Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMPHETAMINES 3OR 4

Facility

$190.45

Service Code	HCPCS 80325
Hospital Charge Code	39990209
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

AMPHETAMINES 3OR 4

Facility

$190.45

Service Code	HCPCS 80325
Hospital Charge Code	39990209
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	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

AMPHETAMINES 3OR 4

Facility

$190.45

Service Code	HCPCS 80325
Hospital Charge Code	3039009
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

AMPHETAMINES 3OR 4

Facility

$190.45

Service Code	HCPCS 80325
Hospital Charge Code	38430009
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	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	39990210
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	3039010
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

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	38430010
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	39990210
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

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	3039010
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

AMPHETAMINES 5 OR MORE

Facility

$190.45

Service Code	HCPCS 80326
Hospital Charge Code	38430010
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

AMPHETAMINE SALT 10MG TAB

Facility

$11.46

Service Code	NDC 555097202
Hospital Charge Code	6063943054
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.72

AMPHETAMINE SALT 10MG TAB

Facility

$11.46

Service Code	NDC 555097202
Hospital Charge Code	6063943054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$4.35
Rate for Payer: Aetna Medicare Advantage	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.92
Rate for Payer: Cigna Commercial	$5.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$2.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.72
Rate for Payer: UnitedHealthcare Commercial	$2.29
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

AMPHETAMINE SALT 5MG TAB

Facility

$13.80

Service Code	NDC 64720013010
Hospital Charge Code	6063943055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna Medicare Advantage	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.14
Rate for Payer: Oxford Commercial	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$2.76
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

AMPHETAMINE SALT 5MG TAB

Facility

$13.80

Service Code	NDC 64720013010
Hospital Charge Code	6063943055
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

AMPHETAMINE SCREEN W/CONF

Facility

$499.75

Service Code	HCPCS 80300
Hospital Charge Code	39900002
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

AMPHETAMINE SCREEN W/CONF

Facility

$499.75

Service Code	HCPCS 80300
Hospital Charge Code	39900002
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: Wellpoint Medicaid Managed Care	$13.24

AMPHETAMINES (QUANT SERUM)

Facility

$179.25

Service Code	HCPCS 80324
Hospital Charge Code	3007002
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

AMPHETAMINES (QUANT SERUM)

Facility

$179.25

Service Code	HCPCS 80324
Hospital Charge Code	3007002
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$68.11
Rate for Payer: Aetna Medicare Advantage	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.71
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

AMPHETAMINES (QUANT URINE)

Facility

$179.25

Service Code	HCPCS 80324
Hospital Charge Code	3007010
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$68.11
Rate for Payer: Aetna Medicare Advantage	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.71
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

AMPHETAMINES (QUANT URINE)

Facility

$179.25

Service Code	HCPCS 80324
Hospital Charge Code	3007010
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

AMPHETAMINES, URINE

Facility

$392.00

Service Code	HCPCS 80324
Hospital Charge Code	38472098
Hospital Revenue Code	301
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$58.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.80

AMPHETAMINES, URINE

Facility

$392.00

Service Code	HCPCS 80324
Hospital Charge Code	38472098
Hospital Revenue Code	301
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial	$148.96
Rate for Payer: Aetna Medicare Advantage	$117.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.96
Rate for Payer: Cigna Commercial	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.39

AMPHETAMINES,URINE

Facility

$106.80

Service Code	HCPCS 80324
Hospital Charge Code	39900041
Hospital Revenue Code	301
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$16.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

AMPHETAMINES,URINE

Facility

$106.80

Service Code	HCPCS 80324
Hospital Charge Code	39900041
Hospital Revenue Code	301
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.58
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.23
Rate for Payer: Cigna Commercial	$53.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

AMPHIPHYSIN ANTIBODY TEST

Facility

$1,925.00

Service Code	HCPCS 84181
Hospital Charge Code	3038553
Hospital Revenue Code	301
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.47
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

Know your out-of-pocket cost for care.

All Charges