Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588N
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588O
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588O
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588N
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

DETACHOL 0.57 ML

Facility

$34.60

Hospital Charge Code	6014005
Hospital Revenue Code	252
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

DETACHOL 0.57 ML

Facility

$34.60

Hospital Charge Code	6014005
Hospital Revenue Code	252
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

DETACHOL 4OZ

Facility

$34.60

Hospital Charge Code	6014013
Hospital Revenue Code	252
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

DETACHOL 4OZ

Facility

$34.60

Hospital Charge Code	6014013
Hospital Revenue Code	252
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

DET AGENT NOS DNA AMP

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	401187798
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DET AGENT NOS DNA AMP

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	401187798
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

DETCT BY NUC ACD CYTOMEGALOVIR

Facility

$303.34

Service Code	HCPCS 87497
Hospital Charge Code	38477203
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$154.64
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$151.67
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$8.04

DETCT BY NUC ACD CYTOMEGALOVIR

Facility

$303.34

Service Code	HCPCS 87497
Hospital Charge Code	38477203
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$45.50

DETCT/BY/NUC ACD MYCOBACTERIA

Facility

$141.99

Service Code	HCPCS 87555
Hospital Charge Code	38477162
Hospital Revenue Code	306
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$73.11
Rate for Payer: Aetna Medicare Advantage	$87.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.03
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$26.88
Rate for Payer: Clover Medicare Advantage	$25.54
Rate for Payer: EmblemHealth Commercial	$80.64
Rate for Payer: Humana Medicare Advantage	$27.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.88
Rate for Payer: Wellcare Medicare Advantage	$26.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

DETCT/BY/NUC ACD MYCOBACTERIA

Facility

$141.99

Service Code	HCPCS 87555
Hospital Charge Code	38477162
Hospital Revenue Code	306
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DETCT BY NUC ACD STAPHYLOCOCCU

Facility

$248.54

Service Code	HCPCS 87641
Hospital Charge Code	38477198
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
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	$94.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.27
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	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
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	$6.59

DETCT BY NUC ACD STAPHYLOCOCCU

Facility

$248.54

Service Code	HCPCS 87641
Hospital Charge Code	38477198
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETCT BY NUC ACD STREPTPCOCCUS

Facility

$248.54

Service Code	HCPCS 87653
Hospital Charge Code	38477199
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
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	$94.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.27
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	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
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	$6.59

DETCT BY NUC ACD STREPTPCOCCUS

Facility

$248.54

Service Code	HCPCS 87653
Hospital Charge Code	38477199
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETECT AGENT NOS DNA AMP

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DETECT AGENT NOS DNA AMP

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798A
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

DETECT AGNT MULT DNA AMPLI

Facility

$433.30

Service Code	HCPCS 87801
Hospital Charge Code	401387501
Hospital Revenue Code	306
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.00

DETECT AGNT MULT DNA AMPLI

Facility

$433.30

Service Code	HCPCS 87801
Hospital Charge Code	401387501
Hospital Revenue Code	306
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$253.40
Rate for Payer: Aetna Commercial	$190.94
Rate for Payer: Aetna Medicare Advantage	$227.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.40
Rate for Payer: Cigna Commercial	$216.65
Rate for Payer: Cigna Medicare Advantage	$70.20
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$56.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Medicare Advantage	$70.20
Rate for Payer: Wellpoint Medicaid Managed Care	$11.48

DETECT BY NUC ACD MYCOBACTERIA

Facility

$248.54

Service Code	HCPCS 87556
Hospital Charge Code	38477196
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$150.45
Rate for Payer: Aetna Commercial	$113.37
Rate for Payer: Aetna Medicare Advantage	$135.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.45
Rate for Payer: Cigna Commercial	$124.27
Rate for Payer: Cigna Medicare Advantage	$41.68
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$41.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$33.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.68
Rate for Payer: Wellcare Medicare Advantage	$41.68
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

DETECT BY NUC ACD MYCOBACTERIA

Facility

$248.54

Service Code	HCPCS 87556
Hospital Charge Code	38477196
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETECT BY NUC ACD STAPHYLOCOCC

Facility

$248.54

Service Code	HCPCS 87640
Hospital Charge Code	38477197
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

Know your out-of-pocket cost for care.

All Charges