Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH WHOLE BLD 48H

Facility

$585.00

Service Code	HCPCS P9010
Hospital Charge Code	397031035
Hospital Revenue Code	390
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

CH WHOLE BLD 48H

Facility

$585.00

Service Code	HCPCS P9010
Hospital Charge Code	397031035
Hospital Revenue Code	390
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$600.44
Rate for Payer: Aetna Medicare Advantage	$715.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$220.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.84
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Cigna Medicare Advantage	$220.75
Rate for Payer: Clover Medicare Advantage	$209.71
Rate for Payer: EmblemHealth Commercial	$662.25
Rate for Payer: Humana Medicare Advantage	$227.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$220.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.75
Rate for Payer: Wellcare Medicare Advantage	$220.75
Rate for Payer: Wellpoint Medicaid Managed Care	$15.50

CH WHOLE BLOOD

Facility

$585.00

Service Code	HCPCS P9010
Hospital Charge Code	397031004
Hospital Revenue Code	390
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

CH WHOLE BLOOD

Facility

$585.00

Service Code	HCPCS P9010
Hospital Charge Code	397031004
Hospital Revenue Code	390
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$600.44
Rate for Payer: Aetna Medicare Advantage	$715.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$220.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.84
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Cigna Medicare Advantage	$220.75
Rate for Payer: Clover Medicare Advantage	$209.71
Rate for Payer: EmblemHealth Commercial	$662.25
Rate for Payer: Humana Medicare Advantage	$227.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$220.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.75
Rate for Payer: Wellcare Medicare Advantage	$220.75
Rate for Payer: Wellpoint Medicaid Managed Care	$15.50

CHYLMD TRACH DNA AMP PROBE

Facility

$390.00

Service Code	HCPCS 87491
Hospital Charge Code	3990245A
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CHYLMD TRACH DNA AMP PROBE

Facility

$390.00

Service Code	HCPCS 87491
Hospital Charge Code	3990245A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH ZINC

Facility

$134.00

Service Code	HCPCS 84630
Hospital Charge Code	397072142
Hospital Revenue Code	301
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.98
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.11
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: Cigna Medicare Advantage	$11.39
Rate for Payer: Clover Medicare Advantage	$10.82
Rate for Payer: EmblemHealth Commercial	$34.17
Rate for Payer: Humana Medicare Advantage	$11.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.39
Rate for Payer: Wellcare Medicare Advantage	$11.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

CH ZINC

Facility

$134.00

Service Code	HCPCS 84630
Hospital Charge Code	397072142
Hospital Revenue Code	301
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

CH ZOLOFT/SERTALINE

Facility

$85.00

Service Code	HCPCS 80299
Hospital Charge Code	397073138
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

CH ZOLOFT/SERTALINE

Facility

$85.00

Service Code	HCPCS 80299
Hospital Charge Code	397073138
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
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	$42.50
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	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
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	$2.25

CH ZONEGRAN

Facility

$154.00

Service Code	HCPCS 80299
Hospital Charge Code	397071085
Hospital Revenue Code	301
Min. Negotiated Rate	$4.08
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	$77.00
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	$46.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
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	$4.08

CH ZONEGRAN

Facility

$154.00

Service Code	HCPCS 80299
Hospital Charge Code	397071085
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

CIBALITH-S/480ML

Facility

$21.00

Hospital Charge Code	60634583
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

CIBALITH-S/480ML

Facility

$21.00

Hospital Charge Code	60634583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CICLOPIROX 0.77% CRE

Facility

$113.00

Hospital Charge Code	60629288
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$56.50
Rate for Payer: Aetna Commercial	$42.94
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$22.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$22.60
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

CICLOPIROX 0.77% CRE

Facility

$113.00

Hospital Charge Code	60629288
Hospital Revenue Code	250
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

CICLOPIROXOLAMINE TOP 90 GM

Facility

$192.65

Hospital Charge Code	6001192
Hospital Revenue Code	252
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$28.90
Rate for Payer: Qualcare PPO/HMO/WC	$28.90

