Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TESTOSTERONE, FREE

Facility

$455.00

Service Code	HCPCS 84402
Hospital Charge Code	38472045
Hospital Revenue Code	301
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$227.50
Rate for Payer: Aetna Commercial	$69.28
Rate for Payer: Aetna Medicare Advantage	$82.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.94
Rate for Payer: Cigna Commercial	$227.50
Rate for Payer: Cigna Medicare Advantage	$25.47
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Medicare Advantage	$25.47
Rate for Payer: Wellpoint Medicaid Managed Care	$12.06

TESTOSTERONE, FREE

Facility

$455.00

Service Code	HCPCS 84402
Hospital Charge Code	38472045
Hospital Revenue Code	301
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

TESTOSTERONE, FREE

Facility

$167.25

Service Code	HCPCS 84402
Hospital Charge Code	3002533
Hospital Revenue Code	301
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$69.28
Rate for Payer: Aetna Medicare Advantage	$82.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.94
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: Cigna Medicare Advantage	$25.47
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Medicare Advantage	$25.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

TESTOSTERONE, FREE***

Facility

$55.00

Hospital Charge Code	3032398
Hospital Revenue Code	309
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

TESTOSTERONE, FREE***

Facility

$55.00

Hospital Charge Code	3032398
Hospital Revenue Code	309
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TESTOSTERONE, FREE, BIO/TOT

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3035149C
Hospital Revenue Code	307
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

TESTOSTERONE, FREE, BIO/TOT

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3035149A
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

TESTOSTERONE, FREE, BIO/TOT

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3035149A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.17
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
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	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

TESTOSTERONE, FREE, BIO/TOT

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3035149B
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

TESTOSTERONE, FREE, BIO/TOT

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3035149B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
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	$78.44
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

TESTOSTERONE, FREE, BIO/TOT

Facility

$412.50

Hospital Charge Code	3035149
Hospital Revenue Code	301
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$156.75
Rate for Payer: Aetna Medicare Advantage	$123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.19
Rate for Payer: Cigna Commercial	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

TESTOSTERONE, FREE, BIO/TOT

Facility

$137.50

Service Code	HCPCS 82040
Hospital Charge Code	3035149C
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.87
Rate for Payer: Cigna Commercial	$68.75
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

TESTOSTERONE, FREE, BIO/TOT

Facility

$412.50

Hospital Charge Code	3035149
Hospital Revenue Code	301
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$61.88
Rate for Payer: Qualcare PPO/HMO/WC	$61.88

TESTOSTERONE INJ 100MG /ML

Facility

$61.45

Hospital Charge Code	6005169
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$23.35
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$12.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$12.29
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

TESTOSTERONE INJ 100MG /ML

Facility

$61.45

Hospital Charge Code	6005169
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

TESTOSTERONE PROPIONATE/1

Facility

$40.00

Hospital Charge Code	60633990
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

TESTOSTERONE PROPIONATE/1

Facility

$40.00

Hospital Charge Code	60633990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

TESTOSTERONE PROPIONATE/5

Facility

$56.00

Hospital Charge Code	60633991
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

TESTOSTERONE PROPIONATE/5

Facility

$56.00

Hospital Charge Code	60633991
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

TESTOSTERONE SERUM TOTAL

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3002532
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.17
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
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	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

TESTOSTERONE SERUM TOTAL

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3002532
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

TESTOSTERONE,SERUM TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38479469
Hospital Revenue Code	301
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$146.40
Rate for Payer: Qualcare PPO/HMO/WC	$146.40

TESTOSTERONE,SERUM TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38479469
Hospital Revenue Code	301
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$488.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.17
Rate for Payer: Cigna Commercial	$488.00
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$25.86

TESTOSTERONE,SERUM-TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38472635
Hospital Revenue Code	301
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$146.40
Rate for Payer: Qualcare PPO/HMO/WC	$146.40

TESTOSTERONE,SERUM-TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38472635
Hospital Revenue Code	301
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$488.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.17
Rate for Payer: Cigna Commercial	$488.00
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$25.86

Know your out-of-pocket cost for care.

All Charges