Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$16.09
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.09
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$16.09
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.09
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$39.59
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900489
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900269
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900269
Hospital Revenue Code	309
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
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	$55.55
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900489
Hospital Revenue Code	309
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
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	$55.55
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

MPO-AB****

Facility

$99.00

Service Code	HCPCS 83520
Hospital Charge Code	3002059
Hospital Revenue Code	301
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

MPO-AB****

Facility

$99.00

Service Code	HCPCS 83520
Hospital Charge Code	3002059
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

MPOX VIR DNA QUAL RT PCR

Facility

$100.00

Service Code	HCPCS 87593
Hospital Charge Code	401312084
Hospital Revenue Code	306
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MPOX VIR DNA QUAL RT PCR

Facility

$100.00

Service Code	HCPCS 87593
Hospital Charge Code	401312084
Hospital Revenue Code	306
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$185.21
Rate for Payer: Aetna Commercial	$139.56
Rate for Payer: Aetna Medicare Advantage	$166.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.21
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$51.31
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Medicare Advantage	$51.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

MRA ABDOMEN W/WO C

Facility

$2,320.85

Service Code	HCPCS 74185
Hospital Charge Code	2400318
Hospital Revenue Code	618
Min. Negotiated Rate	$348.13
Max. Negotiated Rate	$348.13
Rate for Payer: Qualcare PPO/HMO/WC	$348.13

MRA ABDOMEN W/WO C

Facility

$2,320.85

Service Code	HCPCS 74185
Hospital Charge Code	2400318
Hospital Revenue Code	618
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$881.92
Rate for Payer: Aetna Medicare Advantage	$696.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.82
Rate for Payer: Cigna Commercial	$1,160.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$55.93
Rate for Payer: Wellpoint Medicaid Managed Care	$61.50

MRA CHEST W/ C

Facility

$1,937.65

Hospital Charge Code	2400120
Hospital Revenue Code	618
Min. Negotiated Rate	$290.65
Max. Negotiated Rate	$290.65
Rate for Payer: Qualcare PPO/HMO/WC	$290.65

MRA CHEST W/ C

Facility

$1,937.65

Hospital Charge Code	2400120
Hospital Revenue Code	618
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$736.31
Rate for Payer: Aetna Medicare Advantage	$581.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.10
Rate for Payer: Cigna Commercial	$968.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.29
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$290.65
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.70
Rate for Payer: Wellpoint Medicaid Managed Care	$51.35

MRA-CHEST WO/W CONTRAST

Facility

$3,538.00

Service Code	HCPCS 71555
Hospital Charge Code	2408001
Hospital Revenue Code	618
Min. Negotiated Rate	$85.27
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,344.44
Rate for Payer: Aetna Medicare Advantage	$1,061.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$491.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$902.19
Rate for Payer: Cigna Commercial	$1,769.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,061.40
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$530.70
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$85.27
Rate for Payer: Wellpoint Medicaid Managed Care	$93.76

MRA-CHEST WO/W CONTRAST

Facility

$3,538.00

Service Code	HCPCS 71555
Hospital Charge Code	2408001
Hospital Revenue Code	618
Min. Negotiated Rate	$530.70
Max. Negotiated Rate	$530.70
Rate for Payer: Qualcare PPO/HMO/WC	$530.70

MRA HEAD &/OR NECK W/O CONTRST

Facility

$5,866.80

Service Code	HCPCS 70541
Hospital Charge Code	2400067
Hospital Revenue Code	611
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRA HEAD &/OR NECK W/O CONTRST

Facility

$5,866.80

Service Code	HCPCS 70541
Hospital Charge Code	2400067
Hospital Revenue Code	611
Min. Negotiated Rate	$141.39
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$2,229.38
Rate for Payer: Aetna Medicare Advantage	$1,760.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.03
Rate for Payer: Cigna Commercial	$2,933.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.04
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$141.39
Rate for Payer: Wellpoint Medicaid Managed Care	$155.47

MRA HEAD W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70544
Hospital Charge Code	94061027
Hospital Revenue Code	615
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRA HEAD W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70544
Hospital Charge Code	94061027
Hospital Revenue Code	615
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA-LOWER EXTREM WO/W CONT-RT

Facility

$2,895.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2407001
Hospital Revenue Code	616
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,100.10
Rate for Payer: Aetna Medicare Advantage	$868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$738.23
Rate for Payer: Cigna Commercial	$1,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$868.50
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$434.25
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$69.77
Rate for Payer: Wellpoint Medicaid Managed Care	$76.72

MRA-LOWER EXTREM WO/W CONT-RT

Facility

$2,895.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2407001
Hospital Revenue Code	616
Min. Negotiated Rate	$434.25
Max. Negotiated Rate	$434.25
Rate for Payer: Qualcare PPO/HMO/WC	$434.25

Know your out-of-pocket cost for care.

All Charges