Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$22.20
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Oxford Commercial	$11.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$11.68
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$22.20
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Oxford Commercial	$11.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$11.68
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
Hospital Revenue Code	301
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$257.91
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$4,066.66
Rate for Payer: Aetna Medicare Advantage	$3,210.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,728.95
Rate for Payer: Cigna Commercial	$5,350.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,210.53
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$257.91
Rate for Payer: Wellpoint Medicaid Managed Care	$283.60

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$1,605.26
Max. Negotiated Rate	$1,605.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.80
Rate for Payer: Oxford Commercial	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.20
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

DUONEB 0.5MG/2.5MG

Facility

$9.20

Hospital Charge Code	60635786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

DUONEB 0.5MG/2.5MG

Facility

$9.20

Hospital Charge Code	60635786
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.60
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$2.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.35
Rate for Payer: Cigna Commercial	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.76
Rate for Payer: Oxford Commercial	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$1.84
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DUOVISC 0.5-0.55 ML

Facility

$1,338.39

Service Code	NDC 8065183150
Hospital Charge Code	60632265
Hospital Revenue Code	250
Min. Negotiated Rate	$200.76
Max. Negotiated Rate	$200.76
Rate for Payer: Qualcare PPO/HMO/WC	$200.76

DUOVISC 0.5-0.55 ML

Facility

$1,338.39

Service Code	NDC 8065183150
Hospital Charge Code	60632265
Hospital Revenue Code	250
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$669.20
Rate for Payer: Aetna Commercial	$508.59
Rate for Payer: Aetna Medicare Advantage	$401.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$341.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$341.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$341.29
Rate for Payer: Cigna Commercial	$669.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.52
Rate for Payer: Oxford Commercial	$267.68
Rate for Payer: Qualcare PPO/HMO/WC	$200.76
Rate for Payer: UnitedHealthcare Commercial	$267.68
Rate for Payer: UnitedHealthcare Community & State	$32.26
Rate for Payer: Wellpoint Medicaid Managed Care	$35.47

DUOVISC 50 VISCOAT 8065183150

Facility

$445.90

Hospital Charge Code	270632162
Hospital Revenue Code	272
Min. Negotiated Rate	$66.89
Max. Negotiated Rate	$66.89
Rate for Payer: Qualcare PPO/HMO/WC	$66.89

DUOVISC 50 VISCOAT 8065183150

Facility

$445.90

Hospital Charge Code	270632162
Hospital Revenue Code	272
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$222.95
Rate for Payer: Aetna Commercial	$169.44
Rate for Payer: Aetna Medicare Advantage	$133.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.70
Rate for Payer: Cigna Commercial	$222.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.77
Rate for Payer: Oxford Commercial	$89.18
Rate for Payer: Qualcare PPO/HMO/WC	$66.89
Rate for Payer: UnitedHealthcare Commercial	$89.18
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

DUPLEX ART IN & OUT FLOWS LIM

Facility

$17,200.00

Service Code	HCPCS 93976
Hospital Charge Code	2101134
Hospital Revenue Code	921
Min. Negotiated Rate	$117.99
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	$551.76
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	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

DUPLEX ART IN & OUT FLOWS LIM

Facility

$17,200.00

Service Code	HCPCS 93976
Hospital Charge Code	2101134
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

DUPLEX INFLO/OUTFLO BI

Facility

$1,364.48

Service Code	HCPCS 93985
Hospital Charge Code	407693985
Hospital Revenue Code	920
Min. Negotiated Rate	$204.67
Max. Negotiated Rate	$204.67
Rate for Payer: Qualcare PPO/HMO/WC	$204.67

DUPLEX INFLO/OUTFLO BI

Facility

$1,364.48

Service Code	HCPCS 93985
Hospital Charge Code	407693985
Hospital Revenue Code	920
Min. Negotiated Rate	$32.88
Max. Negotiated Rate	$2,301.00
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	$307.98
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	$409.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.67
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$32.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$36.16

DUPLEX INFLO/OUTFLO UNI

Facility

$656.27

Service Code	HCPCS 93986
Hospital Charge Code	407693986
Hospital Revenue Code	920
Min. Negotiated Rate	$15.82
Max. Negotiated Rate	$2,301.00
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	$178.31
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	$196.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.44
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$15.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.39

DUPLEX INFLO/OUTFLO UNI

Facility

$656.27

Service Code	HCPCS 93986
Hospital Charge Code	407693986
Hospital Revenue Code	920
Min. Negotiated Rate	$98.44
Max. Negotiated Rate	$98.44
Rate for Payer: Qualcare PPO/HMO/WC	$98.44

Know your out-of-pocket cost for care.

All Charges