Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPECIAL STAINS-MICROBES

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	38474061
Hospital Revenue Code	310
Min. Negotiated Rate	$13.95
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	$157.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.96
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	$13.95

SPECIAL STAINS-MICROBES

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	38474061
Hospital Revenue Code	310
Min. Negotiated Rate	$78.96
Max. Negotiated Rate	$78.96
Rate for Payer: Qualcare PPO/HMO/WC	$78.96

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$45.48
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.17
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$425.46
Rate for Payer: Wellpoint Medicaid Managed Care	$50.01

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

SPECIAL TELETX PORT PLAN-PC

Facility

$252.60

Service Code	HCPCS 7732126
Hospital Charge Code	85000530
Hospital Revenue Code	333
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$37.89
Rate for Payer: Qualcare PPO/HMO/WC	$37.89

SPECIAL TELETX PORT PLAN-PC

Facility

$252.60

Service Code	HCPCS 7732126
Hospital Charge Code	85000530
Hospital Revenue Code	333
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$95.99
Rate for Payer: Aetna Medicare Advantage	$75.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.41
Rate for Payer: Cigna Commercial	$126.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.78
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.89
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$6.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.69

SPECIAL TELETX PORT PLAN-TC

Facility

$306.55

Service Code	HCPCS 77321TC
Hospital Charge Code	85000525
Hospital Revenue Code	333
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$116.49
Rate for Payer: Aetna Medicare Advantage	$91.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.17
Rate for Payer: Cigna Commercial	$153.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.97
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.98
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

SPECIAL TELETX PORT PLAN-TC

Facility

$306.55

Service Code	HCPCS 77321TC
Hospital Charge Code	85000525
Hospital Revenue Code	333
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$45.98

SPECIFIC GRAVITY, BODY FLUID

Facility

$54.45

Service Code	HCPCS 84315
Hospital Charge Code	3008653
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

SPECIFIC GRAVITY, BODY FLUID

Facility

$54.45

Service Code	HCPCS 84315
Hospital Charge Code	3008653
Hospital Revenue Code	301
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
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	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
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	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIFIC GRAVITY, URINE***

Facility

$13.00

Service Code	HCPCS 81000
Hospital Charge Code	3030533
Hospital Revenue Code	309
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.51
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: Cigna Medicare Advantage	$4.02
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Medicare Advantage	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SPECIFIC GRAVITY, URINE***

Facility

$13.00

Service Code	HCPCS 81000
Hospital Charge Code	3030533
Hospital Revenue Code	309
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.20

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$101.84
Rate for Payer: Aetna Medicare Advantage	$80.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.34
Rate for Payer: Cigna Commercial	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.40
Rate for Payer: Oxford Commercial	$53.60
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$53.60
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

SPECIMEN COLLECTION FEE

Facility

$26.00

Hospital Charge Code	3010451
Hospital Revenue Code	309
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

SPECIMEN COLLECTION FEE

Facility

$26.00

Hospital Charge Code	3010451
Hospital Revenue Code	309
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECTAZOLE 1%/15GM

Facility

$66.00

Hospital Charge Code	60633917
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

Know your out-of-pocket cost for care.

All Charges