Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	38430019
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	39990219
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	38430019
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	39990219
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80340
Hospital Charge Code	39990220
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80340
Hospital Charge Code	3039020
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80340
Hospital Charge Code	3039020
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80340
Hospital Charge Code	39990220
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	39990221
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	3039021
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	38430021
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	39990221
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	38430021
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIEPILEPTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80341
Hospital Charge Code	3039021
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

ANTIFUNGAL CREAM

Facility

$15.81

Service Code	NDC 472073514
Hospital Charge Code	6063943303
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

ANTIFUNGAL CREAM

Facility

$15.81

Service Code	NDC 472073514
Hospital Charge Code	6063943303
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$6.01
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$3.16
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

ANTIGEN DETECT BY IMMUNOFLUOR

Facility

$77.95

Service Code	HCPCS 87260
Hospital Charge Code	38477077
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTIGEN DETECT BY IMMUNOFLUOR

Facility

$77.95

Service Code	HCPCS 87260
Hospital Charge Code	38477077
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.25
Rate for Payer: Aetna Medicare Advantage	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.09
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$14.43
Rate for Payer: Clover Medicare Advantage	$13.71
Rate for Payer: EmblemHealth Commercial	$43.29
Rate for Payer: Humana Medicare Advantage	$14.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.43
Rate for Payer: Wellcare Medicare Advantage	$14.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTIGEN DET IMMUNFLHERPES INFL

Facility

$77.95

Service Code	HCPCS 87275
Hospital Charge Code	38477083
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTIGEN DET IMMUNFLHERPES INFL

Facility

$77.95

Service Code	HCPCS 87275
Hospital Charge Code	38477083
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.22
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTIGEN DET/IMMUNOFL BORDETELL

Facility

$77.95

Service Code	HCPCS 87265
Hospital Charge Code	38477078
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTIGEN DET/IMMUNOFL BORDETELL

Facility

$77.95

Service Code	HCPCS 87265
Hospital Charge Code	38477078
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTIGEN SCREEN (BLOOD TYPING)

Facility

$134.00

Service Code	HCPCS 86902
Hospital Charge Code	38471072
Hospital Revenue Code	309
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

ANTIGEN SCREEN (BLOOD TYPING)

Facility

$134.00

Service Code	HCPCS 86902
Hospital Charge Code	38471072
Hospital Revenue Code	309
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

ANTI GLIADIN ANTIBODY IGG IGA

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3032364
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

Know your out-of-pocket cost for care.

All Charges