Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRIVE SHAFT SEAL RIA

Facility

$89.25

Hospital Charge Code	270671815
Hospital Revenue Code	272
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$44.62
Rate for Payer: Aetna Commercial	$33.91
Rate for Payer: Aetna Medicare Advantage	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.76
Rate for Payer: Cigna Commercial	$44.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.77
Rate for Payer: Oxford Commercial	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$13.39
Rate for Payer: UnitedHealthcare Commercial	$17.85
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

DRIVE SHAFT T10 HEXALOBE

Facility

$790.00

Hospital Charge Code	270690955
Hospital Revenue Code	272
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.00
Rate for Payer: Oxford Commercial	$158.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$158.00
Rate for Payer: UnitedHealthcare Community & State	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.93

DRIVE SHAFT T10 HEXALOBE

Facility

$790.00

Hospital Charge Code	270690955
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DRONEDARONE HCL 400MGTAB

Facility

$57.29

Service Code	NDC 24414210
Hospital Charge Code	60632222
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$8.59
Rate for Payer: Qualcare PPO/HMO/WC	$8.59

DRONEDARONE HCL 400MGTAB

Facility

$57.29

Service Code	NDC 24414210
Hospital Charge Code	60632222
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$28.64
Rate for Payer: Aetna Commercial	$21.77
Rate for Payer: Aetna Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.61
Rate for Payer: Cigna Commercial	$28.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.19
Rate for Payer: Oxford Commercial	$11.46
Rate for Payer: Qualcare PPO/HMO/WC	$8.59
Rate for Payer: UnitedHealthcare Commercial	$11.46
Rate for Payer: UnitedHealthcare Community & State	$1.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

DROPERIDOL/2.5MG/1ML

Facility

$27.00

Hospital Charge Code	60632908
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

DROPERIDOL/2.5MG/1ML

Facility

$27.00

Hospital Charge Code	60632908
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

DROPERIDOL 2.5MG/ML

Facility

$14.27

Service Code	HCPCS J1790
Hospital Charge Code	60630212
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.14

DROPERIDOL 2.5MG/ML

Facility

$14.27

Service Code	HCPCS J1790
Hospital Charge Code	60630212
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: Aetna Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.64
Rate for Payer: Cigna Commercial	$7.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.14
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

DROPERIDOL VL 2.5MG

Facility

$32.85

Hospital Charge Code	6012470
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.43
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$9.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.38
Rate for Payer: Cigna Commercial	$16.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.86
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.93
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

DROPERIDOL VL 2.5MG

Facility

$32.85

Hospital Charge Code	6012470
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.93

DROPFOOT ORTHOSIS

Facility

$445.00

Hospital Charge Code	270624671
Hospital Revenue Code	271
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$66.75
Rate for Payer: Qualcare PPO/HMO/WC	$66.75

DROPFOOT ORTHOSIS

Facility

$445.00

Hospital Charge Code	270624671
Hospital Revenue Code	271
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$222.50
Rate for Payer: Aetna Commercial	$169.10
Rate for Payer: Aetna Medicare Advantage	$133.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.47
Rate for Payer: Cigna Commercial	$222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.50
Rate for Payer: Oxford Commercial	$89.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.75
Rate for Payer: UnitedHealthcare Commercial	$89.00
Rate for Payer: UnitedHealthcare Community & State	$10.72
Rate for Payer: Wellpoint Medicaid Managed Care	$11.79

DROPPER REAGENT DOBELL OCONNOR

Facility

$132.20

Hospital Charge Code	270601597
Hospital Revenue Code	271
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$19.83
Rate for Payer: Qualcare PPO/HMO/WC	$19.83

DROPPER REAGENT DOBELL OCONNOR

Facility

$132.20

Hospital Charge Code	270601597
Hospital Revenue Code	271
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$50.24
Rate for Payer: Aetna Medicare Advantage	$39.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$66.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.66
Rate for Payer: Oxford Commercial	$26.44
Rate for Payer: Qualcare PPO/HMO/WC	$19.83
Rate for Payer: UnitedHealthcare Commercial	$26.44
Rate for Payer: UnitedHealthcare Community & State	$3.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

DROTRECOGIN ALFA 20 MG INJ

Facility

$5,284.00

Hospital Charge Code	60629194
Hospital Revenue Code	250
Min. Negotiated Rate	$127.34
Max. Negotiated Rate	$2,642.00
Rate for Payer: Aetna Commercial	$2,007.92
Rate for Payer: Aetna Medicare Advantage	$1,585.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,347.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,347.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,347.42
Rate for Payer: Cigna Commercial	$2,642.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,585.20
Rate for Payer: Oxford Commercial	$1,056.80
Rate for Payer: Qualcare PPO/HMO/WC	$792.60
Rate for Payer: UnitedHealthcare Commercial	$1,056.80
Rate for Payer: UnitedHealthcare Community & State	$127.34
Rate for Payer: Wellpoint Medicaid Managed Care	$140.03

DROTRECOGIN ALFA 20 MG INJ

Facility

$5,284.00

Hospital Charge Code	60629194
Hospital Revenue Code	250
Min. Negotiated Rate	$792.60
Max. Negotiated Rate	$792.60
Rate for Payer: Qualcare PPO/HMO/WC	$792.60

DROTRECOGIN ALFA 5 MG INJ

Facility

$1,321.65

Hospital Charge Code	60629195
Hospital Revenue Code	250
Min. Negotiated Rate	$198.25
Max. Negotiated Rate	$198.25
Rate for Payer: Qualcare PPO/HMO/WC	$198.25

DROTRECOGIN ALFA 5 MG INJ

Facility

$1,321.65

Hospital Charge Code	60629195
Hospital Revenue Code	250
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$660.83
Rate for Payer: Aetna Commercial	$502.23
Rate for Payer: Aetna Medicare Advantage	$396.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.02
Rate for Payer: Cigna Commercial	$660.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.50
Rate for Payer: Oxford Commercial	$264.33
Rate for Payer: Qualcare PPO/HMO/WC	$198.25
Rate for Payer: UnitedHealthcare Commercial	$264.33
Rate for Payer: UnitedHealthcare Community & State	$31.85
Rate for Payer: Wellpoint Medicaid Managed Care	$35.02

DRSG 3X8 OIL EMULSN NON250381

Facility

$5.00

Hospital Charge Code	270641457W
Hospital Revenue Code	272
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

DRSG 3X8 OIL EMULSN NON250381

Facility

$5.00

Hospital Charge Code	270641457W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

DRSG 4X4 SHEET WD VEIL 5955044

Facility

$5.35

Hospital Charge Code	270627498
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.03
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DRSG 4X4 SHEET WD VEIL 5955044

Facility

$5.35

Hospital Charge Code	270627498
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

DRSG 4x4 SIL S ANTIMIC MSC9340

Facility

$64.00

Hospital Charge Code	270632940
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

DRSG 4x4 SIL S ANTIMIC MSC9340

Facility

$64.00

Hospital Charge Code	270632940
Hospital Revenue Code	272
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

Know your out-of-pocket cost for care.

All Charges