Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLN REM SKIN TAGS < 15CM

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	75190035
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

CLN REM SKIN TAGS < 15CM

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	75190035
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

CLNSCPY FLX W REM LESN BY SNA

Facility

$8,878.50

Service Code	HCPCS 45385
Hospital Charge Code	16000274
Hospital Revenue Code	360
Min. Negotiated Rate	$213.97
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,663.55
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.78
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$213.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$235.28

CLNSCPY FLX W REM LESN BY SNA

Facility

$8,878.50

Service Code	HCPCS 45385
Hospital Charge Code	16000274
Hospital Revenue Code	360
Min. Negotiated Rate	$1,331.78
Max. Negotiated Rate	$1,331.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.78

CLNSPY W/HEMORROIDS LIGATION**

Facility

$861.00

Hospital Charge Code	2300069
Hospital Revenue Code	361
Min. Negotiated Rate	$129.15
Max. Negotiated Rate	$129.15
Rate for Payer: Qualcare PPO/HMO/WC	$129.15

CLNSPY W/HEMORROIDS LIGATION**

Facility

$861.00

Hospital Charge Code	2300069
Hospital Revenue Code	361
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$327.18
Rate for Payer: Aetna Medicare Advantage	$258.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.56
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	$219.56
Rate for Payer: Cigna Commercial	$430.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.30
Rate for Payer: Qualcare PPO/HMO/WC	$129.15
Rate for Payer: UnitedHealthcare Community & State	$20.75
Rate for Payer: Wellpoint Medicaid Managed Care	$22.82

CLN SURG OV NP COMPLEX

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	75190195
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

CLN SURG OV NP COMPLEX

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	75190195
Hospital Revenue Code	510
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$524.46
Rate for Payer: Aetna Commercial	$398.59
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$524.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.68
Rate for Payer: Qualcare PPO/HMO/WC	$157.34
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$27.80

CLN SURG OV NP COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	75190190
Hospital Revenue Code	510
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.46
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.31

CLN SURG OV NP COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	75190190
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

CLN SURG OV NP DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	75190185
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

CLN SURG OV NP DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	75190185
Hospital Revenue Code	510
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.64
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$19.97
Rate for Payer: Wellpoint Medicaid Managed Care	$21.96

CLOBETASOL 0.05% CREAM 30G

Facility

$1,718.28

Service Code	NDC 54569455000
Hospital Charge Code	60629135
Hospital Revenue Code	250
Min. Negotiated Rate	$41.41
Max. Negotiated Rate	$859.14
Rate for Payer: Aetna Commercial	$652.95
Rate for Payer: Aetna Medicare Advantage	$515.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.16
Rate for Payer: Cigna Commercial	$859.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.48
Rate for Payer: Oxford Commercial	$343.66
Rate for Payer: Qualcare PPO/HMO/WC	$257.74
Rate for Payer: UnitedHealthcare Commercial	$343.66
Rate for Payer: UnitedHealthcare Community & State	$41.41
Rate for Payer: Wellpoint Medicaid Managed Care	$45.53

CLOBETASOL 0.05% CREAM 30G

Facility

$1,718.28

Service Code	NDC 54569455000
Hospital Charge Code	60629135
Hospital Revenue Code	250
Min. Negotiated Rate	$257.74
Max. Negotiated Rate	$257.74
Rate for Payer: Qualcare PPO/HMO/WC	$257.74

CLOBETASOL PROP 0.05% CR 15GM

Facility

$859.14

Service Code	NDC 51672125801
Hospital Charge Code	6023413
Hospital Revenue Code	250
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.57
Rate for Payer: Aetna Commercial	$326.47
Rate for Payer: Aetna Medicare Advantage	$257.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.08
Rate for Payer: Cigna Commercial	$429.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.74
Rate for Payer: Oxford Commercial	$171.83
Rate for Payer: Qualcare PPO/HMO/WC	$128.87
Rate for Payer: UnitedHealthcare Commercial	$171.83
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

