Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEPTOSPIRA CULTURE II

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990162B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

LEPTOSPIRA CULTURE II

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990162B
Hospital Revenue Code	309
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

LEPTOSPIRA DNA QUAL RT PCR

Facility

$1,625.00

Service Code	HCPCS 87798
Hospital Charge Code	4010877982
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$812.50
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	$812.50
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	$487.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
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	$43.06

LEPTOSPIRA DNA QUAL RT PCR

Facility

$1,625.00

Service Code	HCPCS 87798
Hospital Charge Code	4010877982
Hospital Revenue Code	306
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

LEPTOSPIRAL AB

Facility

$390.00

Service Code	HCPCS 86720
Hospital Charge Code	397041287
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEPTOSPIRAL AB

Facility

$390.00

Service Code	HCPCS 86720
Hospital Charge Code	397041287
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$52.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.20
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	$58.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.20
Rate for Payer: Clover Medicare Advantage	$15.39
Rate for Payer: EmblemHealth Commercial	$48.60
Rate for Payer: Humana Medicare Advantage	$16.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.20
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	$12.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20
Rate for Payer: Wellcare Medicare Advantage	$16.20
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LEPTOSPIRAL ANTIBODIES

Facility

$103.25

Service Code	HCPCS 86720
Hospital Charge Code	3006681
Hospital Revenue Code	302
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$52.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.20
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	$58.48
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$16.20
Rate for Payer: Clover Medicare Advantage	$15.39
Rate for Payer: EmblemHealth Commercial	$48.60
Rate for Payer: Humana Medicare Advantage	$16.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20
Rate for Payer: Wellcare Medicare Advantage	$16.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

LEPTOSPIRAL ANTIBODIES

Facility

$103.25

Service Code	HCPCS 86720
Hospital Charge Code	3006681
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

LETROZOLE 2.5 MG TAB

Facility

$82.70

Hospital Charge Code	60629958
Hospital Revenue Code	250
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.40

LETROZOLE 2.5 MG TAB

Facility

$82.70

Hospital Charge Code	60629958
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.35
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Aetna Medicare Advantage	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.09
Rate for Payer: Cigna Commercial	$41.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.81
Rate for Payer: Oxford Commercial	$16.54
Rate for Payer: Qualcare PPO/HMO/WC	$12.40
Rate for Payer: UnitedHealthcare Commercial	$16.54
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$133.98
Rate for Payer: Qualcare PPO/HMO/WC	$133.98

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$21.53
Max. Negotiated Rate	$446.59
Rate for Payer: Aetna Commercial	$339.41
Rate for Payer: Aetna Medicare Advantage	$267.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.76
Rate for Payer: Cigna Commercial	$446.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.95
Rate for Payer: Oxford Commercial	$178.64
Rate for Payer: Qualcare PPO/HMO/WC	$133.98
Rate for Payer: UnitedHealthcare Commercial	$178.64
Rate for Payer: UnitedHealthcare Community & State	$21.53
Rate for Payer: Wellpoint Medicaid Managed Care	$23.67

LETTERS, ADBM BARKLEY SYSTEM

Facility

$45.00

Hospital Charge Code	270653924
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

LETTERS, ADBM BARKLEY SYSTEM

Facility

$45.00

Hospital Charge Code	270653924
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

LETTERS ADBM BARKLEY SYSTEM M

Facility

$35.00

Hospital Charge Code	270653926
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

LETTERS ADBM BARKLEY SYSTEM M

Facility

$35.00

Hospital Charge Code	270653926
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

LETTERS ADBM BARKLEY SYSTEM R

Facility

$125.00

Hospital Charge Code	270653909
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

LETTERS ADBM BARKLEY SYSTEM R

Facility

$125.00

Hospital Charge Code	270653909
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.68
Rate for Payer: Aetna Medicare Advantage	$31.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.41
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: Cigna Medicare Advantage	$9.81
Rate for Payer: Clover Medicare Advantage	$9.32
Rate for Payer: EmblemHealth Commercial	$29.43
Rate for Payer: Humana Medicare Advantage	$10.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.81
Rate for Payer: Wellcare Medicare Advantage	$9.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

LEUCOVORIN CALCIUM/100MG

Facility

$574.00

Hospital Charge Code	60633276
Hospital Revenue Code	636
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$138.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.91
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

Know your out-of-pocket cost for care.

All Charges