Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DOCUSATE SOD SENNA TAB

Facility

$4.00

Service Code	NDC 904633961
Hospital Charge Code	60628128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DOCUSATE SOD SENNA TAB

Facility

$4.00

Service Code	NDC 904633961
Hospital Charge Code	60628128
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

DOCUSATE SOD UD LQ 100MG/10ML

Facility

$3.85

Hospital Charge Code	60621826
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

DOCUSATE SOD UD LQ 100MG/10ML

Facility

$3.85

Hospital Charge Code	60621826
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

DOG BONE BUTTON

Facility

$1,750.00

Hospital Charge Code	270675092
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

DOG BONE BUTTON

Facility

$1,750.00

Hospital Charge Code	270675092
Hospital Revenue Code	272
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

DOLASETRON 100 MG/5ML INJ

Facility

$46.80

Hospital Charge Code	60628951
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Commercial	$17.78
Rate for Payer: Aetna Medicare Advantage	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.33
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

DOLASETRON 100 MG/5ML INJ

Facility

$46.80

Hospital Charge Code	60628951
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$11.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.33
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

DOLASETRON 100MG/D5W 50ML IVPB

Facility

$429.45

Hospital Charge Code	60628949
Hospital Revenue Code	636
Min. Negotiated Rate	$64.42
Max. Negotiated Rate	$103.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.93
Rate for Payer: Qualcare PPO/HMO/WC	$64.42

DOLASETRON 100MG/D5W 50ML IVPB

Facility

$429.45

Hospital Charge Code	60628949
Hospital Revenue Code	636
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$214.72
Rate for Payer: Aetna Commercial	$163.19
Rate for Payer: Aetna Medicare Advantage	$128.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.51
Rate for Payer: Cigna Commercial	$214.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.93
Rate for Payer: Qualcare PPO/HMO/WC	$64.42
Rate for Payer: UnitedHealthcare Community & State	$10.35
Rate for Payer: Wellpoint Medicaid Managed Care	$11.38

DOLASETRON 100MG/NaCL 50ML IVP

Facility

$429.45

Hospital Charge Code	60628950
Hospital Revenue Code	636
Min. Negotiated Rate	$64.42
Max. Negotiated Rate	$103.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.93
Rate for Payer: Qualcare PPO/HMO/WC	$64.42

DOLASETRON 100MG/NaCL 50ML IVP

Facility

$429.45

Hospital Charge Code	60628950
Hospital Revenue Code	636
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$214.72
Rate for Payer: Aetna Commercial	$163.19
Rate for Payer: Aetna Medicare Advantage	$128.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.51
Rate for Payer: Cigna Commercial	$214.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.93
Rate for Payer: Qualcare PPO/HMO/WC	$64.42
Rate for Payer: UnitedHealthcare Community & State	$10.35
Rate for Payer: Wellpoint Medicaid Managed Care	$11.38

DOLASETRON 20 MG/ML INJ

Facility

$149.95

Hospital Charge Code	60628952
Hospital Revenue Code	636
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$74.97
Rate for Payer: Aetna Commercial	$56.98
Rate for Payer: Aetna Medicare Advantage	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.24
Rate for Payer: Cigna Commercial	$74.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.29
Rate for Payer: Qualcare PPO/HMO/WC	$22.49
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

DOLASETRON 20 MG/ML INJ

Facility

$149.95

Hospital Charge Code	60628952
Hospital Revenue Code	636
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$36.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.29
Rate for Payer: Qualcare PPO/HMO/WC	$22.49

DOLOBID/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DOLOBID/250MG/TAB

Facility

$3.00

Hospital Charge Code	60632881
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

DOLOBID/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DOLOBID/250MG/TAB

Facility

$3.00

Hospital Charge Code	60632881
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOLOBID/500MG/TAB

Facility

$7.00

Hospital Charge Code	60632882
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DOLOBID/500MG/TAB

Facility

$7.00

Hospital Charge Code	60632882
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DOLOBID/500MG/TAB

Facility

$6.00

Hospital Charge Code	60632883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DOLOBID/500MG/TAB

Facility

$6.00

Hospital Charge Code	60632883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DOLUTEGRAVIR 50MG (TIVICAY)

Facility

$353.22

Service Code	NDC 49702022813
Hospital Charge Code	606380001
Hospital Revenue Code	250
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$176.61
Rate for Payer: Aetna Commercial	$134.22
Rate for Payer: Aetna Medicare Advantage	$105.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.07
Rate for Payer: Cigna Commercial	$176.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.97
Rate for Payer: Oxford Commercial	$70.64
Rate for Payer: Qualcare PPO/HMO/WC	$52.98
Rate for Payer: UnitedHealthcare Commercial	$70.64
Rate for Payer: UnitedHealthcare Community & State	$8.51
Rate for Payer: Wellpoint Medicaid Managed Care	$9.36

DOLUTEGRAVIR 50MG (TIVICAY)

Facility

$353.22

Service Code	NDC 49702022813
Hospital Charge Code	606380001
Hospital Revenue Code	250
Min. Negotiated Rate	$52.98
Max. Negotiated Rate	$52.98
Rate for Payer: Qualcare PPO/HMO/WC	$52.98

DOMEBORO/EACH

Facility

$5.00

Hospital Charge Code	60632884
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

Know your out-of-pocket cost for care.

All Charges