CLOBETASOL PROP 0.05% CR 15GM

Facility

$859.14

Service Code	NDC 51672125801
Hospital Charge Code	6023413
Hospital Revenue Code	250
Min. Negotiated Rate	$128.87
Max. Negotiated Rate	$128.87
Rate for Payer: Qualcare PPO/HMO/WC	$128.87

CLOBETASOL PROP 0.05% GEL 30GM

Facility

$169.65

Hospital Charge Code	60629156
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$84.83
Rate for Payer: Aetna Commercial	$64.47
Rate for Payer: Aetna Medicare Advantage	$50.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.26
Rate for Payer: Cigna Commercial	$84.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.90
Rate for Payer: Oxford Commercial	$33.93
Rate for Payer: Qualcare PPO/HMO/WC	$25.45
Rate for Payer: UnitedHealthcare Commercial	$33.93
Rate for Payer: UnitedHealthcare Community & State	$4.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

CLOBETASOL PROP 0.05% GEL 30GM

Facility

$169.65

Hospital Charge Code	60629156
Hospital Revenue Code	250
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$25.45
Rate for Payer: Qualcare PPO/HMO/WC	$25.45

CLOBETASOL PROP CRM .05% 60GM

Facility

$3,075.03

Service Code	NDC 69238153206
Hospital Charge Code	606390496
Hospital Revenue Code	250
Min. Negotiated Rate	$74.11
Max. Negotiated Rate	$1,537.52
Rate for Payer: Aetna Commercial	$1,168.51
Rate for Payer: Aetna Medicare Advantage	$922.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.13
Rate for Payer: Cigna Commercial	$1,537.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.51
Rate for Payer: Oxford Commercial	$615.01
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Commercial	$615.01
Rate for Payer: UnitedHealthcare Community & State	$74.11
Rate for Payer: Wellpoint Medicaid Managed Care	$81.49

CLOBETASOL PROP CRM .05% 60GM

Facility

$3,075.03

Service Code	NDC 69238153206
Hospital Charge Code	606390496
Hospital Revenue Code	250
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$461.25
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

CLOBETASOL PROPIONATE .05% 30G

Facility

$1,740.33

Service Code	NDC 50383026830
Hospital Charge Code	6008643
Hospital Revenue Code	250
Min. Negotiated Rate	$261.05
Max. Negotiated Rate	$261.05
Rate for Payer: Qualcare PPO/HMO/WC	$261.05

CLOBETASOL PROPIONATE .05% 30G

Facility

$1,740.33

Service Code	NDC 50383026830
Hospital Charge Code	6008643
Hospital Revenue Code	250
Min. Negotiated Rate	$41.94
Max. Negotiated Rate	$870.16
Rate for Payer: Aetna Commercial	$661.33
Rate for Payer: Aetna Medicare Advantage	$522.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.78
Rate for Payer: Cigna Commercial	$870.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.10
Rate for Payer: Oxford Commercial	$348.07
Rate for Payer: Qualcare PPO/HMO/WC	$261.05
Rate for Payer: UnitedHealthcare Commercial	$348.07
Rate for Payer: UnitedHealthcare Community & State	$41.94
Rate for Payer: Wellpoint Medicaid Managed Care	$46.12

CLOCORTOLONE 90 GM CREAM

Facility

$214.35

Hospital Charge Code	60630017
Hospital Revenue Code	250
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$32.15
Rate for Payer: Qualcare PPO/HMO/WC	$32.15

CLOCORTOLONE 90 GM CREAM

Facility

$214.35

Hospital Charge Code	60630017
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$107.17
Rate for Payer: Aetna Commercial	$81.45
Rate for Payer: Aetna Medicare Advantage	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.66
Rate for Payer: Cigna Commercial	$107.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.31
Rate for Payer: Oxford Commercial	$42.87
Rate for Payer: Qualcare PPO/HMO/WC	$32.15
Rate for Payer: UnitedHealthcare Commercial	$42.87
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

CLOMID/50MG/TAB

Facility

$38.00

Hospital Charge Code	60632716
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

Know your out-of-pocket cost for care.

All Charges