Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DTIC/200MG/IV

Facility

$104.00

Hospital Charge Code	60634665
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

DTIC/200MG/IV

Facility

$104.00

Hospital Charge Code	60634665
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$39.52
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$20.80
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

DTIC IV/100MG/VIAL

Facility

$44.00

Hospital Charge Code	60634419
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$10.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

DTIC IV/100MG/VIAL

Facility

$44.00

Hospital Charge Code	60634419
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

DTP 5ML

Facility

$164.50

Hospital Charge Code	6017867
Hospital Revenue Code	250
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

DTP 5ML

Facility

$164.50

Hospital Charge Code	6017867
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$82.25
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$32.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$32.90
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

DUAL LUMEN URETERAL CATHETER

Facility

$168.65

Service Code	HCPCS C1758
Hospital Charge Code	270682456
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$40.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.10
Rate for Payer: Qualcare PPO/HMO/WC	$25.30

DUAL LUMEN URETERAL CATHETER

Facility

$168.65

Service Code	HCPCS C1758
Hospital Charge Code	270682456
Hospital Revenue Code	278
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$84.33
Rate for Payer: Aetna Commercial	$64.09
Rate for Payer: Aetna Medicare Advantage	$50.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.01
Rate for Payer: Cigna Commercial	$84.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.10
Rate for Payer: Qualcare PPO/HMO/WC	$25.30
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

DUALMESH 26CMx34CMx1 1DLMCP08

Facility

$11,515.00

Hospital Charge Code	270641569
Hospital Revenue Code	278
Min. Negotiated Rate	$277.51
Max. Negotiated Rate	$5,757.50
Rate for Payer: Aetna Commercial	$4,375.70
Rate for Payer: Aetna Medicare Advantage	$3,454.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,936.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,936.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,936.32
Rate for Payer: Cigna Commercial	$5,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,786.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,533.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,727.25
Rate for Payer: UnitedHealthcare Community & State	$277.51
Rate for Payer: Wellpoint Medicaid Managed Care	$305.15

DUALMESH 26CMx34CMx1 1DLMCP08

Facility

$11,515.00

Hospital Charge Code	270641569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,727.25
Max. Negotiated Rate	$2,786.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,303.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,786.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,533.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,727.25

DUALMESH DL 15x19x1 0 1DLMCP04

Facility

$4,290.00

Hospital Charge Code	270641528
Hospital Revenue Code	278
Min. Negotiated Rate	$643.50
Max. Negotiated Rate	$1,038.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$643.50

DUALMESH DL 15x19x1 0 1DLMCP04

Facility

$4,290.00

Hospital Charge Code	270641528
Hospital Revenue Code	278
Min. Negotiated Rate	$103.39
Max. Negotiated Rate	$2,145.00
Rate for Payer: Aetna Commercial	$1,630.20
Rate for Payer: Aetna Medicare Advantage	$1,287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.95
Rate for Payer: Cigna Commercial	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$643.50
Rate for Payer: UnitedHealthcare Community & State	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$113.69

DUALMESH DL 18x24x1 0 1DLMCP06

Facility

$6,180.00

Hospital Charge Code	270641529
Hospital Revenue Code	278
Min. Negotiated Rate	$148.94
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$2,348.40
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,359.60
Rate for Payer: Qualcare PPO/HMO/WC	$927.00
Rate for Payer: UnitedHealthcare Community & State	$148.94
Rate for Payer: Wellpoint Medicaid Managed Care	$163.77

DUALMESH DL 18x24x1 0 1DLMCP06

Facility

$6,180.00

Hospital Charge Code	270641529
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,359.60
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

DUAL MOBILITY ECIMA INSERT SZ

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270706147
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

DUAL MOBILITY ECIMA INSERT SZ

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270706147
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

DUAL MOBILITY LINER 64/53

Facility

$25,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270700357
Hospital Revenue Code	278
Min. Negotiated Rate	$608.16
Max. Negotiated Rate	$12,617.50
Rate for Payer: Aetna Commercial	$9,589.30
Rate for Payer: Aetna Medicare Advantage	$7,570.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,434.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,434.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,434.93
Rate for Payer: Cigna Commercial	$12,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,106.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,551.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,785.25
Rate for Payer: UnitedHealthcare Community & State	$608.16
Rate for Payer: Wellpoint Medicaid Managed Care	$668.73

DUAL MOBILITY LINER 64/53

Facility

$25,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270700357
Hospital Revenue Code	278
Min. Negotiated Rate	$3,785.25
Max. Negotiated Rate	$6,106.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,047.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,106.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,551.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,785.25

DUAL MOBILITY LINER SZ 5

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270706144
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

DUAL MOBILITY LINER SZ 5

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270706144
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

DUAL SPIKE ADAPTER

Facility

$72.10

Hospital Charge Code	270681126
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.05
Rate for Payer: Aetna Commercial	$27.40
Rate for Payer: Aetna Medicare Advantage	$21.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.39
Rate for Payer: Cigna Commercial	$36.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.63
Rate for Payer: Oxford Commercial	$14.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.81
Rate for Payer: UnitedHealthcare Commercial	$14.42
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

DUAL SPIKE ADAPTER

Facility

$72.10

Hospital Charge Code	270681126
Hospital Revenue Code	272
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$10.81
Rate for Payer: Qualcare PPO/HMO/WC	$10.81

DUET DRAINAGE EXTERNAL SYS KIT

Facility

$1,125.00

Hospital Charge Code	270670959
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

DUET DRAINAGE EXTERNAL SYS KIT

Facility

$1,125.00

Hospital Charge Code	270670959
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

DULOXETINE 20 MG

Facility

$52.13

Service Code	NDC 2323560
Hospital Charge Code	60629913
Hospital Revenue Code	250
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$7.82
Rate for Payer: Qualcare PPO/HMO/WC	$7.82

Know your out-of-pocket cost for care.

All Charges