Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETMINOPHEN 160MG/5MLCUP

Facility

$1.32

Hospital Charge Code	60635783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

ACETMINOPHEN 160MG/5MLCUP

Facility

$1.32

Hospital Charge Code	60635783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.66
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: Aetna Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.34
Rate for Payer: Cigna Commercial	$0.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.40
Rate for Payer: Oxford Commercial	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.20
Rate for Payer: UnitedHealthcare Commercial	$0.26
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

ACETOHEXAMIDE 250 MG TAB

Facility

$0.85

Hospital Charge Code	60628229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.13

ACETOHEXAMIDE 250 MG TAB

Facility

$0.85

Hospital Charge Code	60628229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna Commercial	$0.32
Rate for Payer: Aetna Medicare Advantage	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.22
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$0.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.13
Rate for Payer: UnitedHealthcare Commercial	$0.17
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

ACETOHEXAMIDE 500 MG TAB

Facility

$6.70

Hospital Charge Code	60628230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.01
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

ACETOHEXAMIDE 500 MG TAB

Facility

$6.70

Hospital Charge Code	60628230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

ACETONE

Facility

$15.40

Hospital Charge Code	6012157
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

ACETONE

Facility

$15.40

Hospital Charge Code	6012157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

ACETONE (BLOOD) QUALITATIVE***

Facility

$21.00

Hospital Charge Code	3010030
Hospital Revenue Code	309
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

ACETONE (BLOOD) QUALITATIVE***

Facility

$21.00

Hospital Charge Code	3010030
Hospital Revenue Code	309
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

ACETONE (KETONE BLOOD SCREEN)

Facility

$54.45

Service Code	HCPCS 82009
Hospital Charge Code	3000031
Hospital Revenue Code	301
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.29
Rate for Payer: Aetna Medicare Advantage	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: Cigna Medicare Advantage	$4.52
Rate for Payer: Clover Medicare Advantage	$4.29
Rate for Payer: EmblemHealth Commercial	$13.56
Rate for Payer: Humana Medicare Advantage	$4.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.52
Rate for Payer: Wellcare Medicare Advantage	$4.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

ACETONE (KETONE BLOOD SCREEN)

Facility

$54.45

Service Code	HCPCS 82009
Hospital Charge Code	3000031
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

ACETONE/KETONE SERUM QUANT

Facility

$58.00

Service Code	HCPCS 82010
Hospital Charge Code	38477052
Hospital Revenue Code	307
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

ACETONE/KETONE SERUM QUANT

Facility

$58.00

Service Code	HCPCS 82010
Hospital Charge Code	38477052
Hospital Revenue Code	307
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

ACETONE SOL 120ML

Facility

$25.60

Hospital Charge Code	60628441
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

ACETONE SOL 120ML

Facility

$25.60

Hospital Charge Code	60628441
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

ACETYCHOLINE RECEPTOR AB

Facility

$205.65

Service Code	HCPCS 83519
Hospital Charge Code	3006921
Hospital Revenue Code	301
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

ACETYCHOLINE RECEPTOR AB

Facility

$205.65

Service Code	HCPCS 83519
Hospital Charge Code	3006921
Hospital Revenue Code	301
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

ACETYLCHOL CHLOR INTRAOCULAR

Facility

$163.20

Hospital Charge Code	6005797
Hospital Revenue Code	250
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

ACETYLCHOL CHLOR INTRAOCULAR

Facility

$163.20

Hospital Charge Code	6005797
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: Aetna Medicare Advantage	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.96
Rate for Payer: Oxford Commercial	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$32.64
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

ACETYLCHOLINE REC BIND AB

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900333
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOLINE REC BIND AB

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900333
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
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	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACETYLCHOLINE REC BINDING AB

Facility

$888.00

Service Code	HCPCS 83519
Hospital Charge Code	38473081
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$444.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$23.53

ACETYLCHOLINE REC BINDING AB

Facility

$888.00

Service Code	HCPCS 83519
Hospital Charge Code	38473081
Hospital Revenue Code	301
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Qualcare PPO/HMO/WC	$133.20

ACETYLCHOLINE REC BLOCK

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3006922
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

Know your out-of-pocket cost for care.

All Charges