Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DOPPLER TRASCRANIAL LIMITED

Facility

$906.00

Service Code	HCPCS 93888
Hospital Charge Code	5300088
Hospital Revenue Code	921
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Qualcare PPO/HMO/WC	$135.90

DOPPLER TRASCRANIAL LIMITED

Facility

$906.00

Service Code	HCPCS 93888
Hospital Charge Code	5300088
Hospital Revenue Code	921
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$6,760.00
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	$265.23
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	$271.80
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.90
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$21.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$24.01

DOPPLER UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
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	$50.36
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 UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DOPRAM INJECTION/20MG/ML

Facility

$266.00

Hospital Charge Code	60634259
Hospital Revenue Code	636
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.37
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

DOPRAM INJECTION/20MG/ML

Facility

$266.00

Hospital Charge Code	60634259
Hospital Revenue Code	636
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$64.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.37
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

DORIPENEM

Facility

$230.00

Hospital Charge Code	60629962
Hospital Revenue Code	636
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

DORIPENEM

Facility

$230.00

Hospital Charge Code	60629962
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$113.19
Max. Negotiated Rate	$182.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$18.19
Max. Negotiated Rate	$377.31
Rate for Payer: Aetna Commercial	$286.76
Rate for Payer: Aetna Medicare Advantage	$226.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.43
Rate for Payer: Cigna Commercial	$377.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19
Rate for Payer: UnitedHealthcare Community & State	$18.19
Rate for Payer: Wellpoint Medicaid Managed Care	$20.00

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$87,711.23

Service Code	APR-DRG 3044
Min. Negotiated Rate	$85,991.40
Max. Negotiated Rate	$87,711.23
Rate for Payer: UnitedHealthcare Community & State	$85,991.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$87,711.23
Rate for Payer: Wellpoint Medicaid Managed Care	$85,991.40

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$57,067.62

Service Code	APR-DRG 3043
Min. Negotiated Rate	$55,948.65
Max. Negotiated Rate	$57,067.62
Rate for Payer: UnitedHealthcare Community & State	$55,948.65
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$57,067.62
Rate for Payer: Wellpoint Medicaid Managed Care	$55,948.65

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$41,038.54

Service Code	APR-DRG 3042
Min. Negotiated Rate	$40,233.86
Max. Negotiated Rate	$41,038.54
Rate for Payer: UnitedHealthcare Community & State	$40,233.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$41,038.54
Rate for Payer: Wellpoint Medicaid Managed Care	$40,233.86

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$34,684.38

Service Code	APR-DRG 3041
Min. Negotiated Rate	$34,004.29
Max. Negotiated Rate	$34,684.38
Rate for Payer: UnitedHealthcare Community & State	$34,004.29
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,684.38
Rate for Payer: Wellpoint Medicaid Managed Care	$34,004.29

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$82,560.98

Service Code	APR-DRG 3033
Min. Negotiated Rate	$80,942.14
Max. Negotiated Rate	$82,560.98
Rate for Payer: UnitedHealthcare Community & State	$80,942.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$82,560.98
Rate for Payer: Wellpoint Medicaid Managed Care	$80,942.14

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$50,336.84

Service Code	APR-DRG 3031
Min. Negotiated Rate	$49,349.84
Max. Negotiated Rate	$50,336.84
Rate for Payer: UnitedHealthcare Community & State	$49,349.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,336.84
Rate for Payer: Wellpoint Medicaid Managed Care	$49,349.84

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$120,757.57

Service Code	APR-DRG 3034
Min. Negotiated Rate	$118,389.77
Max. Negotiated Rate	$120,757.57
Rate for Payer: UnitedHealthcare Community & State	$118,389.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$120,757.57
Rate for Payer: Wellpoint Medicaid Managed Care	$118,389.77

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$59,910.83

Service Code	APR-DRG 3032
Min. Negotiated Rate	$58,736.11
Max. Negotiated Rate	$59,910.83
Rate for Payer: UnitedHealthcare Community & State	$58,736.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$59,910.83
Rate for Payer: Wellpoint Medicaid Managed Care	$58,736.11

DORSAL SPINE 4VW

Facility

$204.00

Hospital Charge Code	2009350
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

DORSAL SPINE 4VW

Facility

$204.00

Hospital Charge Code	2009350
Hospital Revenue Code	320
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$308.33
Rate for Payer: Aetna Commercial	$234.33
Rate for Payer: Aetna Medicare Advantage	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.25
Rate for Payer: Cigna Commercial	$308.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.00
Rate for Payer: Oxford Commercial	$123.33
Rate for Payer: Qualcare PPO/HMO/WC	$92.50
Rate for Payer: UnitedHealthcare Commercial	$123.33
Rate for Payer: UnitedHealthcare Community & State	$14.86
Rate for Payer: Wellpoint Medicaid Managed Care	$16.34

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$92.50

DORZOLAMIDE HCL 2% OPH SOLN 5M

Facility

$382.92

Hospital Charge Code	606350921
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.46
Rate for Payer: Aetna Commercial	$145.51
Rate for Payer: Aetna Medicare Advantage	$114.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.64
Rate for Payer: Cigna Commercial	$191.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.88
Rate for Payer: Oxford Commercial	$76.58
Rate for Payer: Qualcare PPO/HMO/WC	$57.44
Rate for Payer: UnitedHealthcare Commercial	$76.58
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

DORZOLAMIDE HCL 2% OPH SOLN 5M

Facility

$382.92

Hospital Charge Code	606350921
Hospital Revenue Code	250
Min. Negotiated Rate	$57.44
Max. Negotiated Rate	$57.44
Rate for Payer: Qualcare PPO/HMO/WC	$57.44

DORZOLAMIDE OPH SOL .2% 5ML

Facility

$97.30

Hospital Charge Code	6017370
Hospital Revenue Code	252
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.19
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

Know your out-of-pocket cost for care.

All Charges