Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH ETHANOL, URINE

Facility

$180.00

Service Code	HCPCS 80300
Hospital Charge Code	397073221
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CH ETHOSUXIMIDE

Facility

$216.00

Service Code	HCPCS 80168
Hospital Charge Code	397072065
Hospital Revenue Code	301
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

CH ETHOSUXIMIDE

Facility

$216.00

Service Code	HCPCS 80168
Hospital Charge Code	397072065
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.44
Rate for Payer: Aetna Medicare Advantage	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.98
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: Cigna Medicare Advantage	$16.34
Rate for Payer: Clover Medicare Advantage	$15.52
Rate for Payer: EmblemHealth Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$16.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.34
Rate for Payer: Wellcare Medicare Advantage	$16.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

CH ETHYLENE GLYCOL

Facility

$258.00

Service Code	HCPCS 82693
Hospital Charge Code	397072066
Hospital Revenue Code	301
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$40.53
Rate for Payer: Aetna Medicare Advantage	$48.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.78
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: Cigna Medicare Advantage	$14.90
Rate for Payer: Clover Medicare Advantage	$14.15
Rate for Payer: EmblemHealth Commercial	$44.70
Rate for Payer: Humana Medicare Advantage	$15.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.90
Rate for Payer: Wellcare Medicare Advantage	$14.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

CH ETHYLENE GLYCOL

Facility

$258.00

Service Code	HCPCS 82693
Hospital Charge Code	397072066
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073288
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073288
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH EXTRACTION

Facility

$162.00

Service Code	HCPCS 83890
Hospital Charge Code	397073560
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH EXTRACTION

Facility

$162.00

Service Code	HCPCS 83890
Hospital Charge Code	397073560
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073295
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073295
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH EXTRACTION X3

Facility

$40.00

Service Code	HCPCS 83890
Hospital Charge Code	397073280
Hospital Revenue Code	301
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CH EXTRACTION X3

Facility

$40.00

Service Code	HCPCS 83890
Hospital Charge Code	397073280
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CH FACTOR 8 ACTIVITY

Facility

$218.00

Service Code	HCPCS 85240
Hospital Charge Code	397073316
Hospital Revenue Code	305
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.61
Rate for Payer: Cigna Commercial	$109.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$5.78

CH FACTOR 8 ACTIVITY

Facility

$218.00

Service Code	HCPCS 85240
Hospital Charge Code	397073316
Hospital Revenue Code	305
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

CH FACTOR 8 INHIBITOR

Facility

$286.00

Service Code	HCPCS 85335
Hospital Charge Code	397072067
Hospital Revenue Code	305
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

CH FACTOR 8 INHIBITOR

Facility

$286.00

Service Code	HCPCS 85335
Hospital Charge Code	397072067
Hospital Revenue Code	305
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$143.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

CH FACTOR 8 INJ EACH UNIT

Facility

$1.00

Service Code	HCPCS J7194
Hospital Charge Code	397031073
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$6.14
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.14
Rate for Payer: Cigna Medicare Advantage	$1.70
Rate for Payer: Clover Medicare Advantage	$1.61
Rate for Payer: EmblemHealth Commercial	$5.10
Rate for Payer: Humana Medicare Advantage	$1.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.70
Rate for Payer: Wellcare Medicare Advantage	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CH FACTOR 8 INJ EACH UNIT

Facility

$1.00

Service Code	HCPCS J7194
Hospital Charge Code	397031073
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CH FACTOR 8 RELATED ANTIGEN

Facility

$332.00

Service Code	HCPCS 85244
Hospital Charge Code	397073168
Hospital Revenue Code	305
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CH FACTOR 8 RELATED ANTIGEN

Facility

$332.00

Service Code	HCPCS 85244
Hospital Charge Code	397073168
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$166.00
Rate for Payer: Aetna Commercial	$55.54
Rate for Payer: Aetna Medicare Advantage	$66.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.71
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: Cigna Medicare Advantage	$20.42
Rate for Payer: Clover Medicare Advantage	$19.40
Rate for Payer: EmblemHealth Commercial	$61.26
Rate for Payer: Humana Medicare Advantage	$21.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.42
Rate for Payer: Wellcare Medicare Advantage	$20.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

CH FACTOR 8/VIAL

Facility

$21.00

Service Code	HCPCS J7190
Hospital Charge Code	397031072
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

CH FACTOR 8/VIAL

Facility

$21.00

Service Code	HCPCS J7190
Hospital Charge Code	397031072
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$5.08
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.02
Rate for Payer: Cigna Medicare Advantage	$1.39
Rate for Payer: Clover Medicare Advantage	$1.32
Rate for Payer: EmblemHealth Commercial	$4.17
Rate for Payer: Humana Medicare Advantage	$1.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.39
Rate for Payer: Wellcare Medicare Advantage	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CH FACTOR II

Facility

$42.00

Service Code	HCPCS 85210
Hospital Charge Code	397073012
Hospital Revenue Code	305
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.31
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
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	$46.85
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: Cigna Medicare Advantage	$12.98
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

CH FACTOR II

Facility

$42.00

Service Code	HCPCS 85210
Hospital Charge Code	397073012
Hospital Revenue Code	305
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

Know your out-of-pocket cost for care.

All Charges