Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526D
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526B
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526C
Hospital Revenue Code	306
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526D
Hospital Revenue Code	306
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

BACTERIAL ANTIGENS ALL SOURCES

Facility

$75.65

Service Code	HCPCS 87802
Hospital Charge Code	3006526A
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

BACTERIAL MENINGITIDIS AB

Facility

$100.00

Service Code	HCPCS 86609
Hospital Charge Code	3006525
Hospital Revenue Code	302
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

BACTERIAL MENINGITIDIS AB

Facility

$100.00

Service Code	HCPCS 86609
Hospital Charge Code	3006525
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

BACTERIAL VAGINOSIS PANEL I

Facility

$390.00

Service Code	HCPCS 87480
Hospital Charge Code	39990112A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL VAGINOSIS PANEL I

Facility

$390.00

Service Code	HCPCS 87480
Hospital Charge Code	39990112A
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
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	$72.37
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL VAGINOSIS PANEL II

Facility

$390.00

Service Code	HCPCS 87510
Hospital Charge Code	39990112B
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
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	$72.37
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIAL VAGINOSIS PANEL II

Facility

$390.00

Service Code	HCPCS 87510
Hospital Charge Code	39990112B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL VAGINOSIS PANEL III

Facility

$390.00

Service Code	HCPCS 87660
Hospital Charge Code	39990112C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL VAGINOSIS PANEL III

Facility

$390.00

Service Code	HCPCS 87660
Hospital Charge Code	39990112C
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.37
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BACTERIOSTATIC SALINE

Facility

$6.77

Service Code	NDC 409196607
Hospital Charge Code	60628544
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.03
Rate for Payer: Oxford Commercial	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

BACTERIOSTATIC SALINE

Facility

$6.77

Service Code	NDC 409196607
Hospital Charge Code	60628544
Hospital Revenue Code	270
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

BACTERIOSTATIC SALINE 30ML

Facility

$1.95

Hospital Charge Code	6022172
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

BACTERIOSTATIC SALINE 30ML

Facility

$1.95

Hospital Charge Code	6022172
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

BACTERIOSTATIC SALINE CI INJ

Facility

$3.85

Hospital Charge Code	6024152
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

BACTERIOSTATIC SALINE CI INJ

Facility

$3.85

Hospital Charge Code	6024152
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

BACTERIOSTATIC WATER

Facility

$1.95

Hospital Charge Code	6022180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

BACTERIOSTATIC WATER

Facility

$1.95

Hospital Charge Code	6022180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

BACTERIOSTATIC WATER INJ 30ML

Facility

$4.00

Service Code	NDC 409397703
Hospital Charge Code	60628556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BACTERIOSTATIC WATER INJ 30ML

Facility

$4.00

Service Code	NDC 409397703
Hospital Charge Code	60628556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACTISURE WOUND LAVAGE WW

Facility

$3,750.00

Hospital Charge Code	270693604
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

BACTISURE WOUND LAVAGE WW

Facility

$3,750.00

Hospital Charge Code	270693604
Hospital Revenue Code	272
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

Know your out-of-pocket cost for care.

All Charges