Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

B2 GLYCOPROTEIN I (IGG,A, V

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011E
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

B2 GLYCOPROTEIN I (IGG,A, VI

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B2 GLYCOPROTEIN I (IGG,A, VI

Facility

$390.00

Service Code	HCPCS 8614691
Hospital Charge Code	39990011F
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

B2 MICROGLOBULIN,SERUM

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	39900048
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
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	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B2 MICROGLOBULIN,SERUM

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	39900048
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BABESIA MICROTI

Facility

$133.65

Service Code	HCPCS 87207
Hospital Charge Code	3009693
Hospital Revenue Code	309
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

BABESIA MICROTI

Facility

$133.65

Service Code	HCPCS 87207
Hospital Charge Code	3009693
Hospital Revenue Code	309
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.29
Rate for Payer: Aetna Medicare Advantage	$19.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.62
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Medicare Advantage	$5.99
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

BABESIA MICROTI DNA,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900401
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BABESIA MICROTI DNA,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900401
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BABESIA MICROTI (IGG,IGM) I

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104A
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

BABESIA MICROTI (IGG,IGM) I

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BABESIA MICROTI (IGG,IGM) II

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104B
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

BABESIA MICROTI (IGG,IGM) II

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BABESIAQ

Facility

$241.20

Service Code	HCPCS 87798
Hospital Charge Code	39900400
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

BABESIAQ

Facility

$241.20

Service Code	HCPCS 87798
Hospital Charge Code	39900400
Hospital Revenue Code	306
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$153.02
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

BABESIOSIS AB(IGG,IGM) - I

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3035077A
Hospital Revenue Code	300
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

BABESIOSIS AB(IGG,IGM) - I

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3035077A
Hospital Revenue Code	300
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

BABESIOSIS AB(IGG,IGM) - II

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3035077B
Hospital Revenue Code	300
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

BABESIOSIS AB(IGG,IGM) - II

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3035077B
Hospital Revenue Code	300
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

BABESIOSIS AB (IGG,M) I

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048A
Hospital Revenue Code	302
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.77

BABESIOSIS AB (IGG,M) I

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna Medicare Advantage	$25.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.71
Rate for Payer: Cigna Commercial	$42.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.26

BABESIOSIS AB (IGG,M) II

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048B
Hospital Revenue Code	302
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.77

BABESIOSIS AB (IGG,M) II

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna Medicare Advantage	$25.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.71
Rate for Payer: Cigna Commercial	$42.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.26

BABY PIN BALLS REFILL RACK

Facility

$29.15

Hospital Charge Code	270667644
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna Commercial	$11.08
Rate for Payer: Aetna Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.43
Rate for Payer: Cigna Commercial	$14.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.37
Rate for Payer: UnitedHealthcare Commercial	$5.83
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

BABY PIN BALLS REFILL RACK

Facility

$29.15

Hospital Charge Code	270667644
Hospital Revenue Code	272
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$4.37
Rate for Payer: Qualcare PPO/HMO/WC	$4.37

Know your out-of-pocket cost for care.

All Charges