Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HIV GENOSURE MG

Facility

$892.00

Service Code	HCPCS 87900
Hospital Charge Code	3038078
Hospital Revenue Code	306
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$133.80

HIV GENOTYPE/VIRTUAL PHENOTYPE

Facility

$2,000.00

Service Code	HCPCS 87901
Hospital Charge Code	3032340
Hospital Revenue Code	306
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

HIV GENOTYPE/VIRTUAL PHENOTYPE

Facility

$2,000.00

Service Code	HCPCS 87901
Hospital Charge Code	3032340
Hospital Revenue Code	306
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$700.26
Rate for Payer: Aetna Medicare Advantage	$834.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$929.32
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: Cigna Medicare Advantage	$257.45
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$205.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Medicare Advantage	$257.45
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

HIV GENOTYPING,OTHER

Facility

$911.60

Service Code	HCPCS 87906
Hospital Charge Code	38477210
Hospital Revenue Code	306
Min. Negotiated Rate	$136.74
Max. Negotiated Rate	$136.74
Rate for Payer: Qualcare PPO/HMO/WC	$136.74

HIV GENOTYPING,OTHER

Facility

$911.60

Service Code	HCPCS 87906
Hospital Charge Code	38477210
Hospital Revenue Code	306
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$464.68
Rate for Payer: Aetna Commercial	$350.15
Rate for Payer: Aetna Medicare Advantage	$417.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$128.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.68
Rate for Payer: Cigna Commercial	$455.80
Rate for Payer: Cigna Medicare Advantage	$128.73
Rate for Payer: Clover Medicare Advantage	$122.29
Rate for Payer: EmblemHealth Commercial	$386.19
Rate for Payer: Humana Medicare Advantage	$132.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$128.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.74
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$102.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.73
Rate for Payer: Wellcare Medicare Advantage	$128.73
Rate for Payer: Wellpoint Medicaid Managed Care	$24.16

HIVID/0.375MG/TAB

Facility

$6.00

Hospital Charge Code	60634928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

HIVID/0.375MG/TAB

Facility

$6.00

Hospital Charge Code	60634928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

HIVID/0.75MG

Facility

$8.00

Hospital Charge Code	60634903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

HIVID/0.75MG

Facility

$8.00

Hospital Charge Code	60634903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

HIV I DNA

Facility

$414.45

Service Code	HCPCS 87535
Hospital Charge Code	3032335
Hospital Revenue Code	306
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

HIV I DNA

Facility

$414.45

Service Code	HCPCS 87535
Hospital Charge Code	3032335
Hospital Revenue Code	306
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

HIV I/II

Facility

$207.25

Service Code	HCPCS 86703
Hospital Charge Code	3032320
Hospital Revenue Code	302
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

HIV I/II

Facility

$207.25

Service Code	HCPCS 86703
Hospital Charge Code	3032320
Hospital Revenue Code	302
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.29
Rate for Payer: Aetna Medicare Advantage	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.49
Rate for Payer: Cigna Commercial	$103.62
Rate for Payer: Cigna Medicare Advantage	$13.71
Rate for Payer: Clover Medicare Advantage	$13.02
Rate for Payer: EmblemHealth Commercial	$41.13
Rate for Payer: Humana Medicare Advantage	$14.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.71
Rate for Payer: Wellcare Medicare Advantage	$13.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

HIV QUANT PCR WITH REFLEX

Facility

$638.45

Service Code	HCPCS 87536
Hospital Charge Code	3038147
Hospital Revenue Code	306
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

HIV QUANT PCR WITH REFLEX

Facility

$638.45

Service Code	HCPCS 87536
Hospital Charge Code	3038147
Hospital Revenue Code	306
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$319.23
Rate for Payer: Aetna Commercial	$231.47
Rate for Payer: Aetna Medicare Advantage	$275.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.19
Rate for Payer: Cigna Commercial	$319.23
Rate for Payer: Cigna Medicare Advantage	$85.10
Rate for Payer: Clover Medicare Advantage	$80.84
Rate for Payer: EmblemHealth Commercial	$255.30
Rate for Payer: Humana Medicare Advantage	$87.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$68.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.10
Rate for Payer: Wellcare Medicare Advantage	$85.10
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

HIV RNA BY PCR - VIRAL LOAD

Facility

$638.45

Service Code	HCPCS 87536
Hospital Charge Code	3032257
Hospital Revenue Code	306
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

