Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE/100MG

Facility

$3.00

Hospital Charge Code	60632907
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

DOXYCYCLINE HYCLATE/100MG

Facility

$7.00

Hospital Charge Code	60632905
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

DOXYCYCLINE HYCLATE/100MG

Facility

$7.00

Hospital Charge Code	60632905
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DOXYCYCLINE HYCLATE/100MG

Facility

$3.00

Hospital Charge Code	60632907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$3.59
Rate for Payer: Aetna Medicare Advantage	$2.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.41
Rate for Payer: Cigna Commercial	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.83
Rate for Payer: Oxford Commercial	$1.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.42
Rate for Payer: UnitedHealthcare Commercial	$1.89
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

DOXYCYCLINE HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.42

DOXYCYCLINE HYCLATE 100MG TAB

Facility

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.89
Rate for Payer: Aetna Commercial	$7.52
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.93
Rate for Payer: Oxford Commercial	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.96
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

DOXYCYCLINE HYCLATE 100MG TAB

Facility

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632906
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

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632906
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632903
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

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632904
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632904
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

DOXYCYCLINE HYCLATE 50 MG CAP

Facility

$4.85

Hospital Charge Code	60627318
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DOXYCYCLINE HYCLATE 50 MG CAP

Facility

$4.85

Hospital Charge Code	60627318
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DOXYCYCLINE IVPB 200MG/D5W250M

Facility

$208.00

Hospital Charge Code	60627317
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$41.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$41.60
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

DOXYCYCLINE IVPB 200MG/D5W250M

Facility

$208.00

Hospital Charge Code	60627317
Hospital Revenue Code	250
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DOXYCYLINE HYCLATE 100MG ORAL

Facility

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$5.74
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

DOXYCYLINE HYCLATE 100MG ORAL

Facility

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

DPD GENE MUTATION

Facility

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$230.88
Rate for Payer: Aetna Commercial	$173.97
Rate for Payer: Aetna Medicare Advantage	$207.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.88
Rate for Payer: Cigna Commercial	$230.11
Rate for Payer: Cigna Medicare Advantage	$63.96
Rate for Payer: Clover Medicare Advantage	$60.76
Rate for Payer: EmblemHealth Commercial	$191.88
Rate for Payer: Humana Medicare Advantage	$65.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$63.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.03
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$51.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$63.96
Rate for Payer: Wellcare Medicare Advantage	$63.96
Rate for Payer: Wellpoint Medicaid Managed Care	$12.20

DPD GENE MUTATION

Facility

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$69.03
Rate for Payer: Qualcare PPO/HMO/WC	$69.03

DRAIN ABRAMSON TRIPLE LUMEN

Facility

$145.50

Hospital Charge Code	270645146
Hospital Revenue Code	272
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$21.82
Rate for Payer: Qualcare PPO/HMO/WC	$21.82

DRAIN ABRAMSON TRIPLE LUMEN

Facility

$145.50

Hospital Charge Code	270645146
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Commercial	$55.29
Rate for Payer: Aetna Medicare Advantage	$43.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.10
Rate for Payer: Cigna Commercial	$72.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.65
Rate for Payer: Oxford Commercial	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$21.82
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: UnitedHealthcare Community & State	$3.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

Know your out-of-pocket cost for care.

All Charges