Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE ZERO PVA 7 MM LORD

Facility

$16,267.25

Service Code	HCPCS C1889
Hospital Charge Code	270692398
Hospital Revenue Code	278
Min. Negotiated Rate	$2,440.09
Max. Negotiated Rate	$3,936.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,253.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,936.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,578.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,440.09

CAGE ZEUS LORDOTIC 16X22X40

Facility

$27,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692243
Hospital Revenue Code	278
Min. Negotiated Rate	$4,125.00
Max. Negotiated Rate	$6,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00

CAGE ZEUS LORDOTIC 16X22X40

Facility

$27,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692243
Hospital Revenue Code	278
Min. Negotiated Rate	$662.75
Max. Negotiated Rate	$13,750.00
Rate for Payer: Aetna Commercial	$10,450.00
Rate for Payer: Aetna Medicare Advantage	$8,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,012.50
Rate for Payer: Cigna Commercial	$13,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00
Rate for Payer: UnitedHealthcare Community & State	$662.75
Rate for Payer: Wellpoint Medicaid Managed Care	$728.75

CAID MD EVAL

Facility

$800.80

Hospital Charge Code	84509058
Hospital Revenue Code	918
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

CAID MD EVAL

Facility

$800.80

Hospital Charge Code	84509058
Hospital Revenue Code	918
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID MEDICATION MONITORNG ONLY

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509059
Hospital Revenue Code	919
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

CAID MEDICATION MONITORNG ONLY

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509059
Hospital Revenue Code	919
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509056
Hospital Revenue Code	912
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Hospital Charge Code	84050954
Hospital Revenue Code	912
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509056
Hospital Revenue Code	912
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17.91
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Hospital Charge Code	84050954
Hospital Revenue Code	912
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR <21 YRS

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509057
Hospital Revenue Code	913
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR <21 YRS

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509057
Hospital Revenue Code	913
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17.91
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

CALADRYL/180ML

Facility

$8.00

Hospital Charge Code	60632597
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

CALADRYL/180ML

Facility

$8.00

Hospital Charge Code	60632597
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CALAMINE/120ML

Facility

$18.96

Service Code	NDC 395041396
Hospital Charge Code	60632598
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.84

CALAMINE/120ML

Facility

$18.96

Service Code	NDC 395041396
Hospital Charge Code	60632598
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.83
Rate for Payer: Cigna Commercial	$9.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.69
Rate for Payer: Oxford Commercial	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.84
Rate for Payer: UnitedHealthcare Commercial	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CALAMINE/120ML

Facility

$3.00

Hospital Charge Code	60632600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CALAMINE/120ML

Facility

$3.00

Hospital Charge Code	60632600
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

CALAMINE/120ML

Facility

$6.00

Hospital Charge Code	60632599
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

CALAMINE/120ML

Facility

$6.00

Hospital Charge Code	60632599
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CALAMINE PRAMOXINE LOTN

Facility

$47.25

Hospital Charge Code	60628410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

CALAMINE PRAMOXINE LOTN

Facility

$47.25

Hospital Charge Code	60628410
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

C.ALBICANS ABS (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C.ALBICANS ABS (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges