Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OVA AND PARASITES DIRECT SMEAR

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3035156A
Hospital Revenue Code	309
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare Advantage	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$8.90
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.90
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	$7.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Medicare Advantage	$8.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

OVA AND PARASITES DIRECT SMEAR

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3035156A
Hospital Revenue Code	309
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

OVA AND PARISITE IDENTIFICATIO

Facility

$122.60

Service Code	HCPCS 87209
Hospital Charge Code	3990161B
Hospital Revenue Code	309
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$18.39
Rate for Payer: Qualcare PPO/HMO/WC	$18.39

OVA AND PARISITE IDENTIFICATIO

Facility

$122.60

Service Code	HCPCS 87209
Hospital Charge Code	3990161B
Hospital Revenue Code	309
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.90
Rate for Payer: Cigna Commercial	$61.30
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.25

OVA AND PARISITE IDENTIFICATIO

Facility

$60.70

Service Code	HCPCS 87177
Hospital Charge Code	3990161A
Hospital Revenue Code	309
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$9.11
Rate for Payer: Qualcare PPO/HMO/WC	$9.11

OVA AND PARISITE IDENTIFICATIO

Facility

$60.70

Service Code	HCPCS 87177
Hospital Charge Code	3990161A
Hospital Revenue Code	309
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare Advantage	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$30.35
Rate for Payer: Cigna Medicare Advantage	$8.90
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.11
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Medicare Advantage	$8.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

OVAL BURR

Facility

$119.00

Hospital Charge Code	270332555
Hospital Revenue Code	272
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

OVAL BURR

Facility

$119.00

Hospital Charge Code	270332555
Hospital Revenue Code	272
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$59.50
Rate for Payer: Aetna Commercial	$45.22
Rate for Payer: Aetna Medicare Advantage	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.34
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$23.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$23.80
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

Ova + Parasite Exam

Facility

$667.59

Service Code	HCPCS 87209
Hospital Charge Code	39880003B
Hospital Revenue Code	309
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.90
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
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	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

Ova + Parasite Exam

Facility

$526.67

Service Code	HCPCS 87177
Hospital Charge Code	39880003A
Hospital Revenue Code	309
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.00

Ova + Parasite Exam

Facility

$667.59

Service Code	HCPCS 87209
Hospital Charge Code	39880003B
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Ova + Parasite Exam

Facility

$526.67

Service Code	HCPCS 87177
Hospital Charge Code	39880003A
Hospital Revenue Code	309
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$263.33
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare Advantage	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$263.33
Rate for Payer: Cigna Medicare Advantage	$8.90
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Medicare Advantage	$8.90
Rate for Payer: Wellpoint Medicaid Managed Care	$13.96

OVA & PARASITES

Facility

$391.00

Service Code	HCPCS 87177
Hospital Charge Code	38475005
Hospital Revenue Code	309
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

OVA & PARASITES

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3002011
Hospital Revenue Code	309
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

OVA & PARASITES

Facility

$391.00

Service Code	HCPCS 87177
Hospital Charge Code	38475005
Hospital Revenue Code	309
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare Advantage	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: Cigna Medicare Advantage	$8.90
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Medicare Advantage	$8.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.36

OVA & PARASITES

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3002011
Hospital Revenue Code	309
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.21
Rate for Payer: Aetna Medicare Advantage	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$8.90
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.90
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	$7.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Medicare Advantage	$8.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

OVA & PARASITES***

Facility

$32.00

Hospital Charge Code	3012010
Hospital Revenue Code	309
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

OVA & PARASITES***

Facility

$32.00

Hospital Charge Code	3012010
Hospital Revenue Code	309
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

OVARIAN AB SCREEN

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	38479451A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OVARIAN AB SCREEN

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	38479451A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
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	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

OVARIAN MALIGNANCY RISK-ROMA

Facility

$540.59

Service Code	HCPCS 86849
Hospital Charge Code	3038139
Hospital Revenue Code	302
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$270.30
Rate for Payer: Aetna Commercial	$205.42
Rate for Payer: Aetna Medicare Advantage	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.85
Rate for Payer: Cigna Commercial	$270.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$14.33

OVARIAN MALIGNANCY RISK-ROMA

Facility

$540.59

Service Code	HCPCS 86849
Hospital Charge Code	3038139
Hospital Revenue Code	302
Min. Negotiated Rate	$81.09
Max. Negotiated Rate	$81.09
Rate for Payer: Qualcare PPO/HMO/WC	$81.09

OVERDRILL 2.7MM AO CONNECTION

Facility

$1,205.00

Hospital Charge Code	270672587
Hospital Revenue Code	272
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$180.75
Rate for Payer: Qualcare PPO/HMO/WC	$180.75

OVERDRILL 2.7MM AO CONNECTION

Facility

$1,205.00

Hospital Charge Code	270672587
Hospital Revenue Code	272
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$602.50
Rate for Payer: Aetna Commercial	$457.90
Rate for Payer: Aetna Medicare Advantage	$361.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.27
Rate for Payer: Cigna Commercial	$602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.50
Rate for Payer: Oxford Commercial	$241.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.75
Rate for Payer: UnitedHealthcare Commercial	$241.00
Rate for Payer: UnitedHealthcare Community & State	$29.04
Rate for Payer: Wellpoint Medicaid Managed Care	$31.93

OVERDRILL 3.5

Facility

$1,370.00

Hospital Charge Code	270664509
Hospital Revenue Code	270
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$685.00
Rate for Payer: Aetna Commercial	$520.60
Rate for Payer: Aetna Medicare Advantage	$411.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.35
Rate for Payer: Cigna Commercial	$685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.00
Rate for Payer: Oxford Commercial	$274.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.50
Rate for Payer: UnitedHealthcare Commercial	$274.00
Rate for Payer: UnitedHealthcare Community & State	$33.02
Rate for Payer: Wellpoint Medicaid Managed Care	$36.30

Know your out-of-pocket cost for care.

All Charges