Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PAP IG, CT-NG, HPV-HR I

Facility

$252.00

Service Code	HCPCS 87491
Hospital Charge Code	3038521A
Hospital Revenue Code	300
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$126.66
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	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$126.00
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	$75.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
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	$6.68

PAP IG, CT-NG, HPV-HR I

Facility

$252.00

Service Code	HCPCS 87491
Hospital Charge Code	3038521A
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

PAP IG, CT-NG, HPV-HR II

Facility

$252.00

Service Code	HCPCS 87591
Hospital Charge Code	3038521B
Hospital Revenue Code	300
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$126.66
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	$72.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$126.00
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	$75.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
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	$6.68

PAP IG, CT-NG, HPV-HR II

Facility

$252.00

Service Code	HCPCS 87591
Hospital Charge Code	3038521B
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

PAP IG, CT-NG, HPV-HR III

Facility

$248.55

Service Code	HCPCS 87624
Hospital Charge Code	3038521C
Hospital Revenue Code	300
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

PAP IG, CT-NG, HPV-HR III

Facility

$248.55

Service Code	HCPCS 87624
Hospital Charge Code	3038521C
Hospital Revenue Code	300
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
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	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.28
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	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
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	$6.59

PAP IG, CT-NG, HPV-HR IV

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038521D
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.05
Rate for Payer: Cigna Commercial	$336.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

PAP IG, CT-NG, HPV-HR IV

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038521D
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PAP IG, CT-NT, RFX HPV ASCU

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038522C
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.05
Rate for Payer: Cigna Commercial	$336.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

PAP IG, CT-NT, RFX HPV ASCU

Facility

$252.00

Service Code	HCPCS 87491
Hospital Charge Code	3038522A
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

PAP IG, CT-NT, RFX HPV ASCU

Facility

$252.00

Service Code	HCPCS 87491
Hospital Charge Code	3038522A
Hospital Revenue Code	300
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$126.66
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	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$126.00
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	$75.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
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	$6.68

PAP IG, CT-NT, RFX HPV ASCU

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038522C
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PAP IG, CT-NT, RFX HPV ASCU

Facility

$252.00

Service Code	HCPCS 87591
Hospital Charge Code	3038522B
Hospital Revenue Code	300
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$126.66
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	$72.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$126.00
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	$75.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
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	$6.68

PAP IG, CT-NT, RFX HPV ASCU

Facility

$252.00

Service Code	HCPCS 87591
Hospital Charge Code	3038522B
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

PAPILLOMAVIRUS,DNA PROBE TISSU

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009110
Hospital Revenue Code	312
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOMAVIRUS,DNA PROBE TISSU

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009110
Hospital Revenue Code	312
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$144.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

PAPILLOMAVIRUS, HUMAN #1

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009115A
Hospital Revenue Code	310
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOMAVIRUS, HUMAN #1

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009115A
Hospital Revenue Code	310
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$144.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

PAPILLOMAVIRUS, HUMAN #2

Facility

$350.00

Service Code	HCPCS 8836591
Hospital Charge Code	3009115B
Hospital Revenue Code	310
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

PAPILLOMAVIRUS, HUMAN #2

Facility

$350.00

Service Code	HCPCS 8836591
Hospital Charge Code	3009115B
Hospital Revenue Code	310
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOTOME FRIMBERGER PT30FK

Facility

$652.00

Hospital Charge Code	270606338
Hospital Revenue Code	270
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$97.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.80

PAPILLOTOME FRIMBERGER PT30FK

Facility

$652.00

Hospital Charge Code	270606338
Hospital Revenue Code	270
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$326.00
Rate for Payer: Aetna Commercial	$247.76
Rate for Payer: Aetna Medicare Advantage	$195.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.26
Rate for Payer: Cigna Commercial	$326.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.60
Rate for Payer: Oxford Commercial	$130.40
Rate for Payer: Qualcare PPO/HMO/WC	$97.80
Rate for Payer: UnitedHealthcare Commercial	$130.40
Rate for Payer: UnitedHealthcare Community & State	$15.71
Rate for Payer: Wellpoint Medicaid Managed Care	$17.28

PAPILLOTOME SOEHEN PT5.5BII

Facility

$1,073.65

Hospital Charge Code	270600986
Hospital Revenue Code	270
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$407.99
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.10
Rate for Payer: Oxford Commercial	$214.73
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Commercial	$214.73
Rate for Payer: UnitedHealthcare Community & State	$25.87
Rate for Payer: Wellpoint Medicaid Managed Care	$28.45

PAPILLOTOME SOEHEN PT5.5BII

Facility

$1,073.65

Hospital Charge Code	270600986
Hospital Revenue Code	270
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$161.05
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

PAPILLOTOME TAPERTOME 3.5 3282

Facility

$1,226.45

Hospital Charge Code	270608081
Hospital Revenue Code	272
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$613.23
Rate for Payer: Aetna Commercial	$466.05
Rate for Payer: Aetna Medicare Advantage	$367.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.74
Rate for Payer: Cigna Commercial	$613.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.94
Rate for Payer: Oxford Commercial	$245.29
Rate for Payer: Qualcare PPO/HMO/WC	$183.97
Rate for Payer: UnitedHealthcare Commercial	$245.29
Rate for Payer: UnitedHealthcare Community & State	$29.56
Rate for Payer: Wellpoint Medicaid Managed Care	$32.50

Know your out-of-pocket cost for care.

All Charges