Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COCAINE ABUSE AND DEPENDENCE

Facility

$4,931.92

Service Code	APR-DRG 7742
Min. Negotiated Rate	$4,835.22
Max. Negotiated Rate	$4,931.92
Rate for Payer: UnitedHealthcare Community & State	$4,835.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,931.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4,835.22

COCAINE ABUSE AND DEPENDENCE

Facility

$21,654.29

Service Code	APR-DRG 7744
Min. Negotiated Rate	$21,229.70
Max. Negotiated Rate	$21,654.29
Rate for Payer: UnitedHealthcare Community & State	$21,229.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,654.29
Rate for Payer: Wellpoint Medicaid Managed Care	$21,229.70

COCAINE ABUSE AND DEPENDENCE

Facility

$4,038.26

Service Code	APR-DRG 7741
Min. Negotiated Rate	$3,959.08
Max. Negotiated Rate	$4,038.26
Rate for Payer: UnitedHealthcare Community & State	$3,959.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,038.26
Rate for Payer: Wellpoint Medicaid Managed Care	$3,959.08

COCAINE HCL 10%/4ML

Facility

$122.00

Hospital Charge Code	60634342
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

COCAINE HCL 10%/4ML

Facility

$122.00

Hospital Charge Code	60634342
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

COCAINE SERUM

Facility

$190.45

Hospital Charge Code	3000765
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

COCAINE SERUM

Facility

$190.45

Hospital Charge Code	3000765
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

COCAINE SOL 4% 4ML

Facility

$142.75

Hospital Charge Code	6001325
Hospital Revenue Code	251
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.83
Rate for Payer: Oxford Commercial	$28.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$28.55
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

COCAINE SOL 4% 4ML

Facility

$142.75

Hospital Charge Code	6001325
Hospital Revenue Code	251
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

COCAINE,URINE

Facility

$107.00

Service Code	HCPCS 80353
Hospital Charge Code	38472212
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

COCAINE,URINE

Facility

$107.00

Service Code	HCPCS 80353
Hospital Charge Code	38472212
Hospital Revenue Code	301
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
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	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

COCCIDIODES AB IMMUNO

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004116
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

COCCIDIODES AB IMMUNO

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004116
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIODES AB(TP AG),ID

Facility

$78.85

Service Code	HCPCS 86635
Hospital Charge Code	39900229
Hospital Revenue Code	302
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$39.42
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

COCCIDIODES AB(TP AG),ID

Facility

$78.85

Service Code	HCPCS 86635
Hospital Charge Code	39900229
Hospital Revenue Code	302
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.83

COCCIDIODES ANTIBODY

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004108
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIODES ANTIBODY

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004108
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

COCCIDIOIDES AB,W/RFX TO

Facility

$390.00

Service Code	HCPCS 86635
Hospital Charge Code	39900230
Hospital Revenue Code	302
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
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	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COCCIDIOIDES AB,W/RFX TO

Facility

$390.00

Service Code	HCPCS 86635
Hospital Charge Code	39900230
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COCCIDIOIDES ANTIBODIES I

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

COCCIDIOIDES ANTIBODIES I

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099A
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIOIDES ANTIBODIES II

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099B
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIOIDES ANTIBODIES II

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

COCCIDIOIDES ANTIBODY

Facility

$116.00

Service Code	HCPCS 86635
Hospital Charge Code	38473070
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

COCCIDIOIDES ANTIBODY

Facility

$116.00

Service Code	HCPCS 86635
Hospital Charge Code	38473070
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.40
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

Know your out-of-pocket cost for care.

All Charges