Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALANINE AMINOTRANSFERASE (ALT/

Facility

$345.00

Service Code	HCPCS 84460
Hospital Charge Code	38472038
Hospital Revenue Code	301
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

ALANINE AMINOTRANSFERASE (ALT/

Facility

$345.00

Service Code	HCPCS 84460
Hospital Charge Code	38472038
Hospital Revenue Code	301
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$14.42
Rate for Payer: Aetna Medicare Advantage	$17.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.30
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	$19.13
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: Cigna Medicare Advantage	$5.30
Rate for Payer: Clover Medicare Advantage	$5.04
Rate for Payer: EmblemHealth Commercial	$15.90
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.30
Rate for Payer: Wellcare Medicare Advantage	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

ALANINE QUANT SERUM

Facility

$47.25

Service Code	HCPCS 84460
Hospital Charge Code	3006913
Hospital Revenue Code	301
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.42
Rate for Payer: Aetna Medicare Advantage	$17.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.30
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	$19.13
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: Cigna Medicare Advantage	$5.30
Rate for Payer: Clover Medicare Advantage	$5.04
Rate for Payer: EmblemHealth Commercial	$15.90
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.30
Rate for Payer: Wellcare Medicare Advantage	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

ALANINE QUANT SERUM

Facility

$47.25

Service Code	HCPCS 84460
Hospital Charge Code	3006913
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

ALBALON 0.1% LIQUIFILM OP

Facility

$71.00

Hospital Charge Code	60632408
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

ALBALON 0.1% LIQUIFILM OP

Facility

$71.00

Hospital Charge Code	60632408
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ALBALON A

Facility

$71.00

Hospital Charge Code	60634514
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

ALBALON A

Facility

$71.00

Hospital Charge Code	60634514
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ALBENDAZOLE 200 MG TAB

Facility

$1,177.99

Service Code	NDC 52054055028
Hospital Charge Code	60629233
Hospital Revenue Code	250
Min. Negotiated Rate	$176.70
Max. Negotiated Rate	$176.70
Rate for Payer: Qualcare PPO/HMO/WC	$176.70

ALBENDAZOLE 200 MG TAB

Facility

$1,177.99

Service Code	NDC 52054055028
Hospital Charge Code	60629233
Hospital Revenue Code	250
Min. Negotiated Rate	$28.39
Max. Negotiated Rate	$589.00
Rate for Payer: Aetna Commercial	$447.64
Rate for Payer: Aetna Medicare Advantage	$353.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.39
Rate for Payer: Cigna Commercial	$589.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.40
Rate for Payer: Oxford Commercial	$235.60
Rate for Payer: Qualcare PPO/HMO/WC	$176.70
Rate for Payer: UnitedHealthcare Commercial	$235.60
Rate for Payer: UnitedHealthcare Community & State	$28.39
Rate for Payer: Wellpoint Medicaid Managed Care	$31.22

ALBENZA, 200MG, TAB

Facility

$4.00

Hospital Charge Code	60635446
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

ALBENZA, 200MG, TAB

Facility

$4.00

Hospital Charge Code	60635446
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALBUMIN

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	8200300RS
Hospital Revenue Code	307
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

ALBUMIN

Facility

$76.00

Service Code	HCPCS 82040
Hospital Charge Code	38472041
Hospital Revenue Code	307
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$11.40

ALBUMIN

Facility

$76.00

Service Code	HCPCS 82040
Hospital Charge Code	38472041
Hospital Revenue Code	307
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$38.00
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

ALBUMIN

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	8200300RS
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$68.75
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

ALBUMIN 25% - 25G/100ML

Facility

$864.30

Service Code	HCPCS P9047
Hospital Charge Code	60630107
Hospital Revenue Code	636
Min. Negotiated Rate	$129.65
Max. Negotiated Rate	$209.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.16
Rate for Payer: Qualcare PPO/HMO/WC	$129.65

ALBUMIN 25% - 25G/100ML

Facility

$864.30

Service Code	HCPCS P9047
Hospital Charge Code	60630107
Hospital Revenue Code	636
Min. Negotiated Rate	$20.83
Max. Negotiated Rate	$209.16
Rate for Payer: Aetna Commercial	$144.38
Rate for Payer: Aetna Medicare Advantage	$171.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$53.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.60
Rate for Payer: Cigna Medicare Advantage	$53.08
Rate for Payer: Clover Medicare Advantage	$50.43
Rate for Payer: EmblemHealth Commercial	$159.24
Rate for Payer: Humana Medicare Advantage	$54.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$53.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.16
Rate for Payer: Qualcare PPO/HMO/WC	$129.65
Rate for Payer: UnitedHealthcare Community & State	$20.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.08
Rate for Payer: Wellcare Medicare Advantage	$53.08
Rate for Payer: Wellpoint Medicaid Managed Care	$22.90

ALBUMIN 25%/50ML

Facility

$482.00

Hospital Charge Code	60634506
Hospital Revenue Code	636
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$116.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.64
Rate for Payer: Qualcare PPO/HMO/WC	$72.30

ALBUMIN 25%/50ML

Facility

$482.00

Hospital Charge Code	60634506
Hospital Revenue Code	636
Min. Negotiated Rate	$11.62
Max. Negotiated Rate	$241.00
Rate for Payer: Aetna Commercial	$183.16
Rate for Payer: Aetna Medicare Advantage	$144.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.91
Rate for Payer: Cigna Commercial	$241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.64
Rate for Payer: Qualcare PPO/HMO/WC	$72.30
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$12.77

ALBUMIN 5%/250ML

Facility

$322.00

Hospital Charge Code	60634827
Hospital Revenue Code	636
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$161.00
Rate for Payer: Aetna Commercial	$122.36
Rate for Payer: Aetna Medicare Advantage	$96.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.11
Rate for Payer: Cigna Commercial	$161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.92
Rate for Payer: Qualcare PPO/HMO/WC	$48.30
Rate for Payer: UnitedHealthcare Community & State	$7.76
Rate for Payer: Wellpoint Medicaid Managed Care	$8.53

ALBUMIN 5%/250ML

Facility

$322.00

Hospital Charge Code	60634827
Hospital Revenue Code	636
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$77.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.92
Rate for Payer: Qualcare PPO/HMO/WC	$48.30

ALBUMIN, BODY FLUID

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3002848
Hospital Revenue Code	307
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

ALBUMIN, BODY FLUID

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3002848
Hospital Revenue Code	307
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
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	$28.08
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

ALBUMIN CSF PROTEIN ELECT

Facility

$88.00

Service Code	HCPCS 84165
Hospital Charge Code	3006947
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

Know your out-of-pocket cost for care.

All Charges