Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANALGESICS NON-OPIOID 3-5

Facility

$190.45

Service Code	HCPCS 80330
Hospital Charge Code	3039014
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANALGESICS NON-OPIOID 3-5

Facility

$190.45

Service Code	HCPCS 80330
Hospital Charge Code	3039014
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANALGESICS NON-OPIOID 3-5

Facility

$190.45

Service Code	HCPCS 80330
Hospital Charge Code	39990214
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANALGESICS NON-OPIOID 3-5

Facility

$190.45

Service Code	HCPCS 80330
Hospital Charge Code	39990214
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	39990215
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	3039015
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

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	38430015
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

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	39990215
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

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	38430015
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANALGESICS NON-OPIOID 6/MORE

Facility

$190.45

Service Code	HCPCS 80331
Hospital Charge Code	3039015
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANALPRAM HC 1%/30GM

Facility

$291.00

Hospital Charge Code	60633747
Hospital Revenue Code	250
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

ANALPRAM HC 1%/30GM

Facility

$291.00

Hospital Charge Code	60633747
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$110.58
Rate for Payer: Aetna Medicare Advantage	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.20
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.30
Rate for Payer: Oxford Commercial	$58.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: UnitedHealthcare Community & State	$7.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

ANALYTE IMMUNOASSAY, EACH, #1

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3032059B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
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	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANALYTE IMMUNOASSAY, EACH, #1

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3032059B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANALYTE IMMUNOASSAY, EACH, #2

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3032059C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANALYTE IMMUNOASSAY, EACH, #2

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3032059C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
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	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANALYZE NEUROSTIM COMPLEX

Facility

$460.72

Service Code	HCPCS 95972
Hospital Charge Code	1600000290
Hospital Revenue Code	360
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$307.22
Rate for Payer: Aetna Medicare Advantage	$365.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$407.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$407.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$112.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$407.72
Rate for Payer: Cigna Commercial	$226.40
Rate for Payer: Cigna Medicare Advantage	$112.95
Rate for Payer: Clover Medicare Advantage	$107.30
Rate for Payer: EmblemHealth Commercial	$338.85
Rate for Payer: Humana Medicare Advantage	$116.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$112.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.22
Rate for Payer: Qualcare PPO/HMO/WC	$69.11
Rate for Payer: UnitedHealthcare Community & State	$11.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.95
Rate for Payer: Wellcare Medicare Advantage	$112.95
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

ANALYZE NEUROSTIM COMPLEX

Facility

$460.72

Service Code	HCPCS 95972
Hospital Charge Code	1600000290
Hospital Revenue Code	360
Min. Negotiated Rate	$69.11
Max. Negotiated Rate	$69.11
Rate for Payer: Qualcare PPO/HMO/WC	$69.11

ANA PATTERN

Facility

$390.00

Service Code	HCPCS 86039
Hospital Charge Code	397043302
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANA PATTERN

Facility

$390.00

Service Code	HCPCS 86039
Hospital Charge Code	397043302
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$30.36
Rate for Payer: Aetna Medicare Advantage	$36.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.16
Rate for Payer: Clover Medicare Advantage	$10.60
Rate for Payer: EmblemHealth Commercial	$33.48
Rate for Payer: Humana Medicare Advantage	$11.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.16
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	$8.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.16
Rate for Payer: Wellcare Medicare Advantage	$11.16
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANAPLASMPHAGOCYTOPHABIGG&IGM-C

Facility

$117.55

Service Code	HCPCS 86666
Hospital Charge Code	401386666B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$17.63
Rate for Payer: Qualcare PPO/HMO/WC	$17.63

ANAPLASMPHAGOCYTOPHABIGG&IGM-C

Facility

$117.55

Service Code	HCPCS 86666
Hospital Charge Code	401386666B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$58.77
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.63
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

ANAPLASMPHAGOCYTOPHDNAQLRTPCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	4011877983
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANAPLASMPHAGOCYTOPHDNAQLRTPCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	4011877983
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANAPROX/275MG/TAB

Facility

$15.34

Service Code	NDC 53746019301
Hospital Charge Code	60632458
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.30

Know your out-of-pocket cost for care.

All Charges