Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH OPIATES CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073076
Hospital Revenue Code	301
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

CH OPIATES CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073076
Hospital Revenue Code	301
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

CH OPIATES DAU

Facility

$44.00

Service Code	HCPCS 80300
Hospital Charge Code	397071289
Hospital Revenue Code	301
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

CH OPIATES DAU

Facility

$44.00

Service Code	HCPCS 80300
Hospital Charge Code	397071289
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CH OPIATES METAB BY GCMS

Facility

$107.00

Service Code	HCPCS 82542
Hospital Charge Code	397071475
Hospital Revenue Code	301
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

CH OPIATES METAB BY GCMS

Facility

$107.00

Service Code	HCPCS 82542
Hospital Charge Code	397071475
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

CH ORGANISM ID MOLD

Facility

$139.00

Service Code	HCPCS 87107
Hospital Charge Code	397073601
Hospital Revenue Code	309
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CH ORGANISM ID MOLD

Facility

$139.00

Service Code	HCPCS 87107
Hospital Charge Code	397073601
Hospital Revenue Code	309
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.25
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

CH ORGANISM ID MYCOBACTERIA

Facility

$160.00

Service Code	HCPCS 87118
Hospital Charge Code	397073600
Hospital Revenue Code	309
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.74
Rate for Payer: Aetna Medicare Advantage	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.74
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: Cigna Medicare Advantage	$14.61
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.61
Rate for Payer: Wellcare Medicare Advantage	$14.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

CH ORGANISM ID MYCOBACTERIA

Facility

$160.00

Service Code	HCPCS 87118
Hospital Charge Code	397073600
Hospital Revenue Code	309
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

CH OSMOLALITY SERUM

Facility

$57.00

Service Code	HCPCS 83930
Hospital Charge Code	397071096
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

CH OSMOLALITY SERUM

Facility

$57.00

Service Code	HCPCS 83930
Hospital Charge Code	397071096
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.86
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

CH OSMOMALITY URINE

Facility

$57.00

Service Code	HCPCS 83935
Hospital Charge Code	397073042
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

CH OSMOMALITY URINE

Facility

$57.00

Service Code	HCPCS 83935
Hospital Charge Code	397073042
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare Advantage	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.62
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$6.48
Rate for Payer: EmblemHealth Commercial	$20.46
Rate for Payer: Humana Medicare Advantage	$7.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.82
Rate for Payer: Wellcare Medicare Advantage	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

CH OSTEOCALCIN

Facility

$551.00

Service Code	HCPCS 83937
Hospital Charge Code	397070018
Hospital Revenue Code	301
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Aetna Medicare Advantage	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.75
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: Cigna Medicare Advantage	$29.85
Rate for Payer: Clover Medicare Advantage	$28.36
Rate for Payer: EmblemHealth Commercial	$89.55
Rate for Payer: Humana Medicare Advantage	$30.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.85
Rate for Payer: Wellcare Medicare Advantage	$29.85
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

CH OSTEOCALCIN

Facility

$551.00

Service Code	HCPCS 83937
Hospital Charge Code	397070018
Hospital Revenue Code	301
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

CH OXALATE

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	397071029
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH OXALATE

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	397071029
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$46.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.16
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.45
Rate for Payer: Clover Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$43.35
Rate for Payer: Humana Medicare Advantage	$14.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.45
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	$11.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.45
Rate for Payer: Wellcare Medicare Advantage	$14.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH OXCARBAZEPINE LEVEL

Facility

$198.00

Service Code	HCPCS 80299
Hospital Charge Code	397070001
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$124.00
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	$99.00
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	$59.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.70
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	$5.25

CH OXCARBAZEPINE LEVEL

Facility

$198.00

Service Code	HCPCS 80299
Hospital Charge Code	397070001
Hospital Revenue Code	301
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$29.70

CH OXYCODONE SCR AND CONFIRM

Facility

$208.91

Service Code	HCPCS 80301
Hospital Charge Code	3970733
Hospital Revenue Code	301
Min. Negotiated Rate	$31.34
Max. Negotiated Rate	$31.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.34

CH OXYCODONE SCR AND CONFIRM

Facility

$208.91

Service Code	HCPCS 80301
Hospital Charge Code	3970733
Hospital Revenue Code	301
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$79.39
Rate for Payer: Aetna Medicare Advantage	$62.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.27
Rate for Payer: Cigna Commercial	$104.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.34
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

CH PAIN MGT, MEPERIDINE, QN

Facility

$410.00

Hospital Charge Code	3970736
Hospital Revenue Code	301
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare Advantage	$123.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.55
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

CH PAIN MGT, MEPERIDINE, QN

Facility

$410.00

Hospital Charge Code	3970736
Hospital Revenue Code	301
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

CH PAIN MGT, TRAMADOL, QN

Facility

$410.00

Hospital Charge Code	3970735
Hospital Revenue Code	301
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

Know your out-of-pocket cost for care.

All Charges