Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEGIONELLA IGG,IGM 1-6, VII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044G
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

LEGIONELLA IGG,IGM 1-6, VII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044G
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, VIII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044H
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, VIII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044H
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

LEGIONELLA IGG,IGM 1-6, X

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044J
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

LEGIONELLA IGG,IGM 1-6, X

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044J
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, XI

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044K
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, XI

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044K
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

LEGIONELLA IGG,IGM 1-6, XII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044L
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

LEGIONELLA IGG,IGM 1-6, XII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044L
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA PNEUMOPHILA ABS

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3004793
Hospital Revenue Code	302
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$78.42
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

LEGIONELLA PNEUMOPHILA ABS

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3004793
Hospital Revenue Code	302
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

LEGIONELLA PNEUMOPHILA AG

Facility

$75.65

Service Code	HCPCS 87278
Hospital Charge Code	39900281
Hospital Revenue Code	309
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

LEGIONELLA PNEUMOPHILA AG

Facility

$75.65

Service Code	HCPCS 87278
Hospital Charge Code	39900281
Hospital Revenue Code	309
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$50.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.60
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	$56.31
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: Cigna Medicare Advantage	$15.60
Rate for Payer: Clover Medicare Advantage	$14.82
Rate for Payer: EmblemHealth Commercial	$46.80
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.60
Rate for Payer: Wellcare Medicare Advantage	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

LEGIONELLA PNEUMOPHLIA AB

Facility

$105.20

Service Code	HCPCS 86713
Hospital Charge Code	39900248
Hospital Revenue Code	302
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$15.78
Rate for Payer: Qualcare PPO/HMO/WC	$15.78

LEGIONELLA PNEUMOPHLIA AB

Facility

$105.20

Service Code	HCPCS 86713
Hospital Charge Code	39900248
Hospital Revenue Code	302
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$52.60
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

LEGIONELLA SPECIES CULTURE

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	401387081
Hospital Revenue Code	306
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

LEGIONELLA SPECIES CULTURE

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	401387081
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEG MED-LARGE ********

Facility

$225.00

Hospital Charge Code	8002040
Hospital Revenue Code	279
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

LEG MED-LARGE ********

Facility

$225.00

Hospital Charge Code	8002040
Hospital Revenue Code	279
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LEG SCREW T1 10.6 X 88MM

Facility

$3,945.00

Hospital Charge Code	270656526
Hospital Revenue Code	278
Min. Negotiated Rate	$95.07
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,499.10
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.90
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Community & State	$95.07
Rate for Payer: Wellpoint Medicaid Managed Care	$104.54

LEG SCREW T1 10.6 X 88MM

Facility

$3,945.00

Hospital Charge Code	270656526
Hospital Revenue Code	278
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$954.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.90
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

LEG SECTION PAD

Facility

$1,109.40

Hospital Charge Code	270656362
Hospital Revenue Code	271
Min. Negotiated Rate	$26.74
Max. Negotiated Rate	$554.70
Rate for Payer: Aetna Commercial	$421.57
Rate for Payer: Aetna Medicare Advantage	$332.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.90
Rate for Payer: Cigna Commercial	$554.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.82
Rate for Payer: Oxford Commercial	$221.88
Rate for Payer: Qualcare PPO/HMO/WC	$166.41
Rate for Payer: UnitedHealthcare Commercial	$221.88
Rate for Payer: UnitedHealthcare Community & State	$26.74
Rate for Payer: Wellpoint Medicaid Managed Care	$29.40

LEG SECTION PAD

Facility

$1,109.40

Hospital Charge Code	270656362
Hospital Revenue Code	271
Min. Negotiated Rate	$166.41
Max. Negotiated Rate	$166.41
Rate for Payer: Qualcare PPO/HMO/WC	$166.41

LEG SM ********

Facility

$168.00

Hospital Charge Code	8002032
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

Know your out-of-pocket cost for care.

All Charges