Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMILASE FLUID

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479477
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMILASE FLUID

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479477
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$124.60
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.39
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

AMILORIDE 5 MG TAB

Facility

$8.64

Service Code	NDC 49884011701
Hospital Charge Code	60627974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

AMILORIDE 5 MG TAB

Facility

$8.64

Service Code	NDC 49884011701
Hospital Charge Code	60627974
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

AMILORIDE HCTZ TAB 5/50MG

Facility

$5.65

Hospital Charge Code	60627975
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

AMILORIDE HCTZ TAB 5/50MG

Facility

$5.65

Hospital Charge Code	60627975
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

AMIN AID

Facility

$89.00

Hospital Charge Code	60634840
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

AMIN AID

Facility

$89.00

Hospital Charge Code	60634840
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

AMINO ACID PANEL

Facility

$847.00

Service Code	HCPCS 82130
Hospital Charge Code	38472077
Hospital Revenue Code	301
Min. Negotiated Rate	$20.41
Max. Negotiated Rate	$423.50
Rate for Payer: Aetna Commercial	$321.86
Rate for Payer: Aetna Medicare Advantage	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.99
Rate for Payer: Cigna Commercial	$423.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.41
Rate for Payer: Wellpoint Medicaid Managed Care	$22.45

AMINO ACID PANEL

Facility

$847.00

Service Code	HCPCS 82130
Hospital Charge Code	38472077
Hospital Revenue Code	301
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$127.05

AMINO ACID PROFILE, QN, PLASMA

Facility

$667.59

Service Code	HCPCS 82139
Hospital Charge Code	3038131
Hospital Revenue Code	300
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

AMINO ACID PROFILE, QN, PLASMA

Facility

$667.59

Service Code	HCPCS 82139
Hospital Charge Code	3038131
Hospital Revenue Code	300
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.90
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
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	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

AMINO ACID QUALITATIVE

Facility

$98.00

Service Code	HCPCS 82128
Hospital Charge Code	38472083
Hospital Revenue Code	301
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.73
Rate for Payer: Aetna Medicare Advantage	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.07
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: Cigna Medicare Advantage	$13.87
Rate for Payer: Clover Medicare Advantage	$13.18
Rate for Payer: EmblemHealth Commercial	$41.61
Rate for Payer: Humana Medicare Advantage	$14.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.87
Rate for Payer: Wellcare Medicare Advantage	$13.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

AMINO ACID QUALITATIVE

Facility

$98.00

Service Code	HCPCS 82128
Hospital Charge Code	38472083
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

AMINO ACIDS 1000 ML SOL

Facility

$123.80

Hospital Charge Code	60627941
Hospital Revenue Code	250
Min. Negotiated Rate	$18.57
Max. Negotiated Rate	$18.57
Rate for Payer: Qualcare PPO/HMO/WC	$18.57

AMINO ACIDS 1000 ML SOL

Facility

$123.80

Hospital Charge Code	60627941
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$61.90
Rate for Payer: Aetna Commercial	$47.04
Rate for Payer: Aetna Medicare Advantage	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.57
Rate for Payer: Cigna Commercial	$61.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.14
Rate for Payer: Oxford Commercial	$24.76
Rate for Payer: Qualcare PPO/HMO/WC	$18.57
Rate for Payer: UnitedHealthcare Commercial	$24.76
Rate for Payer: UnitedHealthcare Community & State	$2.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

AMINO ACIDS,2-5,QUANT,EACH

Facility

$119.00

Service Code	HCPCS 82136
Hospital Charge Code	38473161
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

AMINO ACIDS,2-5,QUANT,EACH

Facility

$119.00

Service Code	HCPCS 82136
Hospital Charge Code	38473161
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.34
Rate for Payer: Aetna Medicare Advantage	$63.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.79
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$19.61
Rate for Payer: Clover Medicare Advantage	$18.63
Rate for Payer: EmblemHealth Commercial	$58.83
Rate for Payer: Humana Medicare Advantage	$20.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.61
Rate for Payer: Wellcare Medicare Advantage	$19.61
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

AMINO ACIDS 3% W/ LYTES IV

Facility

$60.00

Hospital Charge Code	60627945
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

AMINO ACIDS 3% W/ LYTES IV

Facility

$60.00

Hospital Charge Code	60627945
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

AMINO ACIDS,6 OR MOR,QUANT

Facility

$119.00

Service Code	HCPCS 82139
Hospital Charge Code	38473162
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.90
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

AMINO ACIDS,6 OR MOR,QUANT

Facility

$119.00

Service Code	HCPCS 82139
Hospital Charge Code	38473162
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

AMINO ACIDS (CSF QUANT 2-5)

Facility

$376.85

Service Code	HCPCS 82136
Hospital Charge Code	3003126
Hospital Revenue Code	301
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$56.53
Rate for Payer: Qualcare PPO/HMO/WC	$56.53

AMINO ACIDS (CSF QUANT 2-5)

Facility

$376.85

Service Code	HCPCS 82136
Hospital Charge Code	3003126
Hospital Revenue Code	301
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$188.43
Rate for Payer: Aetna Commercial	$53.34
Rate for Payer: Aetna Medicare Advantage	$63.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.79
Rate for Payer: Cigna Commercial	$188.43
Rate for Payer: Cigna Medicare Advantage	$19.61
Rate for Payer: Clover Medicare Advantage	$18.63
Rate for Payer: EmblemHealth Commercial	$58.83
Rate for Payer: Humana Medicare Advantage	$20.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.61
Rate for Payer: Wellcare Medicare Advantage	$19.61
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

AMINO ACID (SGL QUAL URINE)

Facility

$128.00

Service Code	HCPCS 82139
Hospital Charge Code	3003043
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

Know your out-of-pocket cost for care.

All Charges