Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH STAIN PAS

Facility

$390.00

Service Code	HCPCS 88312
Hospital Charge Code	397061367
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH STAIN, PAS

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061069
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH STAIN, PAS

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061069
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH STAIN, PTAH

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061057
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH STAIN, PTAH

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061057
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH STAIN, RETICULUM

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061068
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH STAIN, RETICULUM

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061068
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH STAIN, TRICHROME

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061060
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH STAIN, TRICHROME

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061060
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH STAIN, VERHOEFE ELASTICA

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061055
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH STAIN, VERHOEFE ELASTICA

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061055
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH STREP A ANTIGEN, THROAT

Facility

$75.10

Service Code	HCPCS 87430
Hospital Charge Code	397041337
Hospital Revenue Code	306
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.72
Rate for Payer: Aetna Medicare Advantage	$54.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.81
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	$60.68
Rate for Payer: Cigna Commercial	$37.55
Rate for Payer: Cigna Medicare Advantage	$16.81
Rate for Payer: Clover Medicare Advantage	$15.97
Rate for Payer: EmblemHealth Commercial	$50.43
Rate for Payer: Humana Medicare Advantage	$17.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.81
Rate for Payer: Wellcare Medicare Advantage	$16.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

CH STREP A ANTIGEN, THROAT

Facility

$75.10

Service Code	HCPCS 87430
Hospital Charge Code	397041337
Hospital Revenue Code	306
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$11.27
Rate for Payer: Qualcare PPO/HMO/WC	$11.27

CH STRIATIONAL AUTOANTIBODY

Facility

$116.00

Service Code	HCPCS 86256
Hospital Charge Code	397073273
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

CH STRIATIONAL AUTOANTIBODY

Facility

$116.00

Service Code	HCPCS 86256
Hospital Charge Code	397073273
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

CH SULFATIDE AUTOANTIBODY

Facility

$701.00

Service Code	HCPCS 83520
Hospital Charge Code	397073554
Hospital Revenue Code	301
Min. Negotiated Rate	$105.15
Max. Negotiated Rate	$105.15
Rate for Payer: Qualcare PPO/HMO/WC	$105.15

CH SULFATIDE AUTOANTIBODY

Facility

$701.00

Service Code	HCPCS 83520
Hospital Charge Code	397073554
Hospital Revenue Code	301
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$350.50
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$350.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.58

CH SULFONYLUREA

Facility

$621.00

Service Code	HCPCS 80300
Hospital Charge Code	397073666
Hospital Revenue Code	301
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$235.98
Rate for Payer: Aetna Medicare Advantage	$186.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.35
Rate for Payer: Cigna Commercial	$310.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16.46

CH SULFONYLUREA

Facility

$621.00

Service Code	HCPCS 80300
Hospital Charge Code	397073666
Hospital Revenue Code	301
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$93.15
Rate for Payer: Qualcare PPO/HMO/WC	$93.15

CH SURESWAB VAGINO VGNIT PLS

Facility

$2,958.00

Hospital Charge Code	3970737
Hospital Revenue Code	301
Min. Negotiated Rate	$443.70
Max. Negotiated Rate	$443.70
Rate for Payer: Qualcare PPO/HMO/WC	$443.70

CH SURESWAB VAGINO VGNIT PLS

Facility

$2,958.00

Hospital Charge Code	3970737
Hospital Revenue Code	301
Min. Negotiated Rate	$71.29
Max. Negotiated Rate	$1,479.00
Rate for Payer: Aetna Commercial	$1,124.04
Rate for Payer: Aetna Medicare Advantage	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$754.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$754.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$754.29
Rate for Payer: Cigna Commercial	$1,479.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$887.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$443.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$71.29
Rate for Payer: Wellpoint Medicaid Managed Care	$78.39

CH T3 FREE

Facility

$278.00

Service Code	HCPCS 84481
Hospital Charge Code	397072016
Hospital Revenue Code	301
Min. Negotiated Rate	$41.70
Max. Negotiated Rate	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$41.70

CH T3 FREE

Facility

$278.00

Service Code	HCPCS 84481
Hospital Charge Code	397072016
Hospital Revenue Code	301
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$139.00
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
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	$61.15
Rate for Payer: Cigna Commercial	$139.00
Rate for Payer: Cigna Medicare Advantage	$16.94
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Medicare Advantage	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$7.37

CH T3 FREE, TRACER DIALYSIS

Facility

$101.00

Service Code	HCPCS 84481
Hospital Charge Code	397071465
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
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	$61.15
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: Cigna Medicare Advantage	$16.94
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Medicare Advantage	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

CH T3 FREE, TRACER DIALYSIS

Facility

$101.00

Service Code	HCPCS 84481
Hospital Charge Code	397071465
Hospital Revenue Code	301
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

Know your out-of-pocket cost for care.

All Charges