Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DONNOTAL LIQUID U/D

Facility

$4.00

Hospital Charge Code	60634965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DONUT ALIGEL 8OD X3ID X 13/4

Facility

$410.00

Hospital Charge Code	270655378
Hospital Revenue Code	279
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

DONUT ALIGEL 8OD X3ID X 13/4

Facility

$410.00

Hospital Charge Code	270655378
Hospital Revenue Code	279
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare Advantage	$123.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.55
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$82.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Community & State	$9.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

DOPAMINE 200MG/250ML IVPB

Facility

$311.55

Hospital Charge Code	6063943100
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$155.78
Rate for Payer: Aetna Commercial	$118.39
Rate for Payer: Aetna Medicare Advantage	$93.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.45
Rate for Payer: Cigna Commercial	$155.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.47
Rate for Payer: Oxford Commercial	$62.31
Rate for Payer: Qualcare PPO/HMO/WC	$46.73
Rate for Payer: UnitedHealthcare Commercial	$62.31
Rate for Payer: UnitedHealthcare Community & State	$7.51
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

DOPAMINE 200MG/250ML IVPB

Facility

$311.55

Hospital Charge Code	6063943100
Hospital Revenue Code	250
Min. Negotiated Rate	$46.73
Max. Negotiated Rate	$46.73
Rate for Payer: Qualcare PPO/HMO/WC	$46.73

DOPAMINE 200MG/D5W/200MG

Facility

$155.00

Hospital Charge Code	60632895
Hospital Revenue Code	636
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

DOPAMINE 200MG/D5W/200MG

Facility

$155.00

Hospital Charge Code	60632895
Hospital Revenue Code	636
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

DOPAMINE 400MG/250ML D5W

Facility

$104.12

Service Code	HCPCS J1265
Hospital Charge Code	60629345
Hospital Revenue Code	636
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.06
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare Advantage	$31.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.55
Rate for Payer: Cigna Commercial	$52.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.62
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

DOPAMINE 400MG/250ML D5W

Facility

$104.12

Service Code	HCPCS J1265
Hospital Charge Code	60629345
Hospital Revenue Code	636
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.62

DOPAMINE 400MG/250ML DEXT

Facility

$23.00

Hospital Charge Code	60635494
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DOPAMINE 400MG/250ML DEXT

Facility

$23.00

Hospital Charge Code	60635494
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

DOPAMINE/40MG/1ML

Facility

$9.00

Hospital Charge Code	60632894
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DOPAMINE/40MG/1ML

Facility

$9.00

Hospital Charge Code	60632894
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DOPAMINE, PLASMA

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	38479450
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DOPAMINE, PLASMA

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	38479450
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DOPPLER COLOR FLOW LTD

Facility

$1,615.00

Service Code	HCPCS 93307
Hospital Charge Code	36540013
Hospital Revenue Code	483
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$2,656.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.50
Rate for Payer: Oxford Commercial	$1,514.00
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Commercial	$2,656.00
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

DOPPLER COLOR FLOW LTD

Facility

$1,615.00

Service Code	HCPCS 93307
Hospital Charge Code	36540013
Hospital Revenue Code	483
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$242.25
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

DOPPLER MIDDLE CEREBRAL ARTERY

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	83653100
Hospital Revenue Code	402
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.30
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$19.11

DOPPLER MIDDLE CEREBRAL ARTERY

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	83653100
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DOPPLER TRANSCEIVER 108910

Facility

$4,750.00

Hospital Charge Code	270640874
Hospital Revenue Code	272
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

DOPPLER TRANSCEIVER 108910

Facility

$4,750.00

Hospital Charge Code	270640874
Hospital Revenue Code	272
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.00
Rate for Payer: Oxford Commercial	$950.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$950.00
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

DOPPLER TRANSCRANIAL******

Facility

$434.00

Service Code	HCPCS 93886
Hospital Charge Code	5400110
Hospital Revenue Code	921
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

DOPPLER TRANSCRANIAL******

Facility

$434.00

Service Code	HCPCS 93886
Hospital Charge Code	5400110
Hospital Revenue Code	921
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.20
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

DOPPLER TRANSCRANIAL COMPL

Facility

$887.05

Service Code	HCPCS 93886
Hospital Charge Code	5300133
Hospital Revenue Code	921
Min. Negotiated Rate	$133.06
Max. Negotiated Rate	$133.06
Rate for Payer: Qualcare PPO/HMO/WC	$133.06

DOPPLER TRANSCRANIAL COMPL

Facility

$887.05

Service Code	HCPCS 93886
Hospital Charge Code	5300133
Hospital Revenue Code	921
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.12
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.06
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$21.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$23.51

Know your out-of-pocket cost for care.

All Charges