Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

H.PYLORI AG,QL,STOOL

Facility

$390.00

Service Code	HCPCS 87338
Hospital Charge Code	39900285
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI AG,QL,STOOL

Facility

$390.00

Service Code	HCPCS 87338
Hospital Charge Code	39900285
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.11
Rate for Payer: Aetna Medicare Advantage	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.38
Rate for Payer: Clover Medicare Advantage	$13.66
Rate for Payer: EmblemHealth Commercial	$43.14
Rate for Payer: Humana Medicare Advantage	$14.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.38
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	$11.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.38
Rate for Payer: Wellcare Medicare Advantage	$14.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H PYLORI BREATH TEST

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	3037010
Hospital Revenue Code	301
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$88.09
Rate for Payer: Qualcare PPO/HMO/WC	$88.09

H PYLORI BREATH TEST

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	3037010
Hospital Revenue Code	301
Min. Negotiated Rate	$15.56
Max. Negotiated Rate	$293.62
Rate for Payer: Aetna Commercial	$183.22
Rate for Payer: Aetna Medicare Advantage	$218.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
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	$243.15
Rate for Payer: Cigna Commercial	$293.62
Rate for Payer: Cigna Medicare Advantage	$67.36
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$53.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Medicare Advantage	$67.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.56

H.PYLORI BREATH TEST

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39900482
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$243.15
Rate for Payer: Aetna Commercial	$183.22
Rate for Payer: Aetna Medicare Advantage	$218.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
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	$243.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$67.36
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67.36
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	$53.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Medicare Advantage	$67.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H.PYLORI BREATH TEST

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39900482
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI,IGG

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479102
Hospital Revenue Code	302
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$540.00
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	$540.00
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	$324.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
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	$28.62

H.PYLORI,IGG

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479102
Hospital Revenue Code	302
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

H.PYLORI (IGG,IGA,IGM) I

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) I

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H-PYLORI STOOL

Facility

$101.85

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.11
Rate for Payer: Aetna Medicare Advantage	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$50.92
Rate for Payer: Cigna Medicare Advantage	$14.38
Rate for Payer: Clover Medicare Advantage	$13.66
Rate for Payer: EmblemHealth Commercial	$43.14
Rate for Payer: Humana Medicare Advantage	$14.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.38
Rate for Payer: Wellcare Medicare Advantage	$14.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

H-PYLORI STOOL

Facility

$101.85

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$15.28
Max. Negotiated Rate	$15.28
Rate for Payer: Qualcare PPO/HMO/WC	$15.28

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$68.80
Max. Negotiated Rate	$68.80
Rate for Payer: Qualcare PPO/HMO/WC	$68.80

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$229.32
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$229.32
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$12.15

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$243.15
Rate for Payer: Aetna Commercial	$183.22
Rate for Payer: Aetna Medicare Advantage	$218.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
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	$243.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$67.36
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67.36
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	$53.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Medicare Advantage	$67.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$4,706.87
Rate for Payer: Aetna Commercial	$3,546.74
Rate for Payer: Aetna Medicare Advantage	$4,224.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,706.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,706.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,303.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,706.87
Rate for Payer: Cigna Commercial	$372.45
Rate for Payer: Cigna Medicare Advantage	$1,303.95
Rate for Payer: Clover Medicare Advantage	$1,238.75
Rate for Payer: EmblemHealth Commercial	$3,911.85
Rate for Payer: Humana Medicare Advantage	$1,343.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$543.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,303.95
Rate for Payer: Wellcare Medicare Advantage	$1,303.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.45
Rate for Payer: Aetna Commercial	$283.06
Rate for Payer: Aetna Medicare Advantage	$223.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.95
Rate for Payer: Cigna Commercial	$372.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

H REFLEX AMP & LATENCY

Facility

$5,700.00

Hospital Charge Code	9109100
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

Know your out-of-pocket cost for care.

All Charges