Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLEANSER DM WD 8oz 50484492000

Facility

$26.15

Hospital Charge Code	270631760
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.92

CLEANSER FOAM ALOE VESTA 8OZ

Facility

$13.52

Hospital Charge Code	270649372
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.76
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: Aetna Medicare Advantage	$4.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.45
Rate for Payer: Cigna Commercial	$6.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

CLEANSER FOAM ALOE VESTA 8OZ

Facility

$13.52

Hospital Charge Code	270649372
Hospital Revenue Code	272
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

CLEANSER SKINTEGY 16oz MSC6016

Facility

$20.11

Hospital Charge Code	270640866
Hospital Revenue Code	272
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02

CLEANSER SKINTEGY 16oz MSC6016

Facility

$20.11

Hospital Charge Code	270640866
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna Commercial	$7.64
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.13
Rate for Payer: Cigna Commercial	$10.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02
Rate for Payer: UnitedHealthcare Commercial	$4.02
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CLEANSER WOUND DERMAL 12oz

Facility

$27.94

Hospital Charge Code	270649371
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

CLEANSER WOUND DERMAL 12oz

Facility

$27.94

Hospital Charge Code	270649371
Hospital Revenue Code	272
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.97
Rate for Payer: Aetna Commercial	$10.62
Rate for Payer: Aetna Medicare Advantage	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.38
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$5.59
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

CLEARCHEST COMFORT BAND EACH

Facility

$314.50

Hospital Charge Code	270692620
Hospital Revenue Code	271
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$157.25
Rate for Payer: Aetna Commercial	$119.51
Rate for Payer: Aetna Medicare Advantage	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.20
Rate for Payer: Cigna Commercial	$157.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.35
Rate for Payer: Oxford Commercial	$62.90
Rate for Payer: Qualcare PPO/HMO/WC	$47.17
Rate for Payer: UnitedHealthcare Commercial	$62.90
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: Wellpoint Medicaid Managed Care	$8.33

CLEARCHEST COMFORT BAND EACH

Facility

$314.50

Hospital Charge Code	270692620
Hospital Revenue Code	271
Min. Negotiated Rate	$47.17
Max. Negotiated Rate	$47.17
Rate for Payer: Qualcare PPO/HMO/WC	$47.17

CLEARCHEST DISP HOSE 1 PR

Facility

$80.00

Hospital Charge Code	270692623
Hospital Revenue Code	271
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

CLEARCHEST DISP HOSE 1 PR

Facility

$80.00

Hospital Charge Code	270692623
Hospital Revenue Code	271
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

CLEARCUT SLIT KNIFE

Facility

$245.00

Hospital Charge Code	270659720
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

CLEARCUT SLIT KNIFE

Facility

$245.00

Hospital Charge Code	270659720
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$49.00
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CLEARMIX SINGLE DOUBLE MIX

Facility

$625.00

Hospital Charge Code	270683515
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

CLEARMIX SINGLE DOUBLE MIX

Facility

$625.00

Hospital Charge Code	270683515
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CLEARMIX TRIPLE MIX

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270686539
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

CLEARMIX TRIPLE MIX

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270686539
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

CLEFT LIP AND PALATE REPAIR

Facility

$10,373.30

Service Code	APR-DRG 0951
Min. Negotiated Rate	$10,169.90
Max. Negotiated Rate	$10,373.30
Rate for Payer: UnitedHealthcare Community & State	$10,169.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,373.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10,169.90

CLEFT LIP AND PALATE REPAIR

Facility

$27,644.61

Service Code	APR-DRG 0954
Min. Negotiated Rate	$27,102.56
Max. Negotiated Rate	$27,644.61
Rate for Payer: UnitedHealthcare Community & State	$27,102.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,644.61
Rate for Payer: Wellpoint Medicaid Managed Care	$27,102.56

CLEFT LIP AND PALATE REPAIR

Facility

$16,611.25

Service Code	APR-DRG 0953
Min. Negotiated Rate	$16,285.54
Max. Negotiated Rate	$16,611.25
Rate for Payer: UnitedHealthcare Community & State	$16,285.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,611.25
Rate for Payer: Wellpoint Medicaid Managed Care	$16,285.54

CLEFT LIP AND PALATE REPAIR

Facility

$11,643.59

Service Code	APR-DRG 0952
Min. Negotiated Rate	$11,415.28
Max. Negotiated Rate	$11,643.59
Rate for Payer: UnitedHealthcare Community & State	$11,415.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,643.59
Rate for Payer: Wellpoint Medicaid Managed Care	$11,415.28

CLEMASTINE 2.68 MG TAB

Facility

$7.25

Hospital Charge Code	60627223
Hospital Revenue Code	252
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CLEMASTINE 2.68 MG TAB

Facility

$7.25

Hospital Charge Code	60627223
Hospital Revenue Code	252
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

CLEMASTINE PPA TAB CR 75

Facility

$3.20

Hospital Charge Code	60627224
Hospital Revenue Code	252
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CLEMASTINE PPA TAB CR 75

Facility

$3.20

Hospital Charge Code	60627224
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

Know your out-of-pocket cost for care.

All Charges