Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH SEPARATION

Facility

$162.00

Service Code	HCPCS 83894
Hospital Charge Code	397073562
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

CH SEPARATION

Facility

$162.00

Service Code	HCPCS 83894
Hospital Charge Code	397073562
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073289
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073289
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CH SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073296
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CH SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073296
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH SEPARATION X3

Facility

$40.00

Service Code	HCPCS 83894
Hospital Charge Code	397073282
Hospital Revenue Code	301
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CH SEPARATION X3

Facility

$40.00

Service Code	HCPCS 83894
Hospital Charge Code	397073282
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CH SEROQUEL

Facility

$258.00

Service Code	HCPCS 80299
Hospital Charge Code	397073204
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH SEROQUEL

Facility

$258.00

Service Code	HCPCS 80299
Hospital Charge Code	397073204
Hospital Revenue Code	301
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

CH SEROTONIN

Facility

$1,671.00

Service Code	HCPCS 84260
Hospital Charge Code	397071011
Hospital Revenue Code	301
Min. Negotiated Rate	$24.78
Max. Negotiated Rate	$835.50
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$835.50
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$44.28

CH SEROTONIN

Facility

$1,671.00

Service Code	HCPCS 84260
Hospital Charge Code	397071011
Hospital Revenue Code	301
Min. Negotiated Rate	$250.65
Max. Negotiated Rate	$250.65
Rate for Payer: Qualcare PPO/HMO/WC	$250.65

CH SEX HORMONE BINDING GLOBU

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	397072124
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.44
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$7.45

CH SEX HORMONE BINDING GLOBU

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	397072124
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

CH SHIGA-LIKE TOXIN AG EIA

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	397071491
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SHIGA-LIKE TOXIN AG EIA

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	397071491
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH SICKLE CELL TEST

Facility

$60.00

Service Code	HCPCS 8566091
Hospital Charge Code	397034882
Hospital Revenue Code	305
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$124.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

CH SICKLE CELL TEST

Facility

$390.00

Service Code	HCPCS 85660
Hospital Charge Code	397021056
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SICKLE CELL TEST

Facility

$390.00

Service Code	HCPCS 85660
Hospital Charge Code	397021056
Hospital Revenue Code	305
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.99
Rate for Payer: Aetna Medicare Advantage	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.51
Rate for Payer: Clover Medicare Advantage	$5.23
Rate for Payer: EmblemHealth Commercial	$16.53
Rate for Payer: Humana Medicare Advantage	$5.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.51
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	$4.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.51
Rate for Payer: Wellcare Medicare Advantage	$5.51
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH SICKLE CELL TEST

Facility

$60.00

Service Code	HCPCS 8566091
Hospital Charge Code	397034882
Hospital Revenue Code	305
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

CH SMEAR COMPLEX STAIN

Facility

$107.00

Service Code	HCPCS 87209
Hospital Charge Code	397071451
Hospital Revenue Code	309
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.90
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

CH SMEAR COMPLEX STAIN

Facility

$107.00

Service Code	HCPCS 87209
Hospital Charge Code	397071451
Hospital Revenue Code	309
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

CH SODIUM

Facility

$40.00

Service Code	HCPCS 84295
Hospital Charge Code	397071107
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CH SODIUM

Facility

$40.00

Service Code	HCPCS 84295
Hospital Charge Code	397071107
Hospital Revenue Code	301
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.36
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CH SODIUM OTHER SOURCE

Facility

$30.00

Service Code	HCPCS 84302
Hospital Charge Code	397073682
Hospital Revenue Code	301
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.22
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.54
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Medicare Advantage	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

Know your out-of-pocket cost for care.

All Charges