Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BB-TAK MTP THREADED

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270694409
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

BB-TAK MTP THREADED

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270694409
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

BB TAK THREADED

Facility

$772.50

Service Code	HCPCS C1713
Hospital Charge Code	270703765
Hospital Revenue Code	278
Min. Negotiated Rate	$18.62
Max. Negotiated Rate	$386.25
Rate for Payer: Aetna Commercial	$293.55
Rate for Payer: Aetna Medicare Advantage	$231.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.99
Rate for Payer: Cigna Commercial	$386.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.88
Rate for Payer: UnitedHealthcare Community & State	$18.62
Rate for Payer: Wellpoint Medicaid Managed Care	$20.47

BB TAK THREADED

Facility

$772.50

Service Code	HCPCS C1713
Hospital Charge Code	270703765
Hospital Revenue Code	278
Min. Negotiated Rate	$115.88
Max. Negotiated Rate	$186.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.88

B.BURGDORFERI AB (IGG,M), I

Facility

$667.59

Service Code	HCPCS 8661791
Hospital Charge Code	39990036A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

B.BURGDORFERI AB (IGG,M), I

Facility

$667.59

Service Code	HCPCS 8661791
Hospital Charge Code	39990036A
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

B.BURGDORFERI AB (IGG,M), II

Facility

$667.59

Service Code	HCPCS 8661791
Hospital Charge Code	39990036B
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

B.BURGDORFERI AB (IGG,M), II

Facility

$667.59

Service Code	HCPCS 8661791
Hospital Charge Code	39990036B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

B.BURGDORFERI AB SCREEN W

Facility

$117.05

Service Code	HCPCS 86618
Hospital Charge Code	39900228
Hospital Revenue Code	302
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$17.56
Rate for Payer: Qualcare PPO/HMO/WC	$17.56

B.BURGDORFERI AB SCREEN W

Facility

$117.05

Service Code	HCPCS 86618
Hospital Charge Code	39900228
Hospital Revenue Code	302
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.47
Rate for Payer: Cigna Commercial	$58.52
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

BC ACHI SPDBRG W/ KL DX CC 3.9

Facility

$14,909.25

Hospital Charge Code	270702069
Hospital Revenue Code	278
Min. Negotiated Rate	$2,236.39
Max. Negotiated Rate	$3,608.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,608.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,280.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.39

BC ACHI SPDBRG W/ KL DX CC 3.9

Facility

$14,909.25

Hospital Charge Code	270702069
Hospital Revenue Code	278
Min. Negotiated Rate	$359.31
Max. Negotiated Rate	$7,454.62
Rate for Payer: Aetna Commercial	$5,665.52
Rate for Payer: Aetna Medicare Advantage	$4,472.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,801.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,801.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,801.86
Rate for Payer: Cigna Commercial	$7,454.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,608.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,280.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,236.39
Rate for Payer: UnitedHealthcare Community & State	$359.31
Rate for Payer: Wellpoint Medicaid Managed Care	$395.10

B-CELL CLONALITY (HEAVY CHAIN)

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38476227
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

B-CELL CLONALITY (HEAVY CHAIN)

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38476227
Hospital Revenue Code	311
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.41

B-CELL CLONALITY (LIGHT CHAIN)

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38476226
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

B-CELL CLONALITY (LIGHT CHAIN)

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38476226
Hospital Revenue Code	311
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.41

B-CELL CLONALITY SCREEN

Facility

$280.00

Service Code	HCPCS 88180
Hospital Charge Code	3006533
Hospital Revenue Code	309
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

B-CELL CLONALITY SCREEN

Facility

$280.00

Service Code	HCPCS 88180
Hospital Charge Code	3006533
Hospital Revenue Code	309
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

B CELLS,TOTAL COUNT

Facility

$267.15

Service Code	HCPCS 86355
Hospital Charge Code	38477200
Hospital Revenue Code	302
Min. Negotiated Rate	$40.07
Max. Negotiated Rate	$40.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.07

B CELLS,TOTAL COUNT

Facility

$267.15

Service Code	HCPCS 86355
Hospital Charge Code	38477200
Hospital Revenue Code	302
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$136.19
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$133.57
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.07
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

BCG 50MG

Facility

$608.00

Service Code	HCPCS 90585
Hospital Charge Code	60635567
Hospital Revenue Code	636
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$304.00
Rate for Payer: Aetna Commercial	$231.04
Rate for Payer: Aetna Medicare Advantage	$182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.04
Rate for Payer: Cigna Commercial	$304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.20
Rate for Payer: UnitedHealthcare Community & State	$14.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.11

BCG 50MG

Facility

$608.00

Service Code	HCPCS 90585
Hospital Charge Code	60635567
Hospital Revenue Code	636
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$147.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.20

BCG VACCINE 800MIL CFU/27MG

Facility

$1,343.40

Hospital Charge Code	6006951
Hospital Revenue Code	636
Min. Negotiated Rate	$201.51
Max. Negotiated Rate	$325.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.10
Rate for Payer: Qualcare PPO/HMO/WC	$201.51

BCG VACCINE 800MIL CFU/27MG

Facility

$1,343.40

Hospital Charge Code	6006951
Hospital Revenue Code	636
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$671.70
Rate for Payer: Aetna Commercial	$510.49
Rate for Payer: Aetna Medicare Advantage	$403.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.57
Rate for Payer: Cigna Commercial	$671.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.10
Rate for Payer: Qualcare PPO/HMO/WC	$201.51
Rate for Payer: UnitedHealthcare Community & State	$32.38
Rate for Payer: Wellpoint Medicaid Managed Care	$35.60

B COMPLEX THIAM C B12 INJ

Facility

$3.85

Hospital Charge Code	6025043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

Know your out-of-pocket cost for care.

All Charges