINE 250 MG/20ML INJ

Facility

$30.95

Service Code	HCPCS J1250
Hospital Charge Code	60627445
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.47
Rate for Payer: Aetna Commercial	$11.76
Rate for Payer: Aetna Medicare Advantage	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.89
Rate for Payer: Cigna Commercial	$15.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.64
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

DOBUTAMINE 250MG/250ML IVPB

Facility

$132.59

Service Code	HCPCS J1250
Hospital Charge Code	6063943099
Hospital Revenue Code	636
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$32.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.89

DOBUTAMINE 250MG/250ML IVPB

Facility

$132.59

Service Code	HCPCS J1250
Hospital Charge Code	6063943099
Hospital Revenue Code	636
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Commercial	$50.38
Rate for Payer: Aetna Medicare Advantage	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.81
Rate for Payer: Cigna Commercial	$66.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.89
Rate for Payer: UnitedHealthcare Community & State	$3.20
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

DOBUTAMINE 500MG/250ML D5W

Facility

$233.03

Service Code	HCPCS J1250
Hospital Charge Code	60629346
Hospital Revenue Code	636
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.52
Rate for Payer: Aetna Commercial	$88.55
Rate for Payer: Aetna Medicare Advantage	$69.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$116.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.39
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

DOBUTAMINE 500MG/250ML D5W

Facility

$233.03

Service Code	HCPCS J1250
Hospital Charge Code	60629346
Hospital Revenue Code	636
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$56.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.39
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

DOBUTAMINE 500MG/250MLD5W

Facility

$67.00

Hospital Charge Code	60635613
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

DOBUTAMINE 500MG/250MLD5W

Facility

$67.00

Hospital Charge Code	60635613
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

DOBUTAMINE/D5W 250MG/250ML PRE

Facility

$21.90

Hospital Charge Code	60630160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.95
Rate for Payer: Aetna Commercial	$8.32
Rate for Payer: Aetna Medicare Advantage	$6.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.58
Rate for Payer: Cigna Commercial	$10.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.29
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

DOBUTAMINE/D5W 250MG/250ML PRE

Facility

$21.90

Hospital Charge Code	60630160
Hospital Revenue Code	636
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$5.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.29

DOBUTAMINE INJ 250MG VIAL

Facility

$53.80

Hospital Charge Code	6002042
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

DOBUTAMINE INJ 250MG VIAL

Facility

$53.80

Hospital Charge Code	6002042
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

DOBUTREX/12.5MG/1ML

Facility

$202.00

Hospital Charge Code	60632874
Hospital Revenue Code	250
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$101.00
Rate for Payer: Aetna Commercial	$76.76
Rate for Payer: Aetna Medicare Advantage	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.60
Rate for Payer: Oxford Commercial	$40.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.30
Rate for Payer: UnitedHealthcare Commercial	$40.40
Rate for Payer: UnitedHealthcare Community & State	$4.87
Rate for Payer: Wellpoint Medicaid Managed Care	$5.35

DOBUTREX/12.5MG/1ML

Facility

$202.00

Hospital Charge Code	60632874
Hospital Revenue Code	250
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$30.30
Rate for Payer: Qualcare PPO/HMO/WC	$30.30

DOBUTREX PM 250MG/250CC

Facility

$191.00

Hospital Charge Code	60635037
Hospital Revenue Code	250
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

DOBUTREX PM 250MG/250CC

Facility

$191.00

Hospital Charge Code	60635037
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$72.58
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.30
Rate for Payer: Oxford Commercial	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$38.20
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

DOCETAXEL 20MG

Facility

$2,987.73

Service Code	HCPCS J9171
Hospital Charge Code	60627377
Hospital Revenue Code	636
Min. Negotiated Rate	$448.16
Max. Negotiated Rate	$723.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$723.03
Rate for Payer: Qualcare PPO/HMO/WC	$448.16

Know your out-of-pocket cost for care.

All Charges