Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.88
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	$3.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Medicare Advantage	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Medicare Advantage	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

CARBON DIOXIDE CO2 PANEL***

Facility

$6.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Medicare Advantage	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CARBON DIOXIDE CO2 PANEL***

Facility

$6.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CARBON MONOXIDE

Facility

$291.25

Service Code	HCPCS 82375
Hospital Charge Code	3007275
Hospital Revenue Code	301
Min. Negotiated Rate	$43.69
Max. Negotiated Rate	$43.69
Rate for Payer: Qualcare PPO/HMO/WC	$43.69

CARBON MONOXIDE

Facility

$291.25

Service Code	HCPCS 82375
Hospital Charge Code	3007275
Hospital Revenue Code	301
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$145.62
Rate for Payer: Aetna Commercial	$33.51
Rate for Payer: Aetna Medicare Advantage	$39.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.47
Rate for Payer: Cigna Commercial	$145.62
Rate for Payer: Cigna Medicare Advantage	$12.32
Rate for Payer: Clover Medicare Advantage	$11.70
Rate for Payer: EmblemHealth Commercial	$36.96
Rate for Payer: Humana Medicare Advantage	$12.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.32
Rate for Payer: Wellcare Medicare Advantage	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$7.72

CARBON MONOXIDE***

Facility

$86.00

Service Code	HCPCS 82375
Hospital Charge Code	3000627
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.51
Rate for Payer: Aetna Medicare Advantage	$39.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.47
Rate for Payer: Cigna Commercial	$43.00
Rate for Payer: Cigna Medicare Advantage	$12.32
Rate for Payer: Clover Medicare Advantage	$11.70
Rate for Payer: EmblemHealth Commercial	$36.96
Rate for Payer: Humana Medicare Advantage	$12.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.32
Rate for Payer: Wellcare Medicare Advantage	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

CARBON MONOXIDE***

Facility

$39.00

Hospital Charge Code	3010626
Hospital Revenue Code	309
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

CARBON MONOXIDE***

Facility

$39.00

Hospital Charge Code	3010626
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

CARBON MONOXIDE***

Facility

$86.00

Service Code	HCPCS 82375
Hospital Charge Code	3000627
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

CARBON ROD 250MM

Facility

$870.35

Service Code	HCPCS C1713
Hospital Charge Code	270702322
Hospital Revenue Code	278
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$435.18
Rate for Payer: Aetna Commercial	$330.73
Rate for Payer: Aetna Medicare Advantage	$261.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.94
Rate for Payer: Cigna Commercial	$435.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$191.48
Rate for Payer: Qualcare PPO/HMO/WC	$130.55
Rate for Payer: UnitedHealthcare Community & State	$20.98
Rate for Payer: Wellpoint Medicaid Managed Care	$23.06

CARBON ROD 250MM

Facility

$870.35

Service Code	HCPCS C1713
Hospital Charge Code	270702322
Hospital Revenue Code	278
Min. Negotiated Rate	$130.55
Max. Negotiated Rate	$210.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$191.48
Rate for Payer: Qualcare PPO/HMO/WC	$130.55

CARBON ROD 300MM

Facility

$2,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270662420
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$574.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

CARBON ROD 300MM

Facility

$2,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270662420
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

CARBON ROD 9.5MM X 500MM

Facility

$1,072.50

Service Code	HCPCS C1713
Hospital Charge Code	270686003
Hospital Revenue Code	278
Min. Negotiated Rate	$160.88
Max. Negotiated Rate	$259.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$160.88

CARBON ROD 9.5MM X 500MM

Facility

$1,072.50

Service Code	HCPCS C1713
Hospital Charge Code	270686003
Hospital Revenue Code	278
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$536.25
Rate for Payer: Aetna Commercial	$407.55
Rate for Payer: Aetna Medicare Advantage	$321.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.49
Rate for Payer: Cigna Commercial	$536.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$160.88
Rate for Payer: UnitedHealthcare Community & State	$25.85
Rate for Payer: Wellpoint Medicaid Managed Care	$28.42

CARBOPLATIN/150MG

Facility

$1,256.00

Hospital Charge Code	60633611
Hospital Revenue Code	636
Min. Negotiated Rate	$188.40
Max. Negotiated Rate	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.95
Rate for Payer: Qualcare PPO/HMO/WC	$188.40

CARBOPLATIN/150MG

Facility

$1,256.00

Hospital Charge Code	60633611
Hospital Revenue Code	636
Min. Negotiated Rate	$30.27
Max. Negotiated Rate	$628.00
Rate for Payer: Aetna Commercial	$477.28
Rate for Payer: Aetna Medicare Advantage	$376.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.28
Rate for Payer: Cigna Commercial	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.95
Rate for Payer: Qualcare PPO/HMO/WC	$188.40
Rate for Payer: UnitedHealthcare Community & State	$30.27
Rate for Payer: Wellpoint Medicaid Managed Care	$33.28

CARBOPLATIN IV 50MG

Facility

$693.80

Hospital Charge Code	6000376
Hospital Revenue Code	636
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$346.90
Rate for Payer: Aetna Commercial	$263.64
Rate for Payer: Aetna Medicare Advantage	$208.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.92
Rate for Payer: Cigna Commercial	$346.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.90
Rate for Payer: Qualcare PPO/HMO/WC	$104.07
Rate for Payer: UnitedHealthcare Community & State	$16.72
Rate for Payer: Wellpoint Medicaid Managed Care	$18.39

CARBOPLATIN IV 50MG

Facility

$693.80

Hospital Charge Code	6000376
Hospital Revenue Code	636
Min. Negotiated Rate	$104.07
Max. Negotiated Rate	$167.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.90
Rate for Payer: Qualcare PPO/HMO/WC	$104.07

CARBOPROST 250 MCG/ML INJ

Facility

$1,445.32

Service Code	NDC 9085608
Hospital Charge Code	60628519
Hospital Revenue Code	250
Min. Negotiated Rate	$34.83
Max. Negotiated Rate	$722.66
Rate for Payer: Aetna Commercial	$549.22
Rate for Payer: Aetna Medicare Advantage	$433.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.56
Rate for Payer: Cigna Commercial	$722.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.60
Rate for Payer: Oxford Commercial	$289.06
Rate for Payer: Qualcare PPO/HMO/WC	$216.80
Rate for Payer: UnitedHealthcare Commercial	$289.06
Rate for Payer: UnitedHealthcare Community & State	$34.83
Rate for Payer: Wellpoint Medicaid Managed Care	$38.30

CARBOPROST 250 MCG/ML INJ

Facility

$1,445.32

Service Code	NDC 9085608
Hospital Charge Code	60628519
Hospital Revenue Code	250
Min. Negotiated Rate	$216.80
Max. Negotiated Rate	$216.80
Rate for Payer: Qualcare PPO/HMO/WC	$216.80

CARBOPROST TRO INJ 250MCG/1ML

Facility

$1,196.20

Hospital Charge Code	6000939
Hospital Revenue Code	250
Min. Negotiated Rate	$179.43
Max. Negotiated Rate	$179.43
Rate for Payer: Qualcare PPO/HMO/WC	$179.43

Know your out-of-pocket cost for care.

All Charges