Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHEM8+ LACTATE

Facility

$113.65

Service Code	HCPCS 83605
Hospital Charge Code	402083605
Hospital Revenue Code	450
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

CHEM CAUTERY GRANULATION TIS

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	412317250
Hospital Revenue Code	361
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$148.57
Rate for Payer: Qualcare PPO/HMO/WC	$148.57

CHEM CAUTERY GRANULATION TIS

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	412317250
Hospital Revenue Code	361
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$26.25

CHEMET/100MG/CAP

Facility

$18.00

Hospital Charge Code	60632676
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CHEMET/100MG/CAP

Facility

$18.00

Hospital Charge Code	60632676
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

CHEMICAL CAUTERIZATION OF GRAN

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	9800550
Hospital Revenue Code	510
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$148.57
Rate for Payer: Qualcare PPO/HMO/WC	$148.57

CHEMICAL CAUTERIZATION OF GRAN

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	9800550
Hospital Revenue Code	510
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.15
Rate for Payer: Qualcare PPO/HMO/WC	$148.57
Rate for Payer: UnitedHealthcare Community & State	$23.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$26.25

CHEMILUMINESCENT ASSAY

Facility

$100.50

Service Code	HCPCS 82397
Hospital Charge Code	38477121
Hospital Revenue Code	301
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$15.07

CHEMILUMINESCENT ASSAY

Facility

$100.50

Service Code	HCPCS 82397
Hospital Charge Code	38477121
Hospital Revenue Code	301
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.41
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.97
Rate for Payer: Cigna Commercial	$50.25
Rate for Payer: Cigna Medicare Advantage	$14.12
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.07
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Medicare Advantage	$14.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

CHEMISTRY 14 PROFILE***

Facility

$78.00

Hospital Charge Code	3003589
Hospital Revenue Code	301
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CHEMISTRY 14 PROFILE***

Facility

$78.00

Hospital Charge Code	3003589
Hospital Revenue Code	301
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CHEMISTRY PROFILE (COMPLETE***

Facility

$60.00

Service Code	HCPCS 85025
Hospital Charge Code	3008083
Hospital Revenue Code	301
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
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	$28.05
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: Cigna Medicare Advantage	$7.77
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Medicare Advantage	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

CHEMISTRY PROFILE (COMPLETE***

Facility

$60.00

Service Code	HCPCS 85025
Hospital Charge Code	3008083
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

CHEMISTRY SPECIAL PROFILE***

Facility

$208.80

Hospital Charge Code	3000536
Hospital Revenue Code	301
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$79.34
Rate for Payer: Aetna Medicare Advantage	$62.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.24
Rate for Payer: Cigna Commercial	$104.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.32
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

CHEMISTRY SPECIAL PROFILE***

Facility

$208.80

Hospital Charge Code	3000536
Hospital Revenue Code	301
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$31.32
Rate for Payer: Qualcare PPO/HMO/WC	$31.32

CHEMO ADMIN INFUSION 0-1HR***

Facility

$226.60

Service Code	HCPCS Q0084
Hospital Charge Code	3400140
Hospital Revenue Code	335
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$33.99
Rate for Payer: Qualcare PPO/HMO/WC	$33.99

CHEMO ADMIN INFUSION 0-1HR***

Facility

$226.60

Service Code	HCPCS Q0084
Hospital Charge Code	3400140
Hospital Revenue Code	335
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$86.11
Rate for Payer: Aetna Medicare Advantage	$67.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.78
Rate for Payer: Cigna Commercial	$113.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.98
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.99
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.00

CHEMO ADMIN INTRATHECAL

Facility

$1,242.40

Service Code	HCPCS 96450
Hospital Charge Code	93500097
Hospital Revenue Code	335
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

CHEMO ADMIN INTRATHECAL

Facility

$1,242.40

Service Code	HCPCS 96450
Hospital Charge Code	93500097
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	93500087
Hospital Revenue Code	335
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	485096413
Hospital Revenue Code	335
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	93500087
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	485096413
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO ADMIN IV PUSH LEVEL 1

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3400132
Hospital Revenue Code	331
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.88
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

CHEMO ADMIN IV PUSH LEVEL 1

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3400132
Hospital Revenue Code	331
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

Know your out-of-pocket cost for care.

All Charges