Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TESTOSTERONE TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERONE TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
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	$88.72
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	$53.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.62
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	$4.70

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TEST PREGNANCY HCG URINE

Facility

$5.00

Hospital Charge Code	270647381
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TEST PREGNANCY HCG URINE

Facility

$5.00

Hospital Charge Code	270647381
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare Advantage	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.42
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Medicare Advantage	$14.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

TETANUS ANTIBODY,IGG

Facility

$128.00

Service Code	HCPCS 86774
Hospital Charge Code	3000478
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare Advantage	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.42
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Medicare Advantage	$14.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

TETANUS ANTIBODY,IGG

Facility

$128.00

Service Code	HCPCS 86774
Hospital Charge Code	3000478
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$38.22
Rate for Payer: Aetna Medicare Advantage	$45.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.72
Rate for Payer: Cigna Commercial	$205.50
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Medicare Advantage	$14.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

TETANUS ANTITOXN ANTIBOD IGG**

Facility

$150.00

Hospital Charge Code	3010477
Hospital Revenue Code	306
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

TETANUS ANTITOXN ANTIBOD IGG**

Facility

$150.00

Hospital Charge Code	3010477
Hospital Revenue Code	306
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare Advantage	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.42
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.80
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	$11.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Medicare Advantage	$14.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TETANUS ANTITOXOID AB

Facility

$128.00

Service Code	HCPCS 86317
Hospital Charge Code	3035056
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.77
Rate for Payer: Aetna Medicare Advantage	$48.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.11
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$14.99
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Medicare Advantage	$14.99
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

TETANUS ANTITOXOID AB

Facility

$128.00

Service Code	HCPCS 86317
Hospital Charge Code	3035056
Hospital Revenue Code	300
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TETANUS DIPHTHERIA ADULT INJ

Facility

$115.45

Service Code	HCPCS 90714
Hospital Charge Code	60628299
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.73
Rate for Payer: Aetna Commercial	$43.87
Rate for Payer: Aetna Medicare Advantage	$34.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.44
Rate for Payer: Cigna Commercial	$57.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

TETANUS DIPHTHERIA ADULT INJ

Facility

$115.45

Service Code	HCPCS 90714
Hospital Charge Code	60628299
Hospital Revenue Code	636
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

TETANUS,DIPH TOXOID ADULT

Facility

$18.00

Hospital Charge Code	60633995
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges