Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CALPROTECTIN, FECAL

Facility

$390.00

Service Code	HCPCS 83993
Hospital Charge Code	3038141
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CALPROTECTIN, FECAL

Facility

$390.00

Service Code	HCPCS 83993
Hospital Charge Code	3038141
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$53.39
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.86
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.63
Rate for Payer: Clover Medicare Advantage	$18.65
Rate for Payer: EmblemHealth Commercial	$58.89
Rate for Payer: Humana Medicare Advantage	$20.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.63
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	$15.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.63
Rate for Payer: Wellcare Medicare Advantage	$19.63
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CALTRATE-600/1.5GM/TAB

Facility

$1.00

Hospital Charge Code	60632607
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CALTRATE-600/1.5GM/TAB

Facility

$1.00

Hospital Charge Code	60632607
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CAMALOX/12OZ

Facility

$61.00

Hospital Charge Code	60634584
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

CAMALOX/12OZ

Facility

$61.00

Hospital Charge Code	60634584
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

CAMERA SOAKER CAP 1488/1288

Facility

$240.55

Hospital Charge Code	270688264
Hospital Revenue Code	272
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$36.08
Rate for Payer: Qualcare PPO/HMO/WC	$36.08

CAMERA SOAKER CAP 1488/1288

Facility

$240.55

Hospital Charge Code	270688264
Hospital Revenue Code	272
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.28
Rate for Payer: Aetna Commercial	$91.41
Rate for Payer: Aetna Medicare Advantage	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.34
Rate for Payer: Cigna Commercial	$120.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.17
Rate for Payer: Oxford Commercial	$48.11
Rate for Payer: Qualcare PPO/HMO/WC	$36.08
Rate for Payer: UnitedHealthcare Commercial	$48.11
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

CAMPTOSAR 20MG/ML

Facility

$2,528.00

Hospital Charge Code	60635128
Hospital Revenue Code	636
Min. Negotiated Rate	$379.20
Max. Negotiated Rate	$611.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.78
Rate for Payer: Qualcare PPO/HMO/WC	$379.20

CAMPTOSAR 20MG/ML

Facility

$2,528.00

Hospital Charge Code	60635128
Hospital Revenue Code	636
Min. Negotiated Rate	$60.92
Max. Negotiated Rate	$1,264.00
Rate for Payer: Aetna Commercial	$960.64
Rate for Payer: Aetna Medicare Advantage	$758.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$644.64
Rate for Payer: Cigna Commercial	$1,264.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.78
Rate for Payer: Qualcare PPO/HMO/WC	$379.20
Rate for Payer: UnitedHealthcare Community & State	$60.92
Rate for Payer: Wellpoint Medicaid Managed Care	$66.99

CAMPTOSAR INJ

Facility

$2,153.00

Hospital Charge Code	60635125
Hospital Revenue Code	636
Min. Negotiated Rate	$322.95
Max. Negotiated Rate	$521.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.03
Rate for Payer: Qualcare PPO/HMO/WC	$322.95

CAMPTOSAR INJ

Facility

$2,153.00

Hospital Charge Code	60635125
Hospital Revenue Code	636
Min. Negotiated Rate	$51.89
Max. Negotiated Rate	$1,076.50
Rate for Payer: Aetna Commercial	$818.14
Rate for Payer: Aetna Medicare Advantage	$645.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$549.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$549.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$549.01
Rate for Payer: Cigna Commercial	$1,076.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.03
Rate for Payer: Qualcare PPO/HMO/WC	$322.95
Rate for Payer: UnitedHealthcare Community & State	$51.89
Rate for Payer: Wellpoint Medicaid Managed Care	$57.05

CAMPYLOBACT JEJUN AB ELISA SER

Facility

$209.23

Service Code	HCPCS 86625
Hospital Charge Code	401386625
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.36
Rate for Payer: Cigna Commercial	$104.61
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.38
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

