Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STREPTOCOCCUS, GROUP A

Facility

$77.95

Service Code	HCPCS 87880
Hospital Charge Code	38472339
Hospital Revenue Code	306
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

STREPTOCOCCUS GROUP A POC

Facility

$390.00

Service Code	HCPCS 87430
Hospital Charge Code	412387430
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.72
Rate for Payer: Aetna Medicare Advantage	$54.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.68
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.81
Rate for Payer: Clover Medicare Advantage	$15.97
Rate for Payer: EmblemHealth Commercial	$50.43
Rate for Payer: Humana Medicare Advantage	$17.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.81
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	$13.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.81
Rate for Payer: Wellcare Medicare Advantage	$16.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

STREPTOCOCCUS GROUP A POC

Facility

$390.00

Service Code	HCPCS 87430
Hospital Charge Code	412387430
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STREPTOCOCCUS PNEMONIAE ANTIGE

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3038148
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

STREPTOCOCCUS PNEMONIAE ANTIGE

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3038148
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

STREPTOKINASE 1.5 MIU/VIAL

Facility

$2,812.50

Hospital Charge Code	6016224
Hospital Revenue Code	636
Min. Negotiated Rate	$421.88
Max. Negotiated Rate	$680.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.62
Rate for Payer: Qualcare PPO/HMO/WC	$421.88

STREPTOKINASE 1.5 MIU/VIAL

Facility

$2,812.50

Hospital Charge Code	6016224
Hospital Revenue Code	636
Min. Negotiated Rate	$67.78
Max. Negotiated Rate	$1,406.25
Rate for Payer: Aetna Commercial	$1,068.75
Rate for Payer: Aetna Medicare Advantage	$843.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$717.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$717.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$717.19
Rate for Payer: Cigna Commercial	$1,406.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.62
Rate for Payer: Qualcare PPO/HMO/WC	$421.88
Rate for Payer: UnitedHealthcare Community & State	$67.78
Rate for Payer: Wellpoint Medicaid Managed Care	$74.53

STREPTOKINASE/1.5MU

Facility

$1,206.00

Hospital Charge Code	60634981
Hospital Revenue Code	636
Min. Negotiated Rate	$180.90
Max. Negotiated Rate	$291.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90

STREPTOKINASE/1.5MU

Facility

$1,206.00

Hospital Charge Code	60634981
Hospital Revenue Code	636
Min. Negotiated Rate	$29.06
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$458.28
Rate for Payer: Aetna Medicare Advantage	$361.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.53
Rate for Payer: Cigna Commercial	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90
Rate for Payer: UnitedHealthcare Community & State	$29.06
Rate for Payer: Wellpoint Medicaid Managed Care	$31.96

STREPTOKINASE 5000U/ML

Facility

$306.60

Hospital Charge Code	6006472
Hospital Revenue Code	636
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$153.30
Rate for Payer: Aetna Commercial	$116.51
Rate for Payer: Aetna Medicare Advantage	$91.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.18
Rate for Payer: Cigna Commercial	$153.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.99
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

STREPTOKINASE 5000U/ML

Facility

$306.60

Hospital Charge Code	6006472
Hospital Revenue Code	636
Min. Negotiated Rate	$45.99
Max. Negotiated Rate	$74.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.99

STREPTOKINASE INJ 250,000IU

Facility

$136.35

Hospital Charge Code	6005052
Hospital Revenue Code	636
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

STREPTOKINASE INJ 250,000IU

Facility

$136.35

Hospital Charge Code	6005052
Hospital Revenue Code	636
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$51.81
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

STREPTOKINASE INJ 250,000U

Facility

$666.70

Hospital Charge Code	60627539
Hospital Revenue Code	636
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$333.35
Rate for Payer: Aetna Commercial	$253.35
Rate for Payer: Aetna Medicare Advantage	$200.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.01
Rate for Payer: Cigna Commercial	$333.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.34
Rate for Payer: Qualcare PPO/HMO/WC	$100.00
Rate for Payer: UnitedHealthcare Community & State	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.67

STREPTOKINASE INJ 250,000U

Facility

$666.70

Hospital Charge Code	60627539
Hospital Revenue Code	636
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$161.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.34
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

STREPTOKINASE INJ 750,000IU

Facility

$391.05

Hospital Charge Code	6005060
Hospital Revenue Code	636
Min. Negotiated Rate	$58.66
Max. Negotiated Rate	$94.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.63
Rate for Payer: Qualcare PPO/HMO/WC	$58.66

STREPTOKINASE INJ 750,000IU

Facility

$391.05

Hospital Charge Code	6005060
Hospital Revenue Code	636
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$195.53
Rate for Payer: Aetna Commercial	$148.60
Rate for Payer: Aetna Medicare Advantage	$117.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.72
Rate for Payer: Cigna Commercial	$195.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.63
Rate for Payer: Qualcare PPO/HMO/WC	$58.66
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10.36

STREPTOKINASE INJ 750,000U

Facility

$1,471.55

Hospital Charge Code	60627540
Hospital Revenue Code	636
Min. Negotiated Rate	$220.73
Max. Negotiated Rate	$356.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.12
Rate for Payer: Qualcare PPO/HMO/WC	$220.73

STREPTOKINASE INJ 750,000U

Facility

$1,471.55

Hospital Charge Code	60627540
Hospital Revenue Code	636
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$735.77
Rate for Payer: Aetna Commercial	$559.19
Rate for Payer: Aetna Medicare Advantage	$441.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.25
Rate for Payer: Cigna Commercial	$735.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.12
Rate for Payer: Qualcare PPO/HMO/WC	$220.73
Rate for Payer: UnitedHealthcare Community & State	$35.46
Rate for Payer: Wellpoint Medicaid Managed Care	$39.00

STREPTOMYCIN SULFATE/1G

Facility

$131.00

Hospital Charge Code	60634822
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

STREPTOMYCIN SULFATE/1G

Facility

$131.00

Hospital Charge Code	60634822
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

STREPTOMYCIN SULFATE 1 GM VIAL

Facility

$150.75

Service Code	HCPCS J3000
Hospital Charge Code	6063943246
Hospital Revenue Code	636
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$75.38
Rate for Payer: Aetna Commercial	$57.28
Rate for Payer: Aetna Medicare Advantage	$45.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.44
Rate for Payer: Cigna Commercial	$75.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

STREPTOMYCIN SULFATE 1 GM VIAL

Facility

$150.75

Service Code	HCPCS J3000
Hospital Charge Code	6063943246
Hospital Revenue Code	636
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$36.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61

STREPTOZOCIN 10 MG INJ

Facility

$293.00

Hospital Charge Code	60634187
Hospital Revenue Code	636
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$70.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.91
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

STREPTOZOCIN 10 MG INJ

Facility

$293.00

Hospital Charge Code	60634187
Hospital Revenue Code	636
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.91
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

Know your out-of-pocket cost for care.

All Charges