Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALCOHOL PREP PAD WEBCOL 2-PLY

Facility

$2.75

Hospital Charge Code	270300045C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.41

ALCOHOL PREP PAD WEBCOL 2-PLY

Facility

$2.75

Hospital Charge Code	270300045C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna Commercial	$1.04
Rate for Payer: Aetna Medicare Advantage	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.70
Rate for Payer: Cigna Commercial	$1.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.83
Rate for Payer: Oxford Commercial	$0.55
Rate for Payer: Qualcare PPO/HMO/WC	$0.41
Rate for Payer: UnitedHealthcare Commercial	$0.55
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	38430006
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	3039006
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	3039006
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	38430006
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	39990206
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	3036034
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	39990206
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 1OR 2

Facility

$190.45

Service Code	HCPCS 80321
Hospital Charge Code	3036034
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	38430007
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	3039007
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	39990207
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	39990207
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	3039007
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOLS BIOMARKERS 3/MORE

Facility

$190.45

Service Code	HCPCS 80322
Hospital Charge Code	38430007
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ALCOHOL/SUBST ABUSE SCRNING 15

Facility

$55.00

Service Code	HCPCS 99408
Hospital Charge Code	5780320
Hospital Revenue Code	450
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

ALCOHOL/SUBST ABUSE SCRNING 15

Facility

$55.00

Service Code	HCPCS 99408
Hospital Charge Code	5780320
Hospital Revenue Code	450
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

ALCOHOL URINE

Facility

$213.65

Service Code	HCPCS 80320
Hospital Charge Code	3032745
Hospital Revenue Code	301
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Aetna Medicare Advantage	$64.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.48
Rate for Payer: Cigna Commercial	$106.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.66

ALCOHOL URINE

Facility

$213.65

Service Code	HCPCS 80320
Hospital Charge Code	3032745
Hospital Revenue Code	301
Min. Negotiated Rate	$32.05
Max. Negotiated Rate	$32.05
Rate for Payer: Qualcare PPO/HMO/WC	$32.05

ALCON IOL MN60AC

Facility

$224.00

Hospital Charge Code	270335954
Hospital Revenue Code	276
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.28
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

ALCON IOL MN60AC

Facility

$224.00

Hospital Charge Code	270335954
Hospital Revenue Code	276
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$54.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.28
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

ALDACTAZIDE 25/25/TAB

Facility

$3.00

Hospital Charge Code	60632410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ALDACTAZIDE 25/25/TAB

Facility

$3.00

Hospital Charge Code	60632409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALDACTAZIDE 25/25/TAB

Facility

$3.00

Hospital Charge Code	60632410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges