Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HSV TYPE 2

Facility

$38.35

Service Code	HCPCS 87140
Hospital Charge Code	39900271
Hospital Revenue Code	309
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.75

HSV TYPE 2

Facility

$38.35

Service Code	HCPCS 87140
Hospital Charge Code	39900271
Hospital Revenue Code	309
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.11
Rate for Payer: Cigna Commercial	$19.18
Rate for Payer: Cigna Medicare Advantage	$5.57
Rate for Payer: Clover Medicare Advantage	$5.29
Rate for Payer: EmblemHealth Commercial	$16.71
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.57
Rate for Payer: Wellcare Medicare Advantage	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

HSV TYPE I/II DNA BY PCR

Facility

$232.00

Service Code	HCPCS 87801
Hospital Charge Code	3035032
Hospital Revenue Code	306
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$253.40
Rate for Payer: Aetna Commercial	$190.94
Rate for Payer: Aetna Medicare Advantage	$227.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.40
Rate for Payer: Cigna Commercial	$116.00
Rate for Payer: Cigna Medicare Advantage	$70.20
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$56.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Medicare Advantage	$70.20
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

HSV TYPE I/II DNA BY PCR

Facility

$232.00

Service Code	HCPCS 87801
Hospital Charge Code	3035032
Hospital Revenue Code	306
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254
Hospital Revenue Code	309
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
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	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254A
Hospital Revenue Code	309
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
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	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HTA PROCEDURE GENESYS KIT

Facility

$7,000.00

Hospital Charge Code	270660174
Hospital Revenue Code	272
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,100.00
Rate for Payer: Oxford Commercial	$1,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Commercial	$1,400.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

HTA PROCEDURE GENESYS KIT

Facility

$7,000.00

Hospital Charge Code	270660174
Hospital Revenue Code	272
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

HTLV 1&2 AB

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900388
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HTLV 1&2 AB

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900388
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HTLV-1 AB, IGG

Facility

$416.00

Service Code	HCPCS 86687
Hospital Charge Code	38476237
Hospital Revenue Code	302
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

HTLV-1 AB, IGG

Facility

$416.00

Service Code	HCPCS 86687
Hospital Charge Code	38476237
Hospital Revenue Code	302
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$24.72
Rate for Payer: Aetna Medicare Advantage	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.81
Rate for Payer: Cigna Commercial	$208.00
Rate for Payer: Cigna Medicare Advantage	$9.09
Rate for Payer: Clover Medicare Advantage	$8.64
Rate for Payer: EmblemHealth Commercial	$27.27
Rate for Payer: Humana Medicare Advantage	$9.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.09
Rate for Payer: Wellcare Medicare Advantage	$9.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.02

HTLV/II,IGE

Facility

$218.00

Service Code	HCPCS 86790
Hospital Charge Code	38476273
Hospital Revenue Code	302
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$109.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.78

HTLV/II,IGE

Facility

$218.00

Service Code	HCPCS 86790
Hospital Charge Code	38476273
Hospital Revenue Code	302
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

HTO IBALANCE XL 9 DEG

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HTO IBALANCE XL 9 DEG

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691461
Hospital Revenue Code	278
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

HU AB,IFA W/RFX WB

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	39900204
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HU AB,IFA W/RFX WB

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	39900204
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	$15.10
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

HU AUTOANTIBODY (ANTI-HU AB)SC

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3008356
Hospital Revenue Code	302
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$124.00
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	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$60.50
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	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
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	$3.21

HU AUTOANTIBODY (ANTI-HU AB)SC

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3008356
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

HUGGER LAP POSEY 6515N

Facility

$113.65

Hospital Charge Code	270613227
Hospital Revenue Code	270
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$43.19
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$22.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$22.73
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

HUGGER LAP POSEY 6515N

Facility

$113.65

Hospital Charge Code	270613227
Hospital Revenue Code	270
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

HUIGREGTSE NDLE KNIFE PAPILL

Facility

$337.00

Hospital Charge Code	270334800
Hospital Revenue Code	272
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$50.55
Rate for Payer: Qualcare PPO/HMO/WC	$50.55

Know your out-of-pocket cost for care.

All Charges