Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH ALBUMIN CSF

Facility

$90.00

Service Code	HCPCS 82042
Hospital Charge Code	397073234
Hospital Revenue Code	307
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CH ALBUMIN CSF

Facility

$105.00

Service Code	HCPCS 82042
Hospital Charge Code	397073019
Hospital Revenue Code	307
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CH ALBUMIN CSF

Facility

$105.00

Service Code	HCPCS 82042
Hospital Charge Code	397073019
Hospital Revenue Code	307
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.08
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CH ALBUMIN CSF

Facility

$90.00

Service Code	HCPCS 82042
Hospital Charge Code	397073223
Hospital Revenue Code	307
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CH ALBUMIN CSF

Facility

$90.00

Service Code	HCPCS 82042
Hospital Charge Code	397073223
Hospital Revenue Code	307
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.08
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CH ALBUMIN FLUID

Facility

$204.00

Service Code	HCPCS 82042
Hospital Charge Code	397073196
Hospital Revenue Code	307
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.08
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

CH ALBUMIN FLUID

Facility

$204.00

Service Code	HCPCS 82042
Hospital Charge Code	397073196
Hospital Revenue Code	307
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

CH ALBUMIN SERUM

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	397073224
Hospital Revenue Code	307
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

CH ALBUMIN SERUM

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	397073235
Hospital Revenue Code	307
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

CH ALBUMIN SERUM

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	397073224
Hospital Revenue Code	307
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

CH ALBUMIN SERUM

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	397073235
Hospital Revenue Code	307
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

CH ALCOHOL ETHYL

Facility

$417.00

Service Code	HCPCS 80320
Hospital Charge Code	397071250
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$158.46
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.33
Rate for Payer: Cigna Commercial	$208.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

CH ALCOHOL ETHYL

Facility

$417.00

Service Code	HCPCS 80320
Hospital Charge Code	397071250
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

CH ALCOHOL, ETHYL, QL, URINE

Facility

$157.00

Service Code	HCPCS 80320
Hospital Charge Code	397071425
Hospital Revenue Code	301
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

CH ALCOHOL, ETHYL, QL, URINE

Facility

$157.00

Service Code	HCPCS 80320
Hospital Charge Code	397071425
Hospital Revenue Code	301
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.66
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

CH ALCOHOL, ETHYL, QL, URINE

Facility

$430.00

Service Code	HCPCS 80320
Hospital Charge Code	397071436
Hospital Revenue Code	301
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$64.50
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

CH ALCOHOL, ETHYL, QL, URINE

Facility

$430.00

Service Code	HCPCS 80320
Hospital Charge Code	397071436
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

CH ALCOHOL, ETHYL, QL, URINE

Facility

$157.00

Hospital Charge Code	397071402
Hospital Revenue Code	301
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

CH ALCOHOL, ETHYL, QL, URINE

Facility

$157.00

Hospital Charge Code	397071402
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.66
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

CH ALCOHOL, ETHYL, QN, URINE

Facility

$417.00

Service Code	HCPCS 80320
Hospital Charge Code	397071426
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

CH ALCOHOL, ETHYL, QN, URINE

Facility

$417.00

Service Code	HCPCS 80320
Hospital Charge Code	397071426
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$158.46
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.33
Rate for Payer: Cigna Commercial	$208.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

CH ALCOHOL FRACTIONATION

Facility

$294.00

Service Code	HCPCS 80320
Hospital Charge Code	397071329
Hospital Revenue Code	301
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$111.72
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.79

CH ALCOHOL FRACTIONATION

Facility

$294.00

Service Code	HCPCS 80320
Hospital Charge Code	397071329
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

CH ALDOLASE

Facility

$167.00

Service Code	HCPCS 82085
Hospital Charge Code	397071248
Hospital Revenue Code	307
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

CH ALDOLASE

Facility

$167.00

Service Code	HCPCS 82085
Hospital Charge Code	397071248
Hospital Revenue Code	307
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

Know your out-of-pocket cost for care.

All Charges