Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CYCLOSPORINE (SPECIFIC BLOOD)

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3031358
Hospital Revenue Code	301
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00

CYGNUS CERV PLATE SYS 30MM 2LV

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705106
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

CYGNUS CERV PLATE SYS 30MM 2LV

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CYGNUS MORE CERV PLATE SYS 10M

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704630
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

CYGNUS MORE CERV PLATE SYS 10M

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

CYLINDER 700LGX 15CM

Facility

$41,460.00

Service Code	HCPCS C1813
Hospital Charge Code	270651347
Hospital Revenue Code	278
Min. Negotiated Rate	$6,219.00
Max. Negotiated Rate	$10,033.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,292.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,033.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,121.20
Rate for Payer: Qualcare PPO/HMO/WC	$6,219.00

CYLINDER 700LGX 15CM

Facility

$41,460.00

Service Code	HCPCS C1813
Hospital Charge Code	270651347
Hospital Revenue Code	278
Min. Negotiated Rate	$999.19
Max. Negotiated Rate	$20,730.00
Rate for Payer: Aetna Commercial	$15,754.80
Rate for Payer: Aetna Medicare Advantage	$12,438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,572.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,572.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,292.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,572.30
Rate for Payer: Cigna Commercial	$20,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,033.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,121.20
Rate for Payer: Qualcare PPO/HMO/WC	$6,219.00
Rate for Payer: UnitedHealthcare Community & State	$999.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,098.69

CYLINDER CAST THGH TO ANK

Facility

$618.00

Service Code	HCPCS 29365
Hospital Charge Code	94186055
Hospital Revenue Code	361
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

CYLINDER CAST THGH TO ANK

Facility

$618.00

Service Code	HCPCS 29365
Hospital Charge Code	94186055
Hospital Revenue Code	361
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

CYLINDER CXR 16CM

Facility

$46,295.00

Hospital Charge Code	270676892
Hospital Revenue Code	278
Min. Negotiated Rate	$6,944.25
Max. Negotiated Rate	$11,203.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,203.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,184.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,944.25

CYLINDER CXR 16CM

Facility

$46,295.00

Hospital Charge Code	270676892
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.71
Max. Negotiated Rate	$23,147.50
Rate for Payer: Aetna Commercial	$17,592.10
Rate for Payer: Aetna Medicare Advantage	$13,888.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,805.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,805.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,805.23
Rate for Payer: Cigna Commercial	$23,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,203.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,184.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,944.25
Rate for Payer: UnitedHealthcare Community & State	$1,115.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1,226.82

CYLINDER SET W/PUMP

Facility

$51,010.00

Service Code	HCPCS C1813
Hospital Charge Code	270687910
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.34
Max. Negotiated Rate	$25,505.00
Rate for Payer: Aetna Commercial	$19,383.80
Rate for Payer: Aetna Medicare Advantage	$15,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,007.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,007.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,007.55
Rate for Payer: Cigna Commercial	$25,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,344.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,222.20
Rate for Payer: Qualcare PPO/HMO/WC	$7,651.50
Rate for Payer: UnitedHealthcare Community & State	$1,229.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1,351.77

CYLINDER SET W/PUMP

Facility

$51,010.00

Service Code	HCPCS C1813
Hospital Charge Code	270687910
Hospital Revenue Code	278
Min. Negotiated Rate	$7,651.50
Max. Negotiated Rate	$12,344.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,344.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,222.20
Rate for Payer: Qualcare PPO/HMO/WC	$7,651.50

CYLINDER TITAN 98141C

Facility

$23,436.00

Hospital Charge Code	270633692
Hospital Revenue Code	272
Min. Negotiated Rate	$564.81
Max. Negotiated Rate	$11,718.00
Rate for Payer: Aetna Commercial	$8,905.68
Rate for Payer: Aetna Medicare Advantage	$7,030.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,976.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,976.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,976.18
Rate for Payer: Cigna Commercial	$11,718.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,030.80
Rate for Payer: Oxford Commercial	$4,687.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,515.40
Rate for Payer: UnitedHealthcare Commercial	$4,687.20
Rate for Payer: UnitedHealthcare Community & State	$564.81
Rate for Payer: Wellpoint Medicaid Managed Care	$621.05

CYLINDER TITAN 98141C

Facility

$23,436.00

Hospital Charge Code	270633692
Hospital Revenue Code	272
Min. Negotiated Rate	$3,515.40
Max. Negotiated Rate	$3,515.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,515.40

CYLINDER TITAN 98161C

Facility

$23,436.00

Hospital Charge Code	270633681
Hospital Revenue Code	272
Min. Negotiated Rate	$3,515.40
Max. Negotiated Rate	$3,515.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,515.40

CYLINDER TITAN 98161C

Facility

$23,436.00

Hospital Charge Code	270633681
Hospital Revenue Code	272
Min. Negotiated Rate	$564.81
Max. Negotiated Rate	$11,718.00
Rate for Payer: Aetna Commercial	$8,905.68
Rate for Payer: Aetna Medicare Advantage	$7,030.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,976.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,976.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,976.18
Rate for Payer: Cigna Commercial	$11,718.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,030.80
Rate for Payer: Oxford Commercial	$4,687.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,515.40
Rate for Payer: UnitedHealthcare Commercial	$4,687.20
Rate for Payer: UnitedHealthcare Community & State	$564.81
Rate for Payer: Wellpoint Medicaid Managed Care	$621.05

CYLINDRICAL PROBE AND TUBE SET

Facility

$2,983.65

Hospital Charge Code	270704080
Hospital Revenue Code	279
Min. Negotiated Rate	$71.91
Max. Negotiated Rate	$1,491.83
Rate for Payer: Aetna Commercial	$1,133.79
Rate for Payer: Aetna Medicare Advantage	$895.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$760.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$760.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$760.83
Rate for Payer: Cigna Commercial	$1,491.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$895.10
Rate for Payer: Oxford Commercial	$596.73
Rate for Payer: Qualcare PPO/HMO/WC	$447.55
Rate for Payer: UnitedHealthcare Commercial	$596.73
Rate for Payer: UnitedHealthcare Community & State	$71.91
Rate for Payer: Wellpoint Medicaid Managed Care	$79.07

CYLINDRICAL PROBE AND TUBE SET

Facility

$2,983.65

Hospital Charge Code	270704080
Hospital Revenue Code	279
Min. Negotiated Rate	$447.55
Max. Negotiated Rate	$447.55
Rate for Payer: Qualcare PPO/HMO/WC	$447.55

CYMBALTA 30MG CAP

Facility

$19.00

Hospital Charge Code	60635664
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CYMBALTA 30MG CAP

Facility

$19.00

Hospital Charge Code	60635664
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

CYMBALTA 30MG CAP

Facility

$20.00

Hospital Charge Code	60635649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CYMBALTA 30MG CAP

Facility

$20.00

Hospital Charge Code	60635649
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

CYPROHEPTADINE 4 MG TAB

Facility

$7.17

Service Code	NDC 93292901
Hospital Charge Code	60627225
Hospital Revenue Code	251
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

CYPROHEPTADINE 4 MG TAB

Facility

$7.17

Service Code	NDC 93292901
Hospital Charge Code	60627225
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.43
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

Know your out-of-pocket cost for care.

All Charges