HIV RNA BY PCR - VIRAL LOAD

Facility

$638.45

Service Code	HCPCS 87536
Hospital Charge Code	3032257
Hospital Revenue Code	306
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$319.23
Rate for Payer: Aetna Commercial	$231.47
Rate for Payer: Aetna Medicare Advantage	$275.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.19
Rate for Payer: Cigna Commercial	$319.23
Rate for Payer: Cigna Medicare Advantage	$85.10
Rate for Payer: Clover Medicare Advantage	$80.84
Rate for Payer: EmblemHealth Commercial	$255.30
Rate for Payer: Humana Medicare Advantage	$87.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$68.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.10
Rate for Payer: Wellcare Medicare Advantage	$85.10
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

HIV SOURCE PATIENT

Facility

$522.00

Service Code	HCPCS 86701
Hospital Charge Code	38479062
Hospital Revenue Code	302
Min. Negotiated Rate	$78.30
Max. Negotiated Rate	$78.30
Rate for Payer: Qualcare PPO/HMO/WC	$78.30

HIV SOURCE PATIENT

Facility

$522.00

Service Code	HCPCS 86701
Hospital Charge Code	38479062
Hospital Revenue Code	302
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$24.18
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.89
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	$32.09
Rate for Payer: Cigna Commercial	$261.00
Rate for Payer: Cigna Medicare Advantage	$8.89
Rate for Payer: Clover Medicare Advantage	$8.45
Rate for Payer: EmblemHealth Commercial	$26.67
Rate for Payer: Humana Medicare Advantage	$9.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.89
Rate for Payer: Wellcare Medicare Advantage	$8.89
Rate for Payer: Wellpoint Medicaid Managed Care	$13.83

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$199,984.61

Service Code	MSDRG 969
Min. Negotiated Rate	$60,892.75
Max. Negotiated Rate	$199,984.61
Rate for Payer: Aetna Commercial	$137,669.54
Rate for Payer: Aetna Medicare Advantage	$199,984.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159,803.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159,803.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64,097.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159,803.07
Rate for Payer: Cigna Commercial	$114,554.01
Rate for Payer: Cigna Medicare Advantage	$64,097.63
Rate for Payer: Clover Medicare Advantage	$60,892.75
Rate for Payer: EmblemHealth Commercial	$192,292.89
Rate for Payer: Humana Medicare Advantage	$66,020.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64,097.63
Rate for Payer: Oxford Commercial	$82,331.49
Rate for Payer: UnitedHealthcare Commercial	$144,370.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$64,097.63
Rate for Payer: Wellcare Medicare Advantage	$64,097.63

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$87,379.25

Service Code	MSDRG 970
Min. Negotiated Rate	$26,605.86
Max. Negotiated Rate	$87,379.25
Rate for Payer: Aetna Commercial	$60,296.82
Rate for Payer: Aetna Medicare Advantage	$87,379.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64,665.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64,665.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,006.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64,665.58
Rate for Payer: Cigna Commercial	$49,356.30
Rate for Payer: Cigna Medicare Advantage	$28,006.17
Rate for Payer: Clover Medicare Advantage	$26,605.86
Rate for Payer: EmblemHealth Commercial	$84,018.51
Rate for Payer: Humana Medicare Advantage	$28,846.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,006.17
Rate for Payer: Oxford Commercial	$35,473.03
Rate for Payer: UnitedHealthcare Commercial	$62,203.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,006.17
Rate for Payer: Wellcare Medicare Advantage	$28,006.17

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$9,399.16

Service Code	APR-DRG 8922
Min. Negotiated Rate	$9,214.86
Max. Negotiated Rate	$9,399.16
Rate for Payer: UnitedHealthcare Community & State	$9,214.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,399.16
Rate for Payer: Wellpoint Medicaid Managed Care	$9,214.86

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$21,429.55

Service Code	APR-DRG 8924
Min. Negotiated Rate	$21,009.36
Max. Negotiated Rate	$21,429.55
Rate for Payer: UnitedHealthcare Community & State	$21,009.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,429.55
Rate for Payer: Wellpoint Medicaid Managed Care	$21,009.36

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$12,896.00

Service Code	APR-DRG 8923
Min. Negotiated Rate	$12,643.14
Max. Negotiated Rate	$12,896.00
Rate for Payer: UnitedHealthcare Community & State	$12,643.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,896.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12,643.14

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$8,929.28

Service Code	APR-DRG 8921
Min. Negotiated Rate	$8,754.20
Max. Negotiated Rate	$8,929.28
Rate for Payer: UnitedHealthcare Community & State	$8,754.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,929.28
Rate for Payer: Wellpoint Medicaid Managed Care	$8,754.20

Know your out-of-pocket cost for care.

All Charges