Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HSV 2 AB, IGM

Facility

$511.00

Service Code	HCPCS 86790
Hospital Charge Code	38476123
Hospital Revenue Code	302
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$76.65

HSV 2 IGG

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	39900381
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV 2 IGG

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	39900381
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
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	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HSV 2 IGM TITER

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	3000378C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV 2 IGM TITER

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	3000378C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
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	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HSV 2 IGM TITER 2ND

Facility

$390.00

Service Code	HCPCS 8669691
Hospital Charge Code	3000378D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV 2 IGM TITER 2ND

Facility

$390.00

Service Code	HCPCS 8669691
Hospital Charge Code	3000378D
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

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999B
Hospital Revenue Code	306
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999B
Hospital Revenue Code	306
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$176.18
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	$176.18
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	$105.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
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	$9.34

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999A
Hospital Revenue Code	306
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999A
Hospital Revenue Code	306
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$176.18
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	$176.18
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	$105.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
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	$9.34

HSV CULTURE

Facility

$220.85

Service Code	HCPCS 87253
Hospital Charge Code	3009251
Hospital Revenue Code	309
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

HSV CULTURE

Facility

$220.85

Service Code	HCPCS 87253
Hospital Charge Code	3009251
Hospital Revenue Code	309
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.94
Rate for Payer: Aetna Medicare Advantage	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.92
Rate for Payer: Cigna Commercial	$110.42
Rate for Payer: Cigna Medicare Advantage	$20.20
Rate for Payer: Clover Medicare Advantage	$19.19
Rate for Payer: EmblemHealth Commercial	$60.60
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.20
Rate for Payer: Wellcare Medicare Advantage	$20.20
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

HSV CULTURE WITHOUT TYPING

Facility

$325.00

Service Code	HCPCS 87255
Hospital Charge Code	3038073
Hospital Revenue Code	309
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.22
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

HSV CULTURE WITHOUT TYPING

Facility

$325.00

Service Code	HCPCS 87255
Hospital Charge Code	3038073
Hospital Revenue Code	309
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

HSV CULTURE,W/REFL TO TYP

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900497
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV CULTURE,W/REFL TO TYP

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900497
Hospital Revenue Code	309
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.22
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
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	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083A
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650A
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.37
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.37
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650B
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083B
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

Know your out-of-pocket cost for care.

All Charges