Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH TRICYCLIC LEVELS

Facility

$85.00

Service Code	HCPCS 80299
Hospital Charge Code	397073115
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
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	$42.50
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	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
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	$2.25

CH TRICYCLIC LEVELS

Facility

$85.00

Service Code	HCPCS 80299
Hospital Charge Code	397073115
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

CH TRIFLUOROPERAZINE, SERUM

Facility

$386.00

Service Code	HCPCS 80342
Hospital Charge Code	397070017
Hospital Revenue Code	301
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$193.00
Rate for Payer: Aetna Commercial	$146.68
Rate for Payer: Aetna Medicare Advantage	$115.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.43
Rate for Payer: Cigna Commercial	$193.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.23

CH TRIFLUOROPERAZINE, SERUM

Facility

$386.00

Service Code	HCPCS 80342
Hospital Charge Code	397070017
Hospital Revenue Code	301
Min. Negotiated Rate	$57.90
Max. Negotiated Rate	$57.90
Rate for Payer: Qualcare PPO/HMO/WC	$57.90

CH TRIGLYCERIDE

Facility

$113.00

Service Code	HCPCS 84478
Hospital Charge Code	397071104
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

CH TRIGLYCERIDE

Facility

$113.00

Service Code	HCPCS 84478
Hospital Charge Code	397071104
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

CH TRILEPTAL(OXCARBAZEPINE)

Facility

$128.00

Service Code	HCPCS 84481
Hospital Charge Code	397073597
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.15
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$16.94
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Medicare Advantage	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CH TRILEPTAL(OXCARBAZEPINE)

Facility

$128.00

Service Code	HCPCS 84481
Hospital Charge Code	397073597
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CH TROPONIN I

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	397073188
Hospital Revenue Code	301
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.92
Rate for Payer: Aetna Medicare Advantage	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.01
Rate for Payer: Cigna Commercial	$61.72
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$37.41
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.47
Rate for Payer: Wellcare Medicare Advantage	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

CH TROPONIN I

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	397073188
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

CH TRYPANOSOMA DETECTION

Facility

$273.00

Service Code	HCPCS 86666
Hospital Charge Code	397071422
Hospital Revenue Code	302
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

CH TRYPANOSOMA DETECTION

Facility

$273.00

Service Code	HCPCS 86666
Hospital Charge Code	397071422
Hospital Revenue Code	302
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

CH TSH

Facility

$629.00

Service Code	HCPCS 84443
Hospital Charge Code	397071209
Hospital Revenue Code	301
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$94.35
Rate for Payer: Qualcare PPO/HMO/WC	$94.35

CH TSH

Facility

$629.00

Service Code	HCPCS 84443
Hospital Charge Code	397071209
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$314.50
Rate for Payer: Aetna Commercial	$45.70
Rate for Payer: Aetna Medicare Advantage	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$314.50
Rate for Payer: Cigna Medicare Advantage	$16.80
Rate for Payer: Clover Medicare Advantage	$15.96
Rate for Payer: EmblemHealth Commercial	$50.40
Rate for Payer: Humana Medicare Advantage	$17.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.80
Rate for Payer: Wellcare Medicare Advantage	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.67

CH TSH RECEPTOR AB

Facility

$457.00

Service Code	HCPCS 84235
Hospital Charge Code	397073159
Hospital Revenue Code	301
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$257.12
Rate for Payer: Aetna Commercial	$193.75
Rate for Payer: Aetna Medicare Advantage	$230.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.12
Rate for Payer: Cigna Commercial	$228.50
Rate for Payer: Cigna Medicare Advantage	$71.23
Rate for Payer: Clover Medicare Advantage	$67.67
Rate for Payer: EmblemHealth Commercial	$213.69
Rate for Payer: Humana Medicare Advantage	$73.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$71.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$56.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.23
Rate for Payer: Wellcare Medicare Advantage	$71.23
Rate for Payer: Wellpoint Medicaid Managed Care	$12.11

CH TSH RECEPTOR AB

Facility

$457.00

Service Code	HCPCS 84235
Hospital Charge Code	397073159
Hospital Revenue Code	301
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$68.55
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

CH TYPE & SCREEN

Facility

$667.59

Service Code	HCPCS 86850
Hospital Charge Code	397031016
Hospital Revenue Code	300
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH TYPE & SCREEN

Facility

$667.59

Service Code	HCPCS 86850
Hospital Charge Code	397031016
Hospital Revenue Code	300
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$200.28
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CH TYSABRI AB

Facility

$225.00

Service Code	HCPCS 86849
Hospital Charge Code	397073675
Hospital Revenue Code	302
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH TYSABRI AB

Facility

$225.00

Service Code	HCPCS 86849
Hospital Charge Code	397073675
Hospital Revenue Code	302
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

CH UCG POC

Facility

$210.00

Service Code	HCPCS 84703
Hospital Charge Code	397071552
Hospital Revenue Code	301
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.45
Rate for Payer: Aetna Medicare Advantage	$24.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.14
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: Cigna Medicare Advantage	$7.52
Rate for Payer: Clover Medicare Advantage	$7.14
Rate for Payer: EmblemHealth Commercial	$22.56
Rate for Payer: Humana Medicare Advantage	$7.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.52
Rate for Payer: Wellcare Medicare Advantage	$7.52
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

CH UCG POC

Facility

$210.00

Service Code	HCPCS 84703
Hospital Charge Code	397071552
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

CHUCK KEY LARGE 1/4

Facility

$104.70

Hospital Charge Code	270645829
Hospital Revenue Code	271
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$15.71
Rate for Payer: Qualcare PPO/HMO/WC	$15.71

CHUCK KEY LARGE 1/4

Facility

$104.70

Hospital Charge Code	270645829
Hospital Revenue Code	271
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.35
Rate for Payer: Aetna Commercial	$39.79
Rate for Payer: Aetna Medicare Advantage	$31.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.70
Rate for Payer: Cigna Commercial	$52.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.41
Rate for Payer: Oxford Commercial	$20.94
Rate for Payer: Qualcare PPO/HMO/WC	$15.71
Rate for Payer: UnitedHealthcare Commercial	$20.94
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

CHUCK KEY SMALL 5/32

Facility

$104.70

Hospital Charge Code	270645830
Hospital Revenue Code	271
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$15.71
Rate for Payer: Qualcare PPO/HMO/WC	$15.71

Know your out-of-pocket cost for care.

All Charges