Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CYANOCOBALAMIN 100 MCG TAB

Facility

$4.00

Service Code	NDC 904113213
Hospital Charge Code	60629046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
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

CYANOCOBALAMIN INJ 1MG/VIAL

Facility

$3.85

Hospital Charge Code	6027213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

CYANOCOBALAMIN INJ 1MG/VIAL

Facility

$3.85

Hospital Charge Code	6027213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$825.43
Max. Negotiated Rate	$825.43
Rate for Payer: Qualcare PPO/HMO/WC	$825.43

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$132.62
Max. Negotiated Rate	$2,751.42
Rate for Payer: Aetna Commercial	$2,091.08
Rate for Payer: Aetna Medicare Advantage	$1,650.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.22
Rate for Payer: Cigna Commercial	$2,751.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,650.85
Rate for Payer: Oxford Commercial	$1,100.57
Rate for Payer: Qualcare PPO/HMO/WC	$825.43
Rate for Payer: UnitedHealthcare Commercial	$1,100.57
Rate for Payer: UnitedHealthcare Community & State	$132.62
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

CYCLANDELATE/400MG/CAP

Facility

$3.00

Hospital Charge Code	60632761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CYCLANDELATE/400MG/CAP

Facility

$3.00

Hospital Charge Code	60632761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$148.58
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10.36

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CYCLIC AMP, PLASMA

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3038107
Hospital Revenue Code	307
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.50

CYCLIC AMP, PLASMA

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3038107
Hospital Revenue Code	307
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.18
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.13
Rate for Payer: Cigna Commercial	$108.33
Rate for Payer: Cigna Medicare Advantage	$25.80
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Medicare Advantage	$25.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

CYCLIC AMP,URINE

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3032061A
Hospital Revenue Code	307
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.50

CYCLIC AMP,URINE

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3032061A
Hospital Revenue Code	307
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.18
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.13
Rate for Payer: Cigna Commercial	$108.33
Rate for Payer: Cigna Medicare Advantage	$25.80
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Medicare Advantage	$25.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

CYCLIC AMP,URINE

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3032061B
Hospital Revenue Code	301
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$22.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.90

CYCLIC AMP,URINE

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3032061B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$76.33
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

CYCLIC CITRULLINATE PEP IGG

Facility

$128.00

Service Code	HCPCS 86200
Hospital Charge Code	3009984
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CYCLIC CITRULLINATE PEP IGG

Facility

$128.00

Service Code	HCPCS 86200
Hospital Charge Code	3009984
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.75
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.75
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

CYCLIC CITRU PEPTIDE AB

Facility

$91.70

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$13.76
Rate for Payer: Qualcare PPO/HMO/WC	$13.76

CYCLIC CITRU PEPTIDE AB

Facility

$91.70

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.75
Rate for Payer: Cigna Commercial	$45.85
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.76
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

Know your out-of-pocket cost for care.

All Charges