Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COTAZYM/CAP

Facility

$3.00

Hospital Charge Code	60632754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COT FINGER 3-1/2 12203

Facility

$49.10

Hospital Charge Code	270650448
Hospital Revenue Code	270
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$7.37

COT FINGER 3-1/2 12203

Facility

$49.10

Hospital Charge Code	270650448
Hospital Revenue Code	270
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.55
Rate for Payer: Aetna Commercial	$18.66
Rate for Payer: Aetna Medicare Advantage	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.52
Rate for Payer: Cigna Commercial	$24.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$9.82
Rate for Payer: Qualcare PPO/HMO/WC	$7.37
Rate for Payer: UnitedHealthcare Commercial	$9.82
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

COTININE, URINE

Facility

$333.00

Service Code	HCPCS 86022
Hospital Charge Code	38473083
Hospital Revenue Code	302
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

COTININE, URINE

Facility

$333.00

Service Code	HCPCS 86022
Hospital Charge Code	38473083
Hospital Revenue Code	302
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

COTRIMOXAZOLE INJ

Facility

$70.40

Hospital Charge Code	6001390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

COTRIMOXAZOLE INJ

Facility

$70.40

Hospital Charge Code	6001390
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

COTRIMOXAZOLE TAB 800MG/160MG

Facility

$1.95

Hospital Charge Code	6022370
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

COTRIMOXAZOLE TAB 800MG/160MG

Facility

$1.95

Hospital Charge Code	6022370
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

COTTON ALLOG WEDGE 6X24X14MM

Facility

$11,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270671557
Hospital Revenue Code	278
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$265.10
Rate for Payer: Wellpoint Medicaid Managed Care	$291.50

COTTON ALLOG WEDGE 6X24X14MM

Facility

$11,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270671557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

COTTON BALLS STER

Facility

$2.40

Hospital Charge Code	270649384
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna Commercial	$0.91
Rate for Payer: Aetna Medicare Advantage	$0.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.61
Rate for Payer: Cigna Commercial	$1.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.72
Rate for Payer: Oxford Commercial	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.36
Rate for Payer: UnitedHealthcare Commercial	$0.48
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

COTTON BALLS STER

Facility

$2.40

Hospital Charge Code	270649384
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Qualcare PPO/HMO/WC	$0.36

COTTON FLAT PLATE

Facility

$4,290.00

Hospital Charge Code	270656500
Hospital Revenue Code	278
Min. Negotiated Rate	$103.39
Max. Negotiated Rate	$2,145.00
Rate for Payer: Aetna Commercial	$1,630.20
Rate for Payer: Aetna Medicare Advantage	$1,287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.95
Rate for Payer: Cigna Commercial	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$643.50
Rate for Payer: UnitedHealthcare Community & State	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$113.69

COTTON FLAT PLATE

Facility

$4,290.00

Hospital Charge Code	270656500
Hospital Revenue Code	278
Min. Negotiated Rate	$643.50
Max. Negotiated Rate	$1,038.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$643.50

COTTON-LEUNG STENT ONLY 7FR

Facility

$253.00

Hospital Charge Code	270332242
Hospital Revenue Code	278
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

COTTON-LEUNG STENT ONLY 7FR

Facility

$253.00

Hospital Charge Code	270332242
Hospital Revenue Code	278
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

COTTON WEDGE 15X20X8MM

Facility

$14,490.00

Hospital Charge Code	270700419
Hospital Revenue Code	278
Min. Negotiated Rate	$349.21
Max. Negotiated Rate	$7,245.00
Rate for Payer: Aetna Commercial	$5,506.20
Rate for Payer: Aetna Medicare Advantage	$4,347.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,694.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,694.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,898.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,694.95
Rate for Payer: Cigna Commercial	$7,245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,506.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,187.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,173.50
Rate for Payer: UnitedHealthcare Community & State	$349.21
Rate for Payer: Wellpoint Medicaid Managed Care	$383.99

COTTON WEDGE 15X20X8MM

Facility

$14,490.00

Hospital Charge Code	270700419
Hospital Revenue Code	278
Min. Negotiated Rate	$2,173.50
Max. Negotiated Rate	$3,506.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,898.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,506.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,187.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,173.50

COTTON WEDGE 8MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270674212
Hospital Revenue Code	278
Min. Negotiated Rate	$119.05
Max. Negotiated Rate	$2,470.00
Rate for Payer: Aetna Commercial	$1,877.20
Rate for Payer: Aetna Medicare Advantage	$1,482.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,259.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,259.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,259.70
Rate for Payer: Cigna Commercial	$2,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.80
Rate for Payer: Qualcare PPO/HMO/WC	$741.00
Rate for Payer: UnitedHealthcare Community & State	$119.05
Rate for Payer: Wellpoint Medicaid Managed Care	$130.91

COTTON WEDGE 8MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270674212
Hospital Revenue Code	278
Min. Negotiated Rate	$741.00
Max. Negotiated Rate	$1,195.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.80
Rate for Payer: Qualcare PPO/HMO/WC	$741.00

COTTON WEDGE BIO 20X14X10X6.5

Facility

$10,136.50

Service Code	HCPCS C1716
Hospital Charge Code	270702334
Hospital Revenue Code	278
Min. Negotiated Rate	$1,520.47
Max. Negotiated Rate	$2,453.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,027.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,230.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,520.47

COTTON WEDGE BIO 20X14X10X6.5

Facility

$10,136.50

Service Code	HCPCS C1716
Hospital Charge Code	270702334
Hospital Revenue Code	278
Min. Negotiated Rate	$244.29
Max. Negotiated Rate	$2,453.03
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,027.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,230.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,520.47
Rate for Payer: UnitedHealthcare Community & State	$244.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$268.62

COUMADIN/10MG/TAB

Facility

$4.00

Hospital Charge Code	60632756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

COUMADIN/10MG/TAB

Facility

$4.00

Hospital Charge Code	60632756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges