Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAFFEINE CITRATE 20MG/ML INJ

Facility

$93.80

Service Code	HCPCS J0706
Hospital Charge Code	6063943068
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$46.90
Rate for Payer: Aetna Commercial	$35.64
Rate for Payer: Aetna Medicare Advantage	$28.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.92
Rate for Payer: Cigna Commercial	$46.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.07
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

CAFFEINE CITRATE 20MG/ML INJ

Facility

$93.80

Service Code	HCPCS J0706
Hospital Charge Code	6063943068
Hospital Revenue Code	636
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$22.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.07

CAFFEINE (QUANT SERUM)

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3007267
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CAFFEINE (QUANT SERUM)

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3007267
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

CAFFEINE (QUANT URINE)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3031572
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
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	$90.83
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	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
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	$4.81

CAFFEINE (QUANT URINE)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3031572
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CAFFEINE-SODIUM 250MG/ML 2ML I

Facility

$144.85

Hospital Charge Code	60628780
Hospital Revenue Code	250
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.42
Rate for Payer: Aetna Commercial	$55.04
Rate for Payer: Aetna Medicare Advantage	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.94
Rate for Payer: Cigna Commercial	$72.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.45
Rate for Payer: Oxford Commercial	$28.97
Rate for Payer: Qualcare PPO/HMO/WC	$21.73
Rate for Payer: UnitedHealthcare Commercial	$28.97
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

CAFFEINE-SODIUM 250MG/ML 2ML I

Facility

$144.85

Hospital Charge Code	60628780
Hospital Revenue Code	250
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$21.73
Rate for Payer: Qualcare PPO/HMO/WC	$21.73

CAFFEINE TAB 100MG

Facility

$3.20

Hospital Charge Code	60628580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

CAFFEINE TAB 100MG

Facility

$3.20

Hospital Charge Code	60628580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CAFF & SODIUM BENZOATE 0.5/2ML

Facility

$41.60

Hospital Charge Code	6016554
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

CAFF & SODIUM BENZOATE 0.5/2ML

Facility

$41.60

Hospital Charge Code	6016554
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$3,908.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$389.21
Max. Negotiated Rate	$8,075.00
Rate for Payer: Aetna Commercial	$6,137.00
Rate for Payer: Aetna Medicare Advantage	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,118.25
Rate for Payer: Cigna Commercial	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50
Rate for Payer: UnitedHealthcare Community & State	$389.21
Rate for Payer: Wellpoint Medicaid Managed Care	$427.98

CAGE 10X24X11MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705930
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X11MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705930
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$642.51
Max. Negotiated Rate	$13,330.00
Rate for Payer: Aetna Commercial	$10,130.80
Rate for Payer: Aetna Medicare Advantage	$7,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,798.30
Rate for Payer: Cigna Commercial	$13,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,865.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00
Rate for Payer: UnitedHealthcare Community & State	$642.51
Rate for Payer: Wellpoint Medicaid Managed Care	$706.49

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$6,451.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,865.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 11X27X11MM

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705993
Hospital Revenue Code	278
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$313.30
Rate for Payer: Wellpoint Medicaid Managed Care	$344.50

CAGE 11X27X11MM

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

Know your out-of-pocket cost for care.

All Charges