Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DOCETAXEL 20MG

Facility

$2,987.73

Service Code	HCPCS J9171
Hospital Charge Code	60627377
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$1,493.87
Rate for Payer: Aetna Commercial	$1,135.34
Rate for Payer: Aetna Medicare Advantage	$896.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.87
Rate for Payer: Cigna Commercial	$1,493.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$723.03
Rate for Payer: Qualcare PPO/HMO/WC	$448.16
Rate for Payer: UnitedHealthcare Community & State	$72.00
Rate for Payer: Wellpoint Medicaid Managed Care	$79.17

DOCETAXEL 80MG

Facility

$11,948.98

Service Code	HCPCS J9171
Hospital Charge Code	60627378
Hospital Revenue Code	636
Min. Negotiated Rate	$287.97
Max. Negotiated Rate	$5,974.49
Rate for Payer: Aetna Commercial	$4,540.61
Rate for Payer: Aetna Medicare Advantage	$3,584.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,046.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,046.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,046.99
Rate for Payer: Cigna Commercial	$5,974.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.35
Rate for Payer: UnitedHealthcare Community & State	$287.97
Rate for Payer: Wellpoint Medicaid Managed Care	$316.65

DOCETAXEL 80MG

Facility

$11,948.98

Service Code	HCPCS J9171
Hospital Charge Code	60627378
Hospital Revenue Code	636
Min. Negotiated Rate	$1,792.35
Max. Negotiated Rate	$2,891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.35

DOCETAXEL INJ 20MG

Facility

$1,061.80

Hospital Charge Code	6016455
Hospital Revenue Code	636
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$530.90
Rate for Payer: Aetna Commercial	$403.48
Rate for Payer: Aetna Medicare Advantage	$318.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.76
Rate for Payer: Cigna Commercial	$530.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.96
Rate for Payer: Qualcare PPO/HMO/WC	$159.27
Rate for Payer: UnitedHealthcare Community & State	$25.59
Rate for Payer: Wellpoint Medicaid Managed Care	$28.14

DOCETAXEL INJ 20MG

Facility

$1,061.80

Hospital Charge Code	6016455
Hospital Revenue Code	636
Min. Negotiated Rate	$159.27
Max. Negotiated Rate	$256.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.96
Rate for Payer: Qualcare PPO/HMO/WC	$159.27

DOCETAXEL INJ 80MG

Facility

$3,177.60

Hospital Charge Code	6016448
Hospital Revenue Code	636
Min. Negotiated Rate	$476.64
Max. Negotiated Rate	$768.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.98
Rate for Payer: Qualcare PPO/HMO/WC	$476.64

DOCETAXEL INJ 80MG

Facility

$3,177.60

Hospital Charge Code	6016448
Hospital Revenue Code	636
Min. Negotiated Rate	$76.58
Max. Negotiated Rate	$1,588.80
Rate for Payer: Aetna Commercial	$1,207.49
Rate for Payer: Aetna Medicare Advantage	$953.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$810.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$810.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$810.29
Rate for Payer: Cigna Commercial	$1,588.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.98
Rate for Payer: Qualcare PPO/HMO/WC	$476.64
Rate for Payer: UnitedHealthcare Community & State	$76.58
Rate for Payer: Wellpoint Medicaid Managed Care	$84.21

DOCUSATE SOD CAP 100MG

Facility

$1.95

Hospital Charge Code	60628125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

DOCUSATE SOD CAP 100MG

Facility

$1.95

Hospital Charge Code	60628125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DOCUSATE SOD CASANTHRANOL CAP

Facility

$3.20

Hospital Charge Code	6024103
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

DOCUSATE SOD CASANTHRANOL CAP

Facility

$3.20

Hospital Charge Code	6024103
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DOCUSATE SOD CASANTHRANOL SYR

Facility

$10.90

Hospital Charge Code	60628127
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

DOCUSATE SOD CASANTHRANOL SYR

Facility

$10.90

Hospital Charge Code	60628127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

DOCUSATE SODIUM 100MG/10ML LIQ

Facility

$14.87

Service Code	NDC 67618010110
Hospital Charge Code	60628126
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare Advantage	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.79
Rate for Payer: Cigna Commercial	$7.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.97
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

DOCUSATE SODIUM 100MG/10ML LIQ

Facility

$14.87

Service Code	NDC 67618010110
Hospital Charge Code	60628126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

DOCUSATE SODIUM/100MG/CAP

Facility

$3.00

Hospital Charge Code	60632876
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOCUSATE SODIUM/100MG/CAP

Facility

$3.00

Hospital Charge Code	60632876
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

DOCUSATE SODIUM/100MG/CAP

Facility

$1.00

Hospital Charge Code	60632875
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

DOCUSATE SODIUM/100MG/CAP

Facility

$1.00

Hospital Charge Code	60632875
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

DOCUSATE SODIUM PEPPERMNT

Facility

$3.00

Hospital Charge Code	60632877
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOCUSATE SODIUM PEPPERMNT

Facility

$3.00

Hospital Charge Code	60632877
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

DOCUSATE SODIUM W/CASANTH

Facility

$1.00

Hospital Charge Code	60632879
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

DOCUSATE SODIUM W/CASANTH

Facility

$3.00

Hospital Charge Code	60632878
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

DOCUSATE SODIUM W/CASANTH

Facility

$3.00

Hospital Charge Code	60632878
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOCUSATE SODIUM W/CASANTH

Facility

$1.00

Hospital Charge Code	60632879
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

Know your out-of-pocket cost for care.

All Charges