Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETYLCHOLINE REC BLOCK

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3006922
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

ACETYLCHOLINE RECEP BINDING

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3006923
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

ACETYLCHOLINE RECEP BINDING

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3006923
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

ACETYLCHOLINE RECEPTOR BLOCKIN

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900471
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOLINE RECEPTOR BLOCKIN

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900471
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 RECEPTOR MODULAT

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900472
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 RECEPTOR MODULAT

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900472
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOL SOL OPH

Facility

$308.27

Service Code	NDC 24208053920
Hospital Charge Code	60628051
Hospital Revenue Code	250
Min. Negotiated Rate	$46.24
Max. Negotiated Rate	$46.24
Rate for Payer: Qualcare PPO/HMO/WC	$46.24

ACETYLCHOL SOL OPH

Facility

$308.27

Service Code	NDC 24208053920
Hospital Charge Code	60628051
Hospital Revenue Code	250
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$154.13
Rate for Payer: Aetna Commercial	$117.14
Rate for Payer: Aetna Medicare Advantage	$92.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.61
Rate for Payer: Cigna Commercial	$154.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.48
Rate for Payer: Oxford Commercial	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.24
Rate for Payer: UnitedHealthcare Commercial	$61.65
Rate for Payer: UnitedHealthcare Community & State	$7.43
Rate for Payer: Wellpoint Medicaid Managed Care	$8.17

ACETYLCYSTEINE 100MG/ML 4ML

Facility

$10.90

Hospital Charge Code	6005805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

ACETYLCYSTEINE 100MG/ML 4ML

Facility

$10.90

Hospital Charge Code	6005805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

ACETYLCYSTEINE 10% 100MG/ML4ML

Facility

$17.15

Service Code	NDC 63323069504
Hospital Charge Code	606361025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.57
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare Advantage	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.37
Rate for Payer: Cigna Commercial	$8.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$3.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.57
Rate for Payer: UnitedHealthcare Commercial	$3.43
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

ACETYLCYSTEINE 10% 100MG/ML4ML

Facility

$17.15

Service Code	NDC 63323069504
Hospital Charge Code	606361025
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$2.57

ACETYLCYSTEINE 200MG/ML 30ML

Facility

$97.30

Hospital Charge Code	6005813
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.19
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

ACETYLCYSTEINE 200MG/ML 30ML

Facility

$97.30

Hospital Charge Code	6005813
Hospital Revenue Code	250
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

ACETYLCYSTEINE 20% 10ML

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	60635744
Hospital Revenue Code	250
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

ACETYLCYSTEINE 20% 10ML

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	60635744
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$56.28
Rate for Payer: Aetna Commercial	$42.77
Rate for Payer: Aetna Medicare Advantage	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.70
Rate for Payer: Cigna Commercial	$56.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.77
Rate for Payer: Oxford Commercial	$22.51
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Commercial	$22.51
Rate for Payer: UnitedHealthcare Community & State	$2.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

ACETYLCYSTEINE 20% INHAL

Facility

$131.00

Hospital Charge Code	60632388
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

ACETYLCYSTEINE 20% INHAL

Facility

$131.00

Hospital Charge Code	60632388
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

ACETYLCYSTEINE 20% SOL (10 ML)

Facility

$54.61

Service Code	NDC 63323069210
Hospital Charge Code	60630103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Commercial	$20.75
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.93
Rate for Payer: Cigna Commercial	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$10.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.19
Rate for Payer: UnitedHealthcare Commercial	$10.92
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

ACETYLCYSTEINE 20% SOL (10 ML)

Facility

$54.61

Service Code	NDC 63323069210
Hospital Charge Code	60630103
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$8.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.19

ACETYLCYSTEINE 6GM/30ML IV

Facility

$208.37

Service Code	HCPCS J0132
Hospital Charge Code	60629831
Hospital Revenue Code	636
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$104.19
Rate for Payer: Aetna Commercial	$79.18
Rate for Payer: Aetna Medicare Advantage	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.13
Rate for Payer: Cigna Commercial	$104.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.43
Rate for Payer: Qualcare PPO/HMO/WC	$31.26
Rate for Payer: UnitedHealthcare Community & State	$5.02
Rate for Payer: Wellpoint Medicaid Managed Care	$5.52

ACETYLCYSTEINE 6GM/30ML IV

Facility

$208.37

Service Code	HCPCS J0132
Hospital Charge Code	60629831
Hospital Revenue Code	636
Min. Negotiated Rate	$31.26
Max. Negotiated Rate	$50.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.43
Rate for Payer: Qualcare PPO/HMO/WC	$31.26

ACETYLCYSTEINE OPH 10%

Facility

$21.15

Hospital Charge Code	6005821
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

ACETYLCYSTEINE OPH 10%

Facility

$21.15

Hospital Charge Code	6005821
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

Know your out-of-pocket cost for care.

All Charges