CICLOPIROXOLAMINE TOP 90 GM

Facility

$192.65

Hospital Charge Code	6001192
Hospital Revenue Code	252
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$96.33
Rate for Payer: Aetna Commercial	$73.21
Rate for Payer: Aetna Medicare Advantage	$57.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.13
Rate for Payer: Cigna Commercial	$96.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.80
Rate for Payer: Oxford Commercial	$38.53
Rate for Payer: Qualcare PPO/HMO/WC	$28.90
Rate for Payer: UnitedHealthcare Commercial	$38.53
Rate for Payer: UnitedHealthcare Community & State	$4.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

CIDEX OPA SOLUTION

Facility

$124.45

Hospital Charge Code	270625194
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$62.23
Rate for Payer: Aetna Commercial	$47.29
Rate for Payer: Aetna Medicare Advantage	$37.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.73
Rate for Payer: Cigna Commercial	$62.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.34
Rate for Payer: Oxford Commercial	$24.89
Rate for Payer: Qualcare PPO/HMO/WC	$18.67
Rate for Payer: UnitedHealthcare Commercial	$24.89
Rate for Payer: UnitedHealthcare Community & State	$3.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.30

CIDEX OPA SOLUTION

Facility

$124.45

Hospital Charge Code	270625194
Hospital Revenue Code	272
Min. Negotiated Rate	$18.67
Max. Negotiated Rate	$18.67
Rate for Payer: Qualcare PPO/HMO/WC	$18.67

CIDOFOVIR 375 MG 5ML VIAL

Facility

$24,083.49

Service Code	HCPCS J0740
Hospital Charge Code	60630119
Hospital Revenue Code	636
Min. Negotiated Rate	$3,612.52
Max. Negotiated Rate	$5,828.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,828.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,612.52

CIDOFOVIR 375 MG 5ML VIAL

Facility

$24,083.49

Service Code	HCPCS J0740
Hospital Charge Code	60630119
Hospital Revenue Code	636
Min. Negotiated Rate	$532.75
Max. Negotiated Rate	$5,828.20
Rate for Payer: Aetna Commercial	$1,525.35
Rate for Payer: Aetna Medicare Advantage	$1,816.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,024.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,024.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$560.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$594.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,024.28
Rate for Payer: Cigna Medicare Advantage	$560.79
Rate for Payer: Clover Medicare Advantage	$532.75
Rate for Payer: EmblemHealth Commercial	$1,682.37
Rate for Payer: Humana Medicare Advantage	$577.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$560.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,828.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,612.52
Rate for Payer: UnitedHealthcare Community & State	$580.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$560.79
Rate for Payer: Wellcare Medicare Advantage	$560.79
Rate for Payer: Wellpoint Medicaid Managed Care	$638.21

CIDOFOVIR INJ 75MG/1ML

Facility

$887.25

Hospital Charge Code	60629176
Hospital Revenue Code	636
Min. Negotiated Rate	$133.09
Max. Negotiated Rate	$214.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.71
Rate for Payer: Qualcare PPO/HMO/WC	$133.09

CIDOFOVIR INJ 75MG/1ML

Facility

$887.25

Hospital Charge Code	60629176
Hospital Revenue Code	636
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$443.62
Rate for Payer: Aetna Commercial	$337.15
Rate for Payer: Aetna Medicare Advantage	$266.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.25
Rate for Payer: Cigna Commercial	$443.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.71
Rate for Payer: Qualcare PPO/HMO/WC	$133.09
Rate for Payer: UnitedHealthcare Community & State	$21.38
Rate for Payer: Wellpoint Medicaid Managed Care	$23.51

CILOSTAZOL 100 MG TAB UD

Facility

$12.19

Service Code	NDC 185022360
Hospital Charge Code	60629892
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

Know your out-of-pocket cost for care.

All Charges