Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CMV IGG/IGM II

Facility

$115.75

Service Code	HCPCS 86645
Hospital Charge Code	39990091B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$57.88
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.36
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

CMV IGG/IGM II

Facility

$115.75

Service Code	HCPCS 86645
Hospital Charge Code	39990091B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$17.36
Rate for Payer: Qualcare PPO/HMO/WC	$17.36

CMV IgM BY EIA

Facility

$157.45

Service Code	HCPCS 86645
Hospital Charge Code	3006574
Hospital Revenue Code	302
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$78.72
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

CMV IgM BY EIA

Facility

$157.45

Service Code	HCPCS 86645
Hospital Charge Code	3006574
Hospital Revenue Code	302
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

CMV NEGATIVE COMPONENT

Facility

$658.00

Hospital Charge Code	38471084
Hospital Revenue Code	382
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$250.04
Rate for Payer: Aetna Medicare Advantage	$197.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.79
Rate for Payer: Cigna Commercial	$329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.40
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$15.86
Rate for Payer: Wellpoint Medicaid Managed Care	$17.44

CMV NEGATIVE COMPONENT

Facility

$658.00

Hospital Charge Code	38471084
Hospital Revenue Code	382
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

CMV PCR

Facility

$430.00

Service Code	HCPCS 87497
Hospital Charge Code	3032121
Hospital Revenue Code	300
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$64.50
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

CMV PCR

Facility

$430.00

Service Code	HCPCS 87497
Hospital Charge Code	3032121
Hospital Revenue Code	300
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

CNNCTR GAS SMPL PRT 2253524804

Facility

$3.25

Hospital Charge Code	270621002
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Commercial	$0.65
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

CNNCTR GAS SMPL PRT 2253524804

Facility

$3.25

Hospital Charge Code	270621002
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

CNS CASE MGMT 1 UNIT / 15 MIN

Facility

$154.00

Service Code	HCPCS Z3358
Hospital Charge Code	94810115
Hospital Revenue Code	918
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

CNS CASE MGMT 1 UNIT / 15 MIN

Facility

$154.00

Service Code	HCPCS Z3358
Hospital Charge Code	94810115
Hospital Revenue Code	918
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

CNS CASE MGMT-RECOV SUP-EA 15

Facility

$51.00

Service Code	HCPCS T2022HF
Hospital Charge Code	94810110
Hospital Revenue Code	910
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

CNS CASE MGMT-RECOV SUP-EA 15

Facility

$51.00

Service Code	HCPCS T2022HF
Hospital Charge Code	94810110
Hospital Revenue Code	910
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

CNS CLINIC CONS 1UNIT/CS15MIN

Facility

$258.00

Service Code	HCPCS 90887
Hospital Charge Code	94810070
Hospital Revenue Code	900
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CNS CLINIC CONS 1UNIT/CS15MIN

Facility

$258.00

Service Code	HCPCS 90887
Hospital Charge Code	94810070
Hospital Revenue Code	900
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23.17
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

CNS DRUG SCREEN

Facility

$578.00

Service Code	HCPCS 80100
Hospital Charge Code	94810001
Hospital Revenue Code	301
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

CNS DRUG SCREEN

Facility

$578.00

Service Code	HCPCS 80100
Hospital Charge Code	94810001
Hospital Revenue Code	301
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

CNS GROUP THERAPY

Facility

$464.00

Service Code	HCPCS 90853
Hospital Charge Code	94810050
Hospital Revenue Code	915
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

CNS GROUP THERAPY

Facility

$464.00

Service Code	HCPCS 90853
Hospital Charge Code	94810050
Hospital Revenue Code	915
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$69.60
Rate for Payer: UnitedHealthcare Community & State	$11.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$12.30

CNS INDIVIDUAL THERAPY 45-50

Facility

$1,017.00

Service Code	HCPCS 90806
Hospital Charge Code	94810025
Hospital Revenue Code	914
Min. Negotiated Rate	$152.55
Max. Negotiated Rate	$152.55
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

CNS INDIVIDUAL THERAPY 45-50

Facility

$1,017.00

Service Code	HCPCS 90806
Hospital Charge Code	94810025
Hospital Revenue Code	914
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$386.46
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$508.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.10
Rate for Payer: Qualcare PPO/HMO/WC	$152.55
Rate for Payer: UnitedHealthcare Community & State	$24.51
Rate for Payer: Wellpoint Medicaid Managed Care	$26.95

CNS INDIV THERAPY 1UNIT/30MIN

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	94810015
Hospital Revenue Code	914
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.80
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$31.23
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

CNS INDIV THERAPY 1UNIT/30MIN

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	94810015
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS IND THRPY W/MED MGT 20-30

Facility

$381.00

Service Code	HCPCS 90805
Hospital Charge Code	94810020
Hospital Revenue Code	914
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$190.50
Rate for Payer: Aetna Commercial	$144.78
Rate for Payer: Aetna Medicare Advantage	$114.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.16
Rate for Payer: Cigna Commercial	$190.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$57.15
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.10

Know your out-of-pocket cost for care.

All Charges