Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	3036028
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

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	3036028
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	38430002
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

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	38430002
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	3039002
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	98410222
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN PRSMPTV 1 CLASS

Facility

$190.45

Service Code	HCPCS 80302
Hospital Charge Code	98410222
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

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	38430005
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	39990205
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

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	3036031
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	3036031
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

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	38430005
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

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	39990205
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	3039005
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUG SCREEN QUANTALCOHOLS

Facility

$190.45

Service Code	HCPCS 80320
Hospital Charge Code	3039005
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

DRUGS OF ABUSE DAS-10 COC

Facility

$62.50

Hospital Charge Code	3000315
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

DRUGS OF ABUSE DAS-10 COC

Facility

$62.50

Hospital Charge Code	3000315
Hospital Revenue Code	301
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

DRUGS OF ABUSE DAS-7m III

Facility

$190.45

Hospital Charge Code	3000313C
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

DRUGS OF ABUSE DAS-7m III

Facility

$190.45

Hospital Charge Code	3000313C
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

DRUGS OF ABUSE DAS-7 PANEL

Facility

$1,333.15

Hospital Charge Code	3000313
Hospital Revenue Code	301
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$666.58
Rate for Payer: Aetna Commercial	$506.60
Rate for Payer: Aetna Medicare Advantage	$399.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$339.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$339.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$339.95
Rate for Payer: Cigna Commercial	$666.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$199.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$32.13
Rate for Payer: Wellpoint Medicaid Managed Care	$35.33

DRUGS OF ABUSE DAS-7 PANEL

Facility

$1,333.15

Hospital Charge Code	3000313
Hospital Revenue Code	301
Min. Negotiated Rate	$199.97
Max. Negotiated Rate	$199.97
Rate for Payer: Qualcare PPO/HMO/WC	$199.97

DRUG TEST PRESUMP CHEM ANLYZR

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	3066037
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.31
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$62.14
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
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	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DRUG TEST PRESUMP CHEM ANLYZR

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	39990169
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP CHEM ANLYZR

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	39990169
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.31
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$62.14
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
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	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DRUG TEST PRESUMP CHEM ANLYZR

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	3066037
Hospital Revenue Code	301
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