Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$8,816.98

Service Code	APR-DRG 7723
Min. Negotiated Rate	$8,644.10
Max. Negotiated Rate	$8,816.98
Rate for Payer: UnitedHealthcare Community & State	$8,644.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,816.98
Rate for Payer: Wellpoint Medicaid Managed Care	$8,644.10

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$7,056.38

Service Code	APR-DRG 7722
Min. Negotiated Rate	$6,918.02
Max. Negotiated Rate	$7,056.38
Rate for Payer: UnitedHealthcare Community & State	$6,918.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,056.38
Rate for Payer: Wellpoint Medicaid Managed Care	$6,918.02

ALCOHOL BLOOD, (COC)***

Facility

$123.00

Service Code	HCPCS 82055
Hospital Charge Code	3032323
Hospital Revenue Code	301
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

ALCOHOL BLOOD, (COC)***

Facility

$123.00

Service Code	HCPCS 82055
Hospital Charge Code	3032323
Hospital Revenue Code	301
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.74
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

ALCOHOL DEHYD 98% AMP 5ML

Facility

$163.00

Hospital Charge Code	60635581
Hospital Revenue Code	250
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

ALCOHOL DEHYD 98% AMP 5ML

Facility

$163.00

Hospital Charge Code	60635581
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Commercial	$61.94
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$32.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$32.60
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

ALCOHOL DEHYDRATED 98% INJ

Facility

$1,406.40

Hospital Charge Code	6063943053
Hospital Revenue Code	250
Min. Negotiated Rate	$33.89
Max. Negotiated Rate	$703.20
Rate for Payer: Aetna Commercial	$534.43
Rate for Payer: Aetna Medicare Advantage	$421.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.63
Rate for Payer: Cigna Commercial	$703.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.92
Rate for Payer: Oxford Commercial	$281.28
Rate for Payer: Qualcare PPO/HMO/WC	$210.96
Rate for Payer: UnitedHealthcare Commercial	$281.28
Rate for Payer: UnitedHealthcare Community & State	$33.89
Rate for Payer: Wellpoint Medicaid Managed Care	$37.27

ALCOHOL DEHYDRATED 98% INJ

Facility

$1,406.40

Hospital Charge Code	6063943053
Hospital Revenue Code	250
Min. Negotiated Rate	$210.96
Max. Negotiated Rate	$210.96
Rate for Payer: Qualcare PPO/HMO/WC	$210.96

ALCOHOL DEXTROSE (GLASS) *****

Facility

$39.00

Hospital Charge Code	7000276
Hospital Revenue Code	258
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

ALCOHOL DEXTROSE (GLASS) *****

Facility

$39.00

Hospital Charge Code	7000276
Hospital Revenue Code	258
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$22,073.31

Service Code	MSDRG 894
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$22,073.31
Rate for Payer: Aetna Commercial	$15,424.19
Rate for Payer: Aetna Medicare Advantage	$22,073.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,258.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,258.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,074.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,258.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Cigna Commercial	$11,544.67
Rate for Payer: Cigna Medicare Advantage	$7,074.78
Rate for Payer: Clover Medicare Advantage	$6,721.04
Rate for Payer: EmblemHealth Commercial	$21,224.34
Rate for Payer: Humana Medicare Advantage	$7,287.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,074.78
Rate for Payer: Oxford Commercial	$8,297.31
Rate for Payer: UnitedHealthcare Commercial	$14,549.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,074.78
Rate for Payer: Wellcare Medicare Advantage	$7,074.78

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$58,538.63

Service Code	MSDRG 896
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$58,538.63
Rate for Payer: Aetna Commercial	$40,480.02
Rate for Payer: Aetna Medicare Advantage	$58,538.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,404.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,404.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,762.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,404.58
Rate for Payer: Cigna Commercial	$32,657.80
Rate for Payer: Cigna Medicare Advantage	$18,762.38
Rate for Payer: Clover Medicare Advantage	$17,824.26
Rate for Payer: EmblemHealth Commercial	$56,287.14
Rate for Payer: Humana Medicare Advantage	$19,325.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,762.38
Rate for Payer: Oxford Commercial	$23,471.60
Rate for Payer: UnitedHealthcare Commercial	$41,158.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,762.38
Rate for Payer: Wellcare Medicare Advantage	$18,762.38

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$30,667.63

Service Code	MSDRG 897
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$30,667.63
Rate for Payer: Aetna Commercial	$21,329.51
Rate for Payer: Aetna Medicare Advantage	$30,667.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,004.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,004.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,004.46
Rate for Payer: Cigna Commercial	$16,520.72
Rate for Payer: Cigna Medicare Advantage	$9,829.37
Rate for Payer: Clover Medicare Advantage	$9,337.90
Rate for Payer: EmblemHealth Commercial	$29,488.11
Rate for Payer: Humana Medicare Advantage	$10,124.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,829.37
Rate for Payer: Oxford Commercial	$11,873.66
Rate for Payer: UnitedHealthcare Commercial	$20,820.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,829.37
Rate for Payer: Wellcare Medicare Advantage	$9,829.37

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$47,888.63

Service Code	MSDRG 895
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$47,888.63
Rate for Payer: Aetna Commercial	$33,162.27
Rate for Payer: Aetna Medicare Advantage	$47,888.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,348.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Cigna Commercial	$26,491.54
Rate for Payer: Cigna Medicare Advantage	$15,348.92
Rate for Payer: Clover Medicare Advantage	$14,581.47
Rate for Payer: EmblemHealth Commercial	$46,046.76
Rate for Payer: Humana Medicare Advantage	$15,809.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,348.92
Rate for Payer: Oxford Commercial	$19,039.82
Rate for Payer: UnitedHealthcare Commercial	$33,386.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,348.92
Rate for Payer: Wellcare Medicare Advantage	$15,348.92

ALCOHOL,ETHYL

Facility

$583.80

Service Code	HCPCS 80320
Hospital Charge Code	38472033
Hospital Revenue Code	301
Min. Negotiated Rate	$87.57
Max. Negotiated Rate	$87.57
Rate for Payer: Qualcare PPO/HMO/WC	$87.57

ALCOHOL,ETHYL

Facility

$583.80

Service Code	HCPCS 80320
Hospital Charge Code	38472033
Hospital Revenue Code	301
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$291.90
Rate for Payer: Aetna Commercial	$221.84
Rate for Payer: Aetna Medicare Advantage	$175.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.87
Rate for Payer: Cigna Commercial	$291.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$15.47

ALCOHOL,ETHYL,QL,URINE

Facility

$499.75

Service Code	HCPCS 80320
Hospital Charge Code	39900407
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

ALCOHOL,ETHYL,QL,URINE

Facility

$499.75

Service Code	HCPCS 80320
Hospital Charge Code	39900407
Hospital Revenue Code	301
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$13.24

ALCOHOL, ETHYL, QN

Facility

$390.00

Service Code	HCPCS 80320
Hospital Charge Code	39900035
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ALCOHOL, ETHYL, QN

Facility

$390.00

Service Code	HCPCS 80320
Hospital Charge Code	39900035
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALCOHOL, ETHYL, QUANT,URINE***

Facility

$92.00

Service Code	HCPCS 80320
Hospital Charge Code	3031127
Hospital Revenue Code	301
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

ALCOHOL, ETHYL, QUANT,URINE***

Facility

$92.00

Service Code	HCPCS 80320
Hospital Charge Code	3031127
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

ALCOHOL ETHYL SOL 100% GAL

Facility

$41.60

Hospital Charge Code	6009377
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

ALCOHOL ETHYL SOL 100% GAL

Facility

$41.60

Hospital Charge Code	6009377
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

ALCOHOL ETHYL SOL 95% GAL

Facility

$37.80

Hospital Charge Code	6009369
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

Know your out-of-pocket cost for care.

All Charges