Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH LEAD WHOLE BLOOD

Facility

$201.00

Service Code	HCPCS 83655
Hospital Charge Code	397073248
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

CH LEGIONELLA URINE ANTIGEN

Facility

$125.00

Service Code	HCPCS 87449
Hospital Charge Code	397041077
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CH LEGIONELLA URINE ANTIGEN

Facility

$125.00

Service Code	HCPCS 87449
Hospital Charge Code	397041077
Hospital Revenue Code	306
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CH LEMS AUTOANTIBODY

Facility

$675.00

Service Code	HCPCS 83519
Hospital Charge Code	397073569
Hospital Revenue Code	301
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

CH LEMS AUTOANTIBODY

Facility

$675.00

Service Code	HCPCS 83519
Hospital Charge Code	397073569
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$17.89

CH LEPTIN

Facility

$84.00

Service Code	HCPCS 82397
Hospital Charge Code	397071459
Hospital Revenue Code	301
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.41
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.97
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: Cigna Medicare Advantage	$14.12
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Medicare Advantage	$14.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

CH LEPTIN

Facility

$84.00

Service Code	HCPCS 82397
Hospital Charge Code	397071459
Hospital Revenue Code	301
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

CH LEUKEMIA LYMPHOMA EVAL

Facility

$4,105.00

Hospital Charge Code	3970729
Hospital Revenue Code	301
Min. Negotiated Rate	$615.75
Max. Negotiated Rate	$615.75
Rate for Payer: Qualcare PPO/HMO/WC	$615.75

CH LEUKEMIA LYMPHOMA EVAL

Facility

$4,105.00

Hospital Charge Code	3970729
Hospital Revenue Code	301
Min. Negotiated Rate	$98.93
Max. Negotiated Rate	$2,052.50
Rate for Payer: Aetna Commercial	$1,559.90
Rate for Payer: Aetna Medicare Advantage	$1,231.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.78
Rate for Payer: Cigna Commercial	$2,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,231.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$615.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$98.93
Rate for Payer: Wellpoint Medicaid Managed Care	$108.78

CH LEUKEMIA/LYMPHOMA: MARROW

Facility

$1,335.00

Service Code	HCPCS 86359
Hospital Charge Code	397073203
Hospital Revenue Code	302
Min. Negotiated Rate	$200.25
Max. Negotiated Rate	$200.25
Rate for Payer: Qualcare PPO/HMO/WC	$200.25

CH LEUKEMIA/LYMPHOMA: MARROW

Facility

$1,335.00

Service Code	HCPCS 86359
Hospital Charge Code	397073203
Hospital Revenue Code	302
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$667.50
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$667.50
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$35.38

CH LEUKOCYTE ALK PHOS

Facility

$390.00

Service Code	HCPCS 85540
Hospital Charge Code	397021050
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH LEUKOCYTE ALK PHOS

Facility

$390.00

Service Code	HCPCS 85540
Hospital Charge Code	397021050
Hospital Revenue Code	305
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: Aetna Medicare Advantage	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$8.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.60
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	$6.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.60
Rate for Payer: Wellcare Medicare Advantage	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH LEUKOCYTE REMOVAL

Facility

$701.00

Service Code	HCPCS P9016
Hospital Charge Code	397031048
Hospital Revenue Code	390
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$584.85
Rate for Payer: Aetna Medicare Advantage	$696.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$215.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$776.16
Rate for Payer: Cigna Commercial	$431.02
Rate for Payer: Cigna Medicare Advantage	$215.02
Rate for Payer: Clover Medicare Advantage	$204.27
Rate for Payer: EmblemHealth Commercial	$645.06
Rate for Payer: Humana Medicare Advantage	$221.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$215.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.30
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.15
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$16.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$215.02
Rate for Payer: Wellcare Medicare Advantage	$215.02
Rate for Payer: Wellpoint Medicaid Managed Care	$18.58

CH LEUKOCYTE REMOVAL

Facility

$701.00

Service Code	HCPCS P9016
Hospital Charge Code	397031048
Hospital Revenue Code	390
Min. Negotiated Rate	$105.15
Max. Negotiated Rate	$105.15
Rate for Payer: Qualcare PPO/HMO/WC	$105.15

CH LEUKOCYTES FECAL

Facility

$390.00

Service Code	HCPCS 89055
Hospital Charge Code	397071121
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH LEUKOCYTES FECAL

Facility

$390.00

Service Code	HCPCS 89055
Hospital Charge Code	397071121
Hospital Revenue Code	300
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH LEVEL 1 - GROSS ONLY

Facility

$390.00

Service Code	HCPCS 88300
Hospital Charge Code	397061000
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH LEVEL 1 - GROSS ONLY

Facility

$390.00

Service Code	HCPCS 88300
Hospital Charge Code	397061000
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH LEVEL 2 - GROSS & MICRO

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	397061364
Hospital Revenue Code	310
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$27.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CH LEVEL 2 - GROSS & MICRO

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	397061364
Hospital Revenue Code	310
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

CH LEVEL 3 - GROSS & MICRO

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	397061021
Hospital Revenue Code	310
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$262.08
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$35.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$23.15

CH LEVEL 3 - GROSS & MICRO

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	397061021
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

CH LEVEL 3-GROSS & MICRO-ADD

Facility

$624.00

Service Code	HCPCS 8830491
Hospital Charge Code	397061085
Hospital Revenue Code	310
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$237.12
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: Wellpoint Medicaid Managed Care	$16.54

CH LEVEL 3-GROSS & MICRO-ADD

Facility

$624.00

Service Code	HCPCS 8830491
Hospital Charge Code	397061085
Hospital Revenue Code	310
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

Know your out-of-pocket cost for care.

All Charges