Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLYCINE IRRIGATION GU ******

Facility

$25.00

Hospital Charge Code	7000474
Hospital Revenue Code	279
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

GLYCOGEN-PAS STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005307
Hospital Revenue Code	310
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$48.73
Rate for Payer: Qualcare PPO/HMO/WC	$48.73

GLYCOGEN-PAS STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005307
Hospital Revenue Code	310
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$223.48
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	$97.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.73
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$92.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

GLYCOHEMOGLOBIN/A1C PANEL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3004273
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GLYCOHEMOGLOBIN/A1C PANEL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3004273
Hospital Revenue Code	301
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

GLYCOHEMOGLOBIN (GHB) TOTAL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3035005
Hospital Revenue Code	301
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

GLYCOHEMOGLOBIN (GHB) TOTAL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3035005
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$70.35

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$234.50
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$234.50
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.43

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$333.80
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	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$333.80
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	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
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	$17.69

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

GLYCOMARK SUGAR SINGLE

Facility

$81.59

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$124.00
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	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$40.80
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	$24.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.24
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	$2.16

GLYCOMARK SUGAR SINGLE

Facility

$81.59

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$12.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.24

GLYCOPYROLATE .2MG/INJ/1M

Facility

$89.00

Hospital Charge Code	60634725
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

GLYCOPYROLATE .2MG/INJ/1M

Facility

$89.00

Hospital Charge Code	60634725
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

GLYCOPYROLATE .2MG/INJ/2M

Facility

$127.00

Hospital Charge Code	60634726
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

GLYCOPYROLATE .2MG/INJ/2M

Facility

$127.00

Hospital Charge Code	60634726
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

GLYCO PYRROLATE

Facility

$47.35

Hospital Charge Code	270656757
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

GLYCO PYRROLATE

Facility

$47.35

Hospital Charge Code	270656757
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.03
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare Advantage	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.22
Rate for Payer: Cigna Commercial	$20.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.02
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01
Rate for Payer: UnitedHealthcare Commercial	$8.01
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$6.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$54.44
Rate for Payer: Aetna Commercial	$41.37
Rate for Payer: Aetna Medicare Advantage	$32.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.76
Rate for Payer: Cigna Commercial	$54.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.66
Rate for Payer: Oxford Commercial	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.33
Rate for Payer: UnitedHealthcare Commercial	$21.78
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$28.01
Rate for Payer: Aetna Medicare Advantage	$22.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$36.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.11
Rate for Payer: Oxford Commercial	$14.74
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$14.74
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

Know your out-of-pocket cost for care.

All Charges