Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$10.41
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	$117.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.41

LEUKERAN/2MG/TAB

Facility

$7.00

Hospital Charge Code	60633281
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LEUKERAN/2MG/TAB

Facility

$7.00

Hospital Charge Code	60633281
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: Aetna Medicare Advantage	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.04
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$8.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.60
Rate for Payer: Wellcare Medicare Advantage	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$307.25

Service Code	HCPCS 85540
Hospital Charge Code	3003456
Hospital Revenue Code	305
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$46.09
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$307.25

Service Code	HCPCS 85540
Hospital Charge Code	3003456
Hospital Revenue Code	305
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$23.39
Rate for Payer: Aetna Medicare Advantage	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.04
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$8.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.60
Rate for Payer: Wellcare Medicare Advantage	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$40.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
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	$44.98
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Medicare Advantage	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

LEUKOCYTE REMOVAL FILTER

Facility

$142.00

Service Code	HCPCS 99999
Hospital Charge Code	3400207
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

LEUKOCYTE REMOVAL FILTER

Facility

$142.00

Service Code	HCPCS 99999
Hospital Charge Code	3400207
Hospital Revenue Code	272
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$28.40
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$28.40
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$32.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

LEUKO FILTER PLT PHERESIS

Facility

$289.65

Hospital Charge Code	3100260
Hospital Revenue Code	272
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$43.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

LEUKO FILTER PLT PHERESIS

Facility

$289.65

Hospital Charge Code	3100260
Hospital Revenue Code	272
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.89
Rate for Payer: Oxford Commercial	$57.93
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Commercial	$57.93
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

LEUKO FILTER PLTS < 7 UNITS

Facility

$273.65

Hospital Charge Code	3100252
Hospital Revenue Code	272
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$136.82
Rate for Payer: Aetna Commercial	$103.99
Rate for Payer: Aetna Medicare Advantage	$82.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.78
Rate for Payer: Cigna Commercial	$136.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.09
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$41.05
Rate for Payer: UnitedHealthcare Commercial	$54.73
Rate for Payer: UnitedHealthcare Community & State	$6.59
Rate for Payer: Wellpoint Medicaid Managed Care	$7.25

LEUKO FILTER PLTS < 7 UNITS

Facility

$273.65

Hospital Charge Code	3100252
Hospital Revenue Code	272
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$41.05
Rate for Payer: Qualcare PPO/HMO/WC	$41.05

LEUKOPHERESIS

Facility

$329.00

Service Code	HCPCS 36520
Hospital Charge Code	3400223
Hospital Revenue Code	380
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

LEUKOPHERESIS

Facility

$329.00

Service Code	HCPCS 36520
Hospital Charge Code	3400223
Hospital Revenue Code	380
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.70
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.72

LEUKO REDUCED PLT PHERESIS

Facility

$6,563.84

Hospital Charge Code	3100125
Hospital Revenue Code	390
Min. Negotiated Rate	$984.58
Max. Negotiated Rate	$984.58
Rate for Payer: Qualcare PPO/HMO/WC	$984.58

LEUKO REDUCED PLT PHERESIS

Facility

$6,563.84

Hospital Charge Code	3100125
Hospital Revenue Code	390
Min. Negotiated Rate	$158.19
Max. Negotiated Rate	$3,281.92
Rate for Payer: Aetna Commercial	$2,494.26
Rate for Payer: Aetna Medicare Advantage	$1,969.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,673.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,673.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,673.78
Rate for Payer: Cigna Commercial	$3,281.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,969.15
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$984.58
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$158.19
Rate for Payer: Wellpoint Medicaid Managed Care	$173.94

LEUKO REDUCED RBC

Facility

$3,113.89

Service Code	HCPCS P9016
Hospital Charge Code	3100303
Hospital Revenue Code	390
Min. Negotiated Rate	$467.08
Max. Negotiated Rate	$467.08
Rate for Payer: Qualcare PPO/HMO/WC	$467.08

LEUKO REDUCED RBC

Facility

$3,113.89

Service Code	HCPCS P9016
Hospital Charge Code	3100303
Hospital Revenue Code	390
Min. Negotiated Rate	$75.04
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$584.85
Rate for Payer: Aetna Medicare Advantage	$696.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$215.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$776.16
Rate for Payer: Cigna Commercial	$431.02
Rate for Payer: Cigna Medicare Advantage	$215.02
Rate for Payer: Clover Medicare Advantage	$204.27
Rate for Payer: EmblemHealth Commercial	$645.06
Rate for Payer: Humana Medicare Advantage	$221.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$215.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.17
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$467.08
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$75.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$215.02
Rate for Payer: Wellcare Medicare Advantage	$215.02
Rate for Payer: Wellpoint Medicaid Managed Care	$82.52

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.38
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

Know your out-of-pocket cost for care.

All Charges