Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH NUCLEOTIDASE 5

Facility

$106.00

Service Code	HCPCS 83915
Hospital Charge Code	397071041
Hospital Revenue Code	301
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

CH NUCLEOTIDASE 5

Facility

$106.00

Service Code	HCPCS 83915
Hospital Charge Code	397071041
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.33
Rate for Payer: Aetna Medicare Advantage	$36.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.25
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: Cigna Medicare Advantage	$11.15
Rate for Payer: Clover Medicare Advantage	$10.59
Rate for Payer: EmblemHealth Commercial	$33.45
Rate for Payer: Humana Medicare Advantage	$11.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.15
Rate for Payer: Wellcare Medicare Advantage	$11.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

CH NUT PROFILE

Facility

$573.00

Service Code	HCPCS 86003
Hospital Charge Code	397073670
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$286.50
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$286.50
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

CH NUT PROFILE

Facility

$573.00

Service Code	HCPCS 86003
Hospital Charge Code	397073670
Hospital Revenue Code	305
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

CH OCCULT BLOOD, GASTRIC

Facility

$390.00

Service Code	HCPCS 82271
Hospital Charge Code	397073172
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH OCCULT BLOOD, GASTRIC

Facility

$390.00

Service Code	HCPCS 82271
Hospital Charge Code	397073172
Hospital Revenue Code	301
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.47
Rate for Payer: Aetna Medicare Advantage	$17.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.32
Rate for Payer: Clover Medicare Advantage	$5.05
Rate for Payer: EmblemHealth Commercial	$15.96
Rate for Payer: Humana Medicare Advantage	$5.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.32
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	$4.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.32
Rate for Payer: Wellcare Medicare Advantage	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH OCCULT BLOOD, STOOL

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	397073027
Hospital Revenue Code	301
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.91
Rate for Payer: Aetna Medicare Advantage	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.38
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.38
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	$3.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Medicare Advantage	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH OCCULT BLOOD, STOOL

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	397073027
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH OCCULT BLOOD, URINE

Facility

$35.00

Service Code	HCPCS 82271
Hospital Charge Code	397073026
Hospital Revenue Code	301
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.47
Rate for Payer: Aetna Medicare Advantage	$17.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: Cigna Medicare Advantage	$5.32
Rate for Payer: Clover Medicare Advantage	$5.05
Rate for Payer: EmblemHealth Commercial	$15.96
Rate for Payer: Humana Medicare Advantage	$5.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.32
Rate for Payer: Wellcare Medicare Advantage	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

CH OCCULT BLOOD, URINE

Facility

$35.00

Service Code	HCPCS 82271
Hospital Charge Code	397073026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

CHOICE DM BAR

Facility

$5.00

Hospital Charge Code	60635264
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

CHOICE DM BAR

Facility

$5.00

Hospital Charge Code	60635264
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CHOLANGIOGRAM

Facility

$331.55

Service Code	HCPCS 47505
Hospital Charge Code	5100518
Hospital Revenue Code	361
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

CHOLANGIOGRAM

Facility

$331.55

Service Code	HCPCS 47505
Hospital Charge Code	5100518
Hospital Revenue Code	361
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
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	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

CHOLANGIOGRAM S&I

Facility

$620.20

Service Code	HCPCS 74305
Hospital Charge Code	5100519
Hospital Revenue Code	320
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$93.03
Rate for Payer: Qualcare PPO/HMO/WC	$93.03

CHOLANGIOGRAM S&I

Facility

$620.20

Service Code	HCPCS 74305
Hospital Charge Code	5100519
Hospital Revenue Code	320
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$235.68
Rate for Payer: Aetna Medicare Advantage	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.15
Rate for Payer: Cigna Commercial	$310.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.06
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.03
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.95
Rate for Payer: Wellpoint Medicaid Managed Care	$16.44

CH OLANZAPINE

Facility

$285.00

Service Code	HCPCS 80299
Hospital Charge Code	397071361
Hospital Revenue Code	301
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.55

CH OLANZAPINE

Facility

$285.00

Service Code	HCPCS 80299
Hospital Charge Code	397071361
Hospital Revenue Code	301
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$42.75
Rate for Payer: Qualcare PPO/HMO/WC	$42.75

CH OLANZAPINE

Facility

$281.00

Service Code	HCPCS 80299
Hospital Charge Code	397073197
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

CH OLANZAPINE

Facility

$281.00

Service Code	HCPCS 80299
Hospital Charge Code	397073197
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.45

CHOLECALCIFEROL 1,000 IU TAB

Facility

$4.00

Service Code	NDC 904582460
Hospital Charge Code	6063943190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CHOLECALCIFEROL 1,000 IU TAB

Facility

$4.00

Service Code	NDC 904582460
Hospital Charge Code	6063943190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CHOLECALCIFEROL 50MCG TAB

Facility

$26.47

Service Code	NDC 80681013200
Hospital Charge Code	606390394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.23
Rate for Payer: Aetna Commercial	$10.06
Rate for Payer: Aetna Medicare Advantage	$7.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.75
Rate for Payer: Cigna Commercial	$13.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.94
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

CHOLECALCIFEROL 50MCG TAB

Facility

$26.47

Service Code	NDC 80681013200
Hospital Charge Code	606390394
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

CHOLECYSTCTMY,W CHOLANGIGRPHY

Facility

$12,472.00

Service Code	HCPCS 47605
Hospital Charge Code	16000984
Hospital Revenue Code	360
Min. Negotiated Rate	$1,870.80
Max. Negotiated Rate	$1,870.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,870.80

Know your out-of-pocket cost for care.

All Charges