Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALPHA 2 MACROGLOBULIN

Facility

$445.00

Service Code	HCPCS 86329
Hospital Charge Code	38472059
Hospital Revenue Code	302
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$66.75
Rate for Payer: Qualcare PPO/HMO/WC	$66.75

ALPHA 2 MACROGLOBULIN

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3006954
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

ALPHA BSM 5.0 STERL 1980902050

Facility

$3,100.00

Hospital Charge Code	270632505
Hospital Revenue Code	272
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$465.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.00

ALPHA BSM 5.0 STERL 1980902050

Facility

$3,100.00

Hospital Charge Code	270632505
Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$1,178.00
Rate for Payer: Aetna Medicare Advantage	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$790.50
Rate for Payer: Cigna Commercial	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.00
Rate for Payer: Oxford Commercial	$620.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.00
Rate for Payer: UnitedHealthcare Commercial	$620.00
Rate for Payer: UnitedHealthcare Community & State	$74.71
Rate for Payer: Wellpoint Medicaid Managed Care	$82.15

ALPHACAN 0.2% OPHT SOL

Facility

$89.00

Hospital Charge Code	60635276
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

ALPHACAN 0.2% OPHT SOL

Facility

$89.00

Hospital Charge Code	60635276
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

ALPHA-CHYMOTRYPSIN VL OPH 750U

Facility

$254.75

Hospital Charge Code	6005920
Hospital Revenue Code	252
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$127.38
Rate for Payer: Aetna Commercial	$96.81
Rate for Payer: Aetna Medicare Advantage	$76.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.96
Rate for Payer: Cigna Commercial	$127.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.42
Rate for Payer: Oxford Commercial	$50.95
Rate for Payer: Qualcare PPO/HMO/WC	$38.21
Rate for Payer: UnitedHealthcare Commercial	$50.95
Rate for Payer: UnitedHealthcare Community & State	$6.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.75

ALPHA-CHYMOTRYPSIN VL OPH 750U

Facility

$254.75

Hospital Charge Code	6005920
Hospital Revenue Code	252
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$38.21
Rate for Payer: Qualcare PPO/HMO/WC	$38.21

ALPHA FETL PROTEIN

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479482
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHA FETL PROTEIN

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479482
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ALPHA FETOPROTEIN (AFP)

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472062
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ALPHA FETOPROTEIN (AFP)

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472062
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHAFETOPROTEIN,AFP

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479404
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ALPHAFETOPROTEIN,AFP

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479404
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHA FETOPROTEIN, AMNIOTIC FL

Facility

$350.00

Service Code	HCPCS 82106
Hospital Charge Code	38472068
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ALPHA FETOPROTEIN, AMNIOTIC FL

Facility

$350.00

Service Code	HCPCS 82106
Hospital Charge Code	38472068
Hospital Revenue Code	301
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$46.24
Rate for Payer: Aetna Medicare Advantage	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.36
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: Cigna Medicare Advantage	$17.00
Rate for Payer: Clover Medicare Advantage	$16.15
Rate for Payer: EmblemHealth Commercial	$51.00
Rate for Payer: Humana Medicare Advantage	$17.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.00
Rate for Payer: Wellcare Medicare Advantage	$17.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ALPHA-FETOPROTEIN L3

Facility

$290.78

Service Code	HCPCS 82107
Hospital Charge Code	401182107
Hospital Revenue Code	301
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$43.62
Rate for Payer: Qualcare PPO/HMO/WC	$43.62

ALPHA-FETOPROTEIN L3

Facility

$290.78

Service Code	HCPCS 82107
Hospital Charge Code	401182107
Hospital Revenue Code	301
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.50
Rate for Payer: Cigna Commercial	$145.39
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

ALPHA FETOPROTEIN,MATERNAL SER

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472065
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ALPHA FETOPROTEIN,MATERNAL SER

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472065
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHAGAN, 0.2%, 5ML

Facility

$121.47

Service Code	NDC 24208041105
Hospital Charge Code	60635466
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$60.73
Rate for Payer: Aetna Commercial	$46.16
Rate for Payer: Aetna Medicare Advantage	$36.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.97
Rate for Payer: Cigna Commercial	$60.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.44
Rate for Payer: Oxford Commercial	$24.29
Rate for Payer: Qualcare PPO/HMO/WC	$18.22
Rate for Payer: UnitedHealthcare Commercial	$24.29
Rate for Payer: UnitedHealthcare Community & State	$2.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.22

ALPHAGAN, 0.2%, 5ML

Facility

$121.47

Service Code	NDC 24208041105
Hospital Charge Code	60635466
Hospital Revenue Code	250
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Qualcare PPO/HMO/WC	$18.22

ALPHA-GLOBIN COMMON MUTAT

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900320
Hospital Revenue Code	310
Min. Negotiated Rate	$348.45
Max. Negotiated Rate	$348.45
Rate for Payer: Qualcare PPO/HMO/WC	$348.45

ALPHA-GLOBIN COMMON MUTAT

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900320
Hospital Revenue Code	310
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$1,161.50
Rate for Payer: Aetna Commercial	$278.15
Rate for Payer: Aetna Medicare Advantage	$331.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.13
Rate for Payer: Cigna Commercial	$1,161.50
Rate for Payer: Cigna Medicare Advantage	$102.26
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$102.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.45
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$81.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Medicare Advantage	$102.26
Rate for Payer: Wellpoint Medicaid Managed Care	$61.56

ALPHA-GLOBIN COMPLETE

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900030
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,087.78
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

Know your out-of-pocket cost for care.

All Charges