Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

ALBUMIN HUMAN 25% 12.5GM/50 ML

Facility

$603.00

Service Code	HCPCS P9047
Hospital Charge Code	60627497
Hospital Revenue Code	636
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$191.60
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	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.08
Rate for Payer: Wellcare Medicare Advantage	$53.08
Rate for Payer: Wellpoint Medicaid Managed Care	$15.98

ALBUMIN HUMAN 25% 12.5GM/50 ML

Facility

$603.00

Service Code	HCPCS P9047
Hospital Charge Code	60627497
Hospital Revenue Code	636
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$145.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

ALBUMIN,(HUMAN),25%,50ML INFSN

Facility

$418.00

Hospital Charge Code	60631027
Hospital Revenue Code	636
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$158.84
Rate for Payer: Aetna Medicare Advantage	$125.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Community & State	$10.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ALBUMIN,(HUMAN),25%,50ML INFSN

Facility

$418.00

Hospital Charge Code	60631027
Hospital Revenue Code	636
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$101.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

ALBUMIN HUMAN 5% 12.5GM/250 ML

Facility

$603.00

Service Code	HCPCS P9045
Hospital Charge Code	60627498
Hospital Revenue Code	636
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$191.60
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	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.08
Rate for Payer: Wellcare Medicare Advantage	$53.08
Rate for Payer: Wellpoint Medicaid Managed Care	$15.98

ALBUMIN HUMAN 5% 12.5GM/250 ML

Facility

$603.00

Service Code	HCPCS P9045
Hospital Charge Code	60627498
Hospital Revenue Code	636
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$145.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

ALBUMIN HUMAN 5% 250ML BTL

Facility

$317.45

Hospital Charge Code	6007512
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$120.63
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.82
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

ALBUMIN HUMAN 5% 250ML BTL

Facility

$317.45

Hospital Charge Code	6007512
Hospital Revenue Code	636
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$76.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.82
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

ALBUMIN,(HUMAN),5%,250ML INFSN

Facility

$398.00

Hospital Charge Code	60631028
Hospital Revenue Code	636
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$96.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.32
Rate for Payer: Qualcare PPO/HMO/WC	$59.70

ALBUMIN,(HUMAN),5%,250ML INFSN

Facility

$398.00

Hospital Charge Code	60631028
Hospital Revenue Code	636
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$199.00
Rate for Payer: Aetna Commercial	$151.24
Rate for Payer: Aetna Medicare Advantage	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.49
Rate for Payer: Cigna Commercial	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.32
Rate for Payer: Qualcare PPO/HMO/WC	$59.70
Rate for Payer: UnitedHealthcare Community & State	$9.59
Rate for Payer: Wellpoint Medicaid Managed Care	$10.55

ALBUMIN HUMAN 5% RENAL 250 ML

Facility

$450.00

Hospital Charge Code	60627498R
Hospital Revenue Code	636
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ALBUMIN HUMAN 5% RENAL 250 ML

Facility

$450.00

Hospital Charge Code	60627498R
Hospital Revenue Code	636
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ALBUMIN PERICARDIAL FLUID

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3002845
Hospital Revenue Code	307
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

ALBUMIN PERICARDIAL FLUID

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3002845
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,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39900324
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALBUMIN,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39900324
Hospital Revenue Code	307
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

Albumin, Peritoneal Fluid

Facility

$83.25

Service Code	HCPCS 82042
Hospital Charge Code	39888025
Hospital Revenue Code	307
Min. Negotiated Rate	$2.21
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	$41.62
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	$24.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.49
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	$2.21

Albumin, Peritoneal Fluid

Facility

$83.25

Service Code	HCPCS 82042
Hospital Charge Code	39888025
Hospital Revenue Code	307
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$12.49

ALBUMIN PERITONEAL FLUID

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3002844
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 PERITONEAL FLUID

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3002844
Hospital Revenue Code	307
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

ALBUMIN, PERITONEAL FLUID

Facility

$667.59

Service Code	HCPCS 82042
Hospital Charge Code	39900033
Hospital Revenue Code	307
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$333.80
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	$333.80
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	$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	$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	$17.69

ALBUMIN, PERITONEAL FLUID

Facility

$667.59

Service Code	HCPCS 82042
Hospital Charge Code	39900033
Hospital Revenue Code	307
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ALBUMIN,PLEURAL FLUID

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39900323
Hospital Revenue Code	307
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

ALBUMIN,PLEURAL FLUID

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39900323
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges