Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMINO ACID (SGL QUAL URINE)

Facility

$128.00

Service Code	HCPCS 82139
Hospital Charge Code	3003043
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
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	$64.00
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	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
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	$3.39

AMINO ACID SINGLE

Facility

$153.65

Service Code	HCPCS 82131
Hospital Charge Code	3035104
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

AMINO ACID SINGLE

Facility

$153.65

Service Code	HCPCS 82131
Hospital Charge Code	3035104
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

AMINO ACID SINGLE (CYSTINE)

Facility

$153.65

Service Code	HCPCS 82131
Hospital Charge Code	3035102
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

AMINO ACID SINGLE (CYSTINE)

Facility

$153.65

Service Code	HCPCS 82131
Hospital Charge Code	3035102
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

AMINO ACIDS INJ 15%

Facility

$3.20

Hospital Charge Code	60627942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

AMINO ACIDS INJ 15%

Facility

$3.20

Hospital Charge Code	60627942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

AMINO ACIDS INJ 4%

Facility

$3.20

Hospital Charge Code	60627943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

AMINO ACIDS INJ 4%

Facility

$3.20

Hospital Charge Code	60627943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

AMINO ACIDS INJ 6.5%

Facility

$3.20

Hospital Charge Code	60627944
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

AMINO ACIDS INJ 6.5%

Facility

$3.20

Hospital Charge Code	60627944
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

AMINO ACIDS;SING,QUANT,EACH

Facility

$119.00

Service Code	HCPCS 82139
Hospital Charge Code	38473160
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;SING,QUANT,EACH

Facility

$119.00

Service Code	HCPCS 82139
Hospital Charge Code	38473160
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 SOL INJ

Facility

$53.80

Hospital Charge Code	6006027
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

AMINO ACIDS SOL INJ

Facility

$53.80

Hospital Charge Code	6006027
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

AMINO ACID URINE QT

Facility

$1,500.00

Service Code	HCPCS 82139
Hospital Charge Code	397072025
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$750.00
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	$750.00
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	$450.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
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	$39.75

AMINO ACID URINE QT

Facility

$1,500.00

Service Code	HCPCS 82139
Hospital Charge Code	397072025
Hospital Revenue Code	301
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

AMINOCAPROIC ACID/250MG

Facility

$18.00

Hospital Charge Code	60632434
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

AMINOCAPROIC ACID/250MG

Facility

$18.00

Hospital Charge Code	60632434
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

AMINOCAPROIC ACID 500 MG TAB

Facility

$163.68

Service Code	NDC 49411005030
Hospital Charge Code	60627520
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$81.84
Rate for Payer: Aetna Commercial	$62.20
Rate for Payer: Aetna Medicare Advantage	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.74
Rate for Payer: Cigna Commercial	$81.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.10
Rate for Payer: Oxford Commercial	$32.74
Rate for Payer: Qualcare PPO/HMO/WC	$24.55
Rate for Payer: UnitedHealthcare Commercial	$32.74
Rate for Payer: UnitedHealthcare Community & State	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.34

AMINOCAPROIC ACID 500 MG TAB

Facility

$163.68

Service Code	NDC 49411005030
Hospital Charge Code	60627520
Hospital Revenue Code	250
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$24.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.55

AMINOCAPROIC ACID INJ 5G/20ML

Facility

$18.02

Service Code	NDC 409434673
Hospital Charge Code	60627521
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

AMINOCAPROIC ACID INJ 5G/20ML

Facility

$18.02

Service Code	NDC 409434673
Hospital Charge Code	60627521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.01
Rate for Payer: Aetna Commercial	$6.85
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$9.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

AMINOCAPROIC ACID LIQ 25%

Facility

$628.50

Hospital Charge Code	6006035
Hospital Revenue Code	251
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$314.25
Rate for Payer: Aetna Commercial	$238.83
Rate for Payer: Aetna Medicare Advantage	$188.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.27
Rate for Payer: Cigna Commercial	$314.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.55
Rate for Payer: Oxford Commercial	$125.70
Rate for Payer: Qualcare PPO/HMO/WC	$94.28
Rate for Payer: UnitedHealthcare Commercial	$125.70
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.66

AMINOCAPROIC ACID LIQ 25%

Facility

$628.50

Hospital Charge Code	6006035
Hospital Revenue Code	251
Min. Negotiated Rate	$94.28
Max. Negotiated Rate	$94.28
Rate for Payer: Qualcare PPO/HMO/WC	$94.28

Know your out-of-pocket cost for care.

All Charges