Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH PENICILLOYL G (C1) IGE

Facility

$30.00

Service Code	HCPCS 86003
Hospital Charge Code	397071524
Hospital Revenue Code	305
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
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	$15.00
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	$9.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
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	$0.80

CH PENICILLOYL G (C1) IGE

Facility

$30.00

Service Code	HCPCS 86003
Hospital Charge Code	397071524
Hospital Revenue Code	305
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

CH PEP+IMMUNOFIX 24 H URINE

Facility

$239.00

Hospital Charge Code	3970728
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

CH PEP+IMMUNOFIX 24 H URINE

Facility

$239.00

Hospital Charge Code	3970728
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

CH PERGABALIN

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	397073685
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

CH PERGABALIN

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	397073685
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
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	$162.00
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	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
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	$8.59

CH PEROXIDASE

Facility

$152.00

Service Code	HCPCS 88319
Hospital Charge Code	397021082
Hospital Revenue Code	310
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$111.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

CH PEROXIDASE

Facility

$152.00

Service Code	HCPCS 88319
Hospital Charge Code	397021082
Hospital Revenue Code	310
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

CH PHENCYCLIDINE CONF GC

Facility

$695.00

Service Code	HCPCS 80300
Hospital Charge Code	397073156
Hospital Revenue Code	301
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$104.25
Rate for Payer: Qualcare PPO/HMO/WC	$104.25

CH PHENCYCLIDINE CONF GC

Facility

$695.00

Service Code	HCPCS 80300
Hospital Charge Code	397073156
Hospital Revenue Code	301
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$347.50
Rate for Payer: Aetna Commercial	$264.10
Rate for Payer: Aetna Medicare Advantage	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.22
Rate for Payer: Cigna Commercial	$347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.75
Rate for Payer: Wellpoint Medicaid Managed Care	$18.42

CH PHENCYCLIDINE DAU

Facility

$44.00

Hospital Charge Code	397071292
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CH PHENCYCLIDINE DAU

Facility

$44.00

Hospital Charge Code	397071292
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 PHENOBARBITAL SERUM

Facility

$78.00

Service Code	HCPCS 80184
Hospital Charge Code	397071227
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
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	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CH PHENOBARBITAL SERUM

Facility

$78.00

Service Code	HCPCS 80184
Hospital Charge Code	397071227
Hospital Revenue Code	301
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH PHENOTHIAZINES SERUM

Facility

$373.00

Service Code	HCPCS 80342
Hospital Charge Code	397073121
Hospital Revenue Code	301
Min. Negotiated Rate	$55.95
Max. Negotiated Rate	$55.95
Rate for Payer: Qualcare PPO/HMO/WC	$55.95

CH PHENOTHIAZINES SERUM

Facility

$373.00

Service Code	HCPCS 80342
Hospital Charge Code	397073121
Hospital Revenue Code	301
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$186.50
Rate for Payer: Aetna Commercial	$141.74
Rate for Payer: Aetna Medicare Advantage	$111.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.11
Rate for Payer: Cigna Commercial	$186.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.88

CH PHENOTHIAZINES URINE

Facility

$97.00

Service Code	HCPCS 80342
Hospital Charge Code	397073105
Hospital Revenue Code	301
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

CH PHENOTHIAZINES URINE

Facility

$97.00

Service Code	HCPCS 80342
Hospital Charge Code	397073105
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

CH PHENYTOIN FREE

Facility

$149.00

Service Code	HCPCS 80186
Hospital Charge Code	397073072
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare Advantage	$44.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.67
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: Cigna Medicare Advantage	$13.76
Rate for Payer: Clover Medicare Advantage	$13.07
Rate for Payer: EmblemHealth Commercial	$41.28
Rate for Payer: Humana Medicare Advantage	$14.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.76
Rate for Payer: Wellcare Medicare Advantage	$13.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CH PHENYTOIN FREE

Facility

$149.00

Service Code	HCPCS 80186
Hospital Charge Code	397073072
Hospital Revenue Code	301
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CH PH FECAL

Facility

$68.00

Service Code	HCPCS 83986
Hospital Charge Code	397071010
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

CH PH FECAL

Facility

$68.00

Service Code	HCPCS 83986
Hospital Charge Code	397071010
Hospital Revenue Code	301
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
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	$12.92
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

CH PHIL CHROM

Facility

$2,700.00

Service Code	HCPCS 83890
Hospital Charge Code	397073029
Hospital Revenue Code	301
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

CH PHIL CHROM

Facility

$2,700.00

Service Code	HCPCS 83890
Hospital Charge Code	397073029
Hospital Revenue Code	301
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

CH PHIL CHROM & DNA

Facility

$2,862.00

Service Code	HCPCS 81240
Hospital Charge Code	397073030
Hospital Revenue Code	310
Min. Negotiated Rate	$52.55
Max. Negotiated Rate	$1,431.00
Rate for Payer: Aetna Commercial	$178.68
Rate for Payer: Aetna Medicare Advantage	$212.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.12
Rate for Payer: Cigna Commercial	$1,431.00
Rate for Payer: Cigna Medicare Advantage	$65.69
Rate for Payer: Clover Medicare Advantage	$62.41
Rate for Payer: EmblemHealth Commercial	$197.07
Rate for Payer: Humana Medicare Advantage	$67.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$65.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$429.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$52.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.69
Rate for Payer: Wellcare Medicare Advantage	$65.69
Rate for Payer: Wellpoint Medicaid Managed Care	$75.84

Know your out-of-pocket cost for care.

All Charges