Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY,RICKETTSIA

Facility

$137.49

Service Code	HCPCS 86757
Hospital Charge Code	38476305
Hospital Revenue Code	302
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

ANTIBODY SCREEN

Facility

$775.02

Service Code	HCPCS 86850
Hospital Charge Code	3100526
Hospital Revenue Code	300
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$232.51
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

ANTIBODY SCREEN

Facility

$775.02

Service Code	HCPCS 86850
Hospital Charge Code	3100526
Hospital Revenue Code	300
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

ANTIBODY SCREEN***

Facility

$39.00

Service Code	HCPCS 86850
Hospital Charge Code	3100666A
Hospital Revenue Code	300
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

ANTIBODY SCREEN***

Facility

$39.00

Service Code	HCPCS 86850
Hospital Charge Code	3100666A
Hospital Revenue Code	300
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

ANTIBODY SCREEN*****

Facility

$95.00

Service Code	HCPCS 86850
Hospital Charge Code	3100666B
Hospital Revenue Code	300
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

ANTIBODY SCREEN*****

Facility

$95.00

Service Code	HCPCS 86850
Hospital Charge Code	3100666B
Hospital Revenue Code	300
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

ANTIBODY SCREEN (INDIRECT COOM

Facility

$455.00

Service Code	HCPCS 86850
Hospital Charge Code	38471004
Hospital Revenue Code	302
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$12.06

ANTIBODY SCREEN (INDIRECT COOM

Facility

$455.00

Service Code	HCPCS 86850
Hospital Charge Code	38471004
Hospital Revenue Code	302
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

ANTIBODY SCREEN (PHASES)

Facility

$77.65

Service Code	HCPCS 86850
Hospital Charge Code	3101102
Hospital Revenue Code	300
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.27
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$9.77
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

ANTIBODY SCREEN (PHASES)

Facility

$77.65

Service Code	HCPCS 86850
Hospital Charge Code	3101102
Hospital Revenue Code	300
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100658
Hospital Revenue Code	302
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100658
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100534
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100534
Hospital Revenue Code	300
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANTIBODY TITRATION

Facility

$135.00

Service Code	HCPCS 86886
Hospital Charge Code	38471016
Hospital Revenue Code	300
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ANTIBODY TITRATION

Facility

$135.00

Service Code	HCPCS 86886
Hospital Charge Code	38471016
Hospital Revenue Code	300
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

ANTIBODY TOXOPLASMA

Facility

$157.47

Hospital Charge Code	3000377A
Hospital Revenue Code	306
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.84
Rate for Payer: Aetna Medicare Advantage	$47.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.15
Rate for Payer: Cigna Commercial	$78.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

ANTIBODY TOXOPLASMA

Facility

$157.47

Hospital Charge Code	3000377A
Hospital Revenue Code	306
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

ANTIBODY TOXOPLASMA IGM

Facility

$146.38

Hospital Charge Code	3000377B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$21.96
Rate for Payer: Qualcare PPO/HMO/WC	$21.96

ANTIBODY TOXOPLASMA IGM

Facility

$146.38

Hospital Charge Code	3000377B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.62
Rate for Payer: Aetna Medicare Advantage	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.33
Rate for Payer: Cigna Commercial	$73.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

ANTIBODY VIRUS NOS

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	401386790A
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

ANTIBODY VIRUS NOS

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	401386790A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY VIRUS,NOT SPECIFIED 1

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476270
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
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	$98.50
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	$59.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.55
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	$5.22

ANTIBODY VIRUS,NOT SPECIFIED 1

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476270
Hospital Revenue Code	302
Min. Negotiated Rate	$29.55
Max. Negotiated Rate	$29.55
Rate for Payer: Qualcare PPO/HMO/WC	$29.55

Know your out-of-pocket cost for care.

All Charges