Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS B CORE AB TOTAL

Facility

$390.00

Service Code	HCPCS 86704
Hospital Charge Code	39900382
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
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	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HEPATITIS B CORE AB TOTAL

Facility

$390.00

Service Code	HCPCS 86704
Hospital Charge Code	39900382
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS B CORE AB TOTAL

Facility

$116.00

Service Code	HCPCS 86704
Hospital Charge Code	3007465
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

HEPATITIS B CORE AB TOTAL

Facility

$116.00

Service Code	HCPCS 86704
Hospital Charge Code	3006442C
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

HEPATITIS B CORE ANTIBODY

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38479436
Hospital Revenue Code	306
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

HEPATITIS B CORE ANTIBODY

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38479436
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$287.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$287.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.21

HEPATITIS B CORE ANTIBODY HBCA

Facility

$559.00

Service Code	HCPCS 87350
Hospital Charge Code	38479432
Hospital Revenue Code	306
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$83.85

HEPATITIS B CORE ANTIBODY HBCA

Facility

$559.00

Service Code	HCPCS 87350
Hospital Charge Code	38479432
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$279.50
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$14.81

HEPATITIS B CORE ANTIBODY HBCA

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38472350
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$287.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$287.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.21

HEPATITIS B CORE ANTIBODY HBCA

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38472350
Hospital Revenue Code	306
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

HEPATITIS B CORE ANTIBODY, IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38472353
Hospital Revenue Code	302
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$381.50
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.49
Rate for Payer: Cigna Commercial	$381.50
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$20.22

HEPATITIS B CORE ANTIBODY, IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38472353
Hospital Revenue Code	302
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$114.45
Rate for Payer: Qualcare PPO/HMO/WC	$114.45

HEPATITIS B CORE ANTIBODY,IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38479433
Hospital Revenue Code	302
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$114.45
Rate for Payer: Qualcare PPO/HMO/WC	$114.45

HEPATITIS B CORE ANTIBODY,IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38479433
Hospital Revenue Code	302
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$381.50
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.49
Rate for Payer: Cigna Commercial	$381.50
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$20.22

HEPATITIS B CORE IGM

Facility

$80.90

Service Code	HCPCS 86705
Hospital Charge Code	39900522
Hospital Revenue Code	302
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.49
Rate for Payer: Cigna Commercial	$40.45
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

HEPATITIS B CORE IGM

Facility

$80.90

Service Code	HCPCS 86705
Hospital Charge Code	39900522
Hospital Revenue Code	302
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.13

HEPATITIS B,DNA,BDNA

Facility

$481.00

Service Code	HCPCS 87517
Hospital Charge Code	38475109
Hospital Revenue Code	306
Min. Negotiated Rate	$72.15
Max. Negotiated Rate	$72.15
Rate for Payer: Qualcare PPO/HMO/WC	$72.15

HEPATITIS B,DNA,BDNA

Facility

$481.00

Service Code	HCPCS 87517
Hospital Charge Code	38475109
Hospital Revenue Code	306
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$240.50
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	$240.50
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	$144.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.15
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	$12.75

HEPATITIS B DNA PCR

Facility

$303.34

Service Code	HCPCS 87517
Hospital Charge Code	38478094
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$154.64
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	$151.67
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	$91.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.50
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	$8.04

HEPATITIS B DNA PCR

Facility

$303.34

Service Code	HCPCS 87517
Hospital Charge Code	38478094
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$45.50

HEPATITIS Be AB HBeAb

Facility

$124.85

Service Code	HCPCS 86707
Hospital Charge Code	3008026
Hospital Revenue Code	302
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.76
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

HEPATITIS Be AB HBeAb

Facility

$124.85

Service Code	HCPCS 86707
Hospital Charge Code	3008026
Hospital Revenue Code	302
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

HEPATITIS Be AG HBeAg

Facility

$65.65

Service Code	HCPCS 87350
Hospital Charge Code	3008018
Hospital Revenue Code	306
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

HEPATITIS Be AG HBeAg

Facility

$65.65

Service Code	HCPCS 87350
Hospital Charge Code	3008018
Hospital Revenue Code	306
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

HEPATITIS BE ANTIBODY

Facility

$390.00

Service Code	HCPCS 86707
Hospital Charge Code	39900383
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

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