Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLOTRIMAZOLE TAB VAG 100MG

Facility

$21.15

Hospital Charge Code	6001309
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CLOTTIN FACTR VIII VON WILLEBR

Facility

$162.50

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

CLOTTIN FACTR VIII VON WILLEBR

Facility

$162.50

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$81.25
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.38
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.31

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$29.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.88
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: Cigna Medicare Advantage	$9.11
Rate for Payer: Clover Medicare Advantage	$8.65
Rate for Payer: EmblemHealth Commercial	$27.33
Rate for Payer: Humana Medicare Advantage	$9.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.11
Rate for Payer: Wellcare Medicare Advantage	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

CLOTTING INH/ANTICOAG PROT C

Facility

$97.95

Service Code	HCPCS 85303
Hospital Charge Code	38477120
Hospital Revenue Code	305
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$14.69
Rate for Payer: Qualcare PPO/HMO/WC	$14.69

CLOTTING INH/ANTICOAG PROT C

Facility

$97.95

Service Code	HCPCS 85303
Hospital Charge Code	38477120
Hospital Revenue Code	305
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.64
Rate for Payer: Aetna Medicare Advantage	$44.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.96
Rate for Payer: Cigna Commercial	$48.98
Rate for Payer: Cigna Medicare Advantage	$13.84
Rate for Payer: Clover Medicare Advantage	$13.15
Rate for Payer: EmblemHealth Commercial	$41.52
Rate for Payer: Humana Medicare Advantage	$14.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.84
Rate for Payer: Wellcare Medicare Advantage	$13.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

CLOTTING INH/ANTICOAG PROTEIN

Facility

$108.50

Service Code	HCPCS 85306
Hospital Charge Code	38477130
Hospital Revenue Code	305
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.67
Rate for Payer: Aetna Medicare Advantage	$49.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.30
Rate for Payer: Cigna Commercial	$54.25
Rate for Payer: Cigna Medicare Advantage	$15.32
Rate for Payer: Clover Medicare Advantage	$14.55
Rate for Payer: EmblemHealth Commercial	$45.96
Rate for Payer: Humana Medicare Advantage	$15.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.32
Rate for Payer: Wellcare Medicare Advantage	$15.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.88

CLOTTING INH/ANTICOAG PROTEIN

Facility

$108.50

Service Code	HCPCS 85306
Hospital Charge Code	38477130
Hospital Revenue Code	305
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$16.27

CLOTTRIEVER SYSTEM

Facility

$45,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270697175
Hospital Revenue Code	278
Min. Negotiated Rate	$6,750.00
Max. Negotiated Rate	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,890.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,750.00

CLOTTRIEVER SYSTEM

Facility

$45,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270697175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.50
Max. Negotiated Rate	$22,500.00
Rate for Payer: Aetna Commercial	$17,100.00
Rate for Payer: Aetna Medicare Advantage	$13,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,475.00
Rate for Payer: Cigna Commercial	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,890.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,750.00
Rate for Payer: UnitedHealthcare Community & State	$1,084.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1,192.50

CLOURSE DEVICE CELT 5F

Facility

$5,000.00

Hospital Charge Code	270705360
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOURSE DEVICE CELT 5F

Facility

$5,000.00

Hospital Charge Code	270705360
Hospital Revenue Code	279
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

CLOURSE DEVICE CELT 6F

Facility

$5,000.00

Hospital Charge Code	270705361
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOURSE DEVICE CELT 6F

Facility

$5,000.00

Hospital Charge Code	270705361
Hospital Revenue Code	279
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

CLOURSE DEVICE CELT 7F

Facility

$5,000.00

Hospital Charge Code	270705362
Hospital Revenue Code	279
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

CLOURSE DEVICE CELT 7F

Facility

$5,000.00

Hospital Charge Code	270705362
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOVERLEAF 3-HOLE 2452-088-03

Facility

$422.45

Hospital Charge Code	270610281
Hospital Revenue Code	272
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$211.22
Rate for Payer: Aetna Commercial	$160.53
Rate for Payer: Aetna Medicare Advantage	$126.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.72
Rate for Payer: Cigna Commercial	$211.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.73
Rate for Payer: Oxford Commercial	$84.49
Rate for Payer: Qualcare PPO/HMO/WC	$63.37
Rate for Payer: UnitedHealthcare Commercial	$84.49
Rate for Payer: UnitedHealthcare Community & State	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.19

CLOVERLEAF 3-HOLE 2452-088-03

Facility

$422.45

Hospital Charge Code	270610281
Hospital Revenue Code	272
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$63.37
Rate for Payer: Qualcare PPO/HMO/WC	$63.37

CLOZAPINE

Facility

$390.00

Service Code	HCPCS 80159
Hospital Charge Code	39900480
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.81
Rate for Payer: Aetna Medicare Advantage	$65.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.74
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.15
Rate for Payer: Clover Medicare Advantage	$19.14
Rate for Payer: EmblemHealth Commercial	$60.45
Rate for Payer: Humana Medicare Advantage	$20.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.15
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	$16.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.15
Rate for Payer: Wellcare Medicare Advantage	$20.15
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CLOZAPINE

Facility

$390.00

Service Code	HCPCS 80159
Hospital Charge Code	39900480
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOZAPINE 100 MG TAB

Facility

$22.31

Service Code	NDC 93777201
Hospital Charge Code	60628808
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$8.48
Rate for Payer: Aetna Medicare Advantage	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.69
Rate for Payer: Cigna Commercial	$11.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.69
Rate for Payer: Oxford Commercial	$4.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.35
Rate for Payer: UnitedHealthcare Commercial	$4.46
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

CLOZAPINE 100 MG TAB

Facility

$22.31

Service Code	NDC 93777201
Hospital Charge Code	60628808
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$3.35

CLOZAPINE 25 MG TAB

Facility

$38.79

Service Code	NDC 78012606
Hospital Charge Code	60628809
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.39
Rate for Payer: Aetna Commercial	$14.74
Rate for Payer: Aetna Medicare Advantage	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.89
Rate for Payer: Cigna Commercial	$19.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.64
Rate for Payer: Oxford Commercial	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.82
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

CLOZAPINE 25 MG TAB

Facility

$38.79

Service Code	NDC 78012606
Hospital Charge Code	60628809
Hospital Revenue Code	250
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$5.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.82

Know your out-of-pocket cost for care.

All Charges