CAMPYLOBACT JEJUN AB ELISA SER

Facility

$209.23

Service Code	HCPCS 86625
Hospital Charge Code	401386625
Hospital Revenue Code	302
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$31.38
Rate for Payer: Qualcare PPO/HMO/WC	$31.38

CAM WALKER II LARGE SIZE 10.5

Facility

$807.75

Service Code	HCPCS L4386
Hospital Charge Code	270662590
Hospital Revenue Code	271
Min. Negotiated Rate	$121.16
Max. Negotiated Rate	$121.16
Rate for Payer: Qualcare PPO/HMO/WC	$121.16

CAM WALKER II LARGE SIZE 10.5

Facility

$807.75

Service Code	HCPCS L4386
Hospital Charge Code	270662590
Hospital Revenue Code	271
Min. Negotiated Rate	$19.47
Max. Negotiated Rate	$403.88
Rate for Payer: Aetna Commercial	$306.94
Rate for Payer: Aetna Medicare Advantage	$242.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.98
Rate for Payer: Cigna Commercial	$403.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.32
Rate for Payer: Oxford Commercial	$161.55
Rate for Payer: Qualcare PPO/HMO/WC	$121.16
Rate for Payer: UnitedHealthcare Commercial	$161.55
Rate for Payer: UnitedHealthcare Community & State	$19.47
Rate for Payer: Wellpoint Medicaid Managed Care	$21.41

CAN 10CM RF 22GA CURV 72200032

Facility

$1,750.00

Hospital Charge Code	270639694
Hospital Revenue Code	272
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CAN 10CM RF 22GA CURV 72200032

Facility

$1,750.00

Hospital Charge Code	270639694
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CANAKINUMAB 150MG/ML

Facility

$3,830.00

Service Code	HCPCS J0638
Hospital Charge Code	6064943018
Hospital Revenue Code	636
Min. Negotiated Rate	$574.50
Max. Negotiated Rate	$926.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.86
Rate for Payer: Qualcare PPO/HMO/WC	$574.50

CANAKINUMAB 150MG/ML

Facility

$3,830.00

Service Code	HCPCS J0638
Hospital Charge Code	6064943018
Hospital Revenue Code	636
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$926.86
Rate for Payer: Aetna Commercial	$406.83
Rate for Payer: Aetna Medicare Advantage	$484.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$149.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$539.90
Rate for Payer: Cigna Medicare Advantage	$149.57
Rate for Payer: Clover Medicare Advantage	$142.09
Rate for Payer: EmblemHealth Commercial	$448.71
Rate for Payer: Humana Medicare Advantage	$154.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$149.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.86
Rate for Payer: Qualcare PPO/HMO/WC	$574.50
Rate for Payer: UnitedHealthcare Community & State	$92.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.57
Rate for Payer: Wellcare Medicare Advantage	$149.57
Rate for Payer: Wellpoint Medicaid Managed Care	$101.50

CANASA 1000MG SUPP

Facility

$46.00

Hospital Charge Code	60635537
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

CANASA 1000MG SUPP

Facility

$46.00

Hospital Charge Code	60635537
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

can be used

Facility

$46.00

Service Code	HCPCS 82570
Hospital Charge Code	3009085
Hospital Revenue Code	301
Min. Negotiated Rate	$1.22
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	$23.00
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	$13.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
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	$1.22

can be used

Facility

$46.00

Service Code	HCPCS 82570
Hospital Charge Code	3009085
Hospital Revenue Code	301
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

CANC BON CHP 4 030400300

Facility

$2,175.00

Hospital Charge Code	270639514
Hospital Revenue Code	272
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$826.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.50
Rate for Payer: Oxford Commercial	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Commercial	$435.00
Rate for Payer: UnitedHealthcare Community & State	$52.42
Rate for Payer: Wellpoint Medicaid Managed Care	$57.64

Know your out-of-pocket cost for care.

All Charges