Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CADEXOMER IODINE 0.9% GEL

Facility

$918.30

Service Code	NDC 40565012249
Hospital Charge Code	60630080
Hospital Revenue Code	250
Min. Negotiated Rate	$137.75
Max. Negotiated Rate	$137.75
Rate for Payer: Qualcare PPO/HMO/WC	$137.75

CADEXOMER IODINE 40 GM GEL

Facility

$95.75

Hospital Charge Code	60630016
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$47.88
Rate for Payer: Aetna Commercial	$36.38
Rate for Payer: Aetna Medicare Advantage	$28.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.42
Rate for Payer: Cigna Commercial	$47.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.73
Rate for Payer: Oxford Commercial	$19.15
Rate for Payer: Qualcare PPO/HMO/WC	$14.36
Rate for Payer: UnitedHealthcare Commercial	$19.15
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

CADEXOMER IODINE 40 GM GEL

Facility

$95.75

Hospital Charge Code	60630016
Hospital Revenue Code	250
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$14.36
Rate for Payer: Qualcare PPO/HMO/WC	$14.36

CAD FOR DIAG MAMMO

Facility

$263.00

Service Code	HCPCS 77051
Hospital Charge Code	94061443
Hospital Revenue Code	401
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$99.94
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.90
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.45
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

CAD FOR DIAG MAMMO

Facility

$263.00

Service Code	HCPCS 77051
Hospital Charge Code	94061443
Hospital Revenue Code	401
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$39.45
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

CADIUM (URINE)

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3031069
Hospital Revenue Code	301
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

CADIUM (URINE)

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3031069
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.32

CADIUM,URINE

Facility

$372.00

Service Code	HCPCS 82300
Hospital Charge Code	38472144
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

CADIUM,URINE

Facility

$372.00

Service Code	HCPCS 82300
Hospital Charge Code	38472144
Hospital Revenue Code	301
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

CADMIUM

Facility

$157.60

Hospital Charge Code	39990166B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.89
Rate for Payer: Aetna Medicare Advantage	$47.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.19
Rate for Payer: Cigna Commercial	$78.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.64
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.18

CADMIUM

Facility

$157.60

Hospital Charge Code	39990166B
Hospital Revenue Code	301
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$23.64

CADMIUM

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3007259
Hospital Revenue Code	301
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

CADMIUM

Facility

$372.00

Service Code	HCPCS 82300
Hospital Charge Code	38473062
Hospital Revenue Code	301
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

CADMIUM

Facility

$372.00

Service Code	HCPCS 82300
Hospital Charge Code	38473062
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401083018B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CADMIUM

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3007259
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.32

CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401083018B
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
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	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CADMIUM URINE

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3031070B
Hospital Revenue Code	301
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

CADMIUM URINE

Facility

$200.85

Service Code	HCPCS 82300
Hospital Charge Code	3031070B
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.33
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.32

CAD-SCREENING MAMMOGRAPHY

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2008050
Hospital Revenue Code	403
Min. Negotiated Rate	$26.45
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$417.09
Rate for Payer: Aetna Medicare Advantage	$329.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.89
Rate for Payer: Cigna Commercial	$548.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.28
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.64
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$26.45
Rate for Payer: Wellpoint Medicaid Managed Care	$29.09

CAD-SCREENING MAMMOGRAPHY

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2008050
Hospital Revenue Code	403
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

CAFERGOT/TAB

Facility

$6.00

Hospital Charge Code	60632596
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CAFERGOT/TAB

Facility

$6.00

Hospital Charge Code	60632596
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CAFFEINE

Facility

$272.00

Service Code	HCPCS 80299
Hospital Charge Code	38472922
Hospital Revenue Code	301
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

CAFFEINE

Facility

$272.00

Service Code	HCPCS 80299
Hospital Charge Code	38472922
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

Know your out-of-pocket cost for care.

All Charges