Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VARICELLA ZOSTER ANTIBODIE,IGG

Facility

$424.00

Service Code	HCPCS 86787
Hospital Charge Code	38476146
Hospital Revenue Code	302
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

VARICELLA ZOSTER ANTIBODIE,IGM

Facility

$424.00

Service Code	HCPCS 86787
Hospital Charge Code	38476149
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$212.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

VARICELLA ZOSTER ANTIBODIE,IGM

Facility

$424.00

Service Code	HCPCS 86787
Hospital Charge Code	38476149
Hospital Revenue Code	302
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

VARICELLA ZOSTER ANTIBODY

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3009611
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

VARICELLA ZOSTER ANTIBODY

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3009611
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

VARICELLA ZOSTER, IGG

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3006756
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

VARICELLA ZOSTER, IGG

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3006756
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

VARICELLA ZOSTER, IGM

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3009610
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

VARICELLA ZOSTER, IGM

Facility

$141.65

Service Code	HCPCS 86787
Hospital Charge Code	3009610
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

VARICELLA ZOSTER VIR,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900305
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VARICELLA ZOSTER VIR,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900305
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

VARILIFT LX 11MMX24MM

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692844
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

VARILIFT LX 11MMX24MM

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692844
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

VARILIFT LX 11MMX28MM

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692843
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

VARILIFT LX 11MMX28MM

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692843
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

VARILIFT LX HT 10MM 28MM LONG

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692794
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

VARILIFT LX HT 10MM 28MM LONG

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692794
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

VARISYNC ALIF 28X40X14MM 15DEG

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705504
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

VARISYNC ALIF 28X40X14MM 15DEG

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705504
Hospital Revenue Code	278
Min. Negotiated Rate	$783.25
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$783.25
Rate for Payer: Wellpoint Medicaid Managed Care	$861.25

VARISYNC ALIF CAGE 24X30MM 8DE

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705848
Hospital Revenue Code	278
Min. Negotiated Rate	$783.25
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$783.25
Rate for Payer: Wellpoint Medicaid Managed Care	$861.25

VARISYNC ALIF CAGE 24X30MM 8DE

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705848
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

VARISYNC ALIF F3D-Z. CAGE 24X3

Facility

$35,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704099
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$8,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00

VARISYNC ALIF F3D-Z. CAGE 24X3

Facility

$35,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704099
Hospital Revenue Code	278
Min. Negotiated Rate	$843.50
Max. Negotiated Rate	$17,500.00
Rate for Payer: Aetna Commercial	$13,300.00
Rate for Payer: Aetna Medicare Advantage	$10,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,925.00
Rate for Payer: Cigna Commercial	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00
Rate for Payer: UnitedHealthcare Community & State	$843.50
Rate for Payer: Wellpoint Medicaid Managed Care	$927.50

VARITHENA 180MG/18ML INJ FOAM

Facility

$23,416.50

Service Code	NDC 60635011801
Hospital Charge Code	6063943398
Hospital Revenue Code	250
Min. Negotiated Rate	$564.34
Max. Negotiated Rate	$11,708.25
Rate for Payer: Aetna Commercial	$8,898.27
Rate for Payer: Aetna Medicare Advantage	$7,024.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,971.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,971.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,971.21
Rate for Payer: Cigna Commercial	$11,708.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,024.95
Rate for Payer: Oxford Commercial	$4,683.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,512.47
Rate for Payer: UnitedHealthcare Commercial	$4,683.30
Rate for Payer: UnitedHealthcare Community & State	$564.34
Rate for Payer: Wellpoint Medicaid Managed Care	$620.54

VARITHENA 180MG/18ML INJ FOAM

Facility

$23,416.50

Service Code	NDC 60635011801
Hospital Charge Code	6063943398
Hospital Revenue Code	250
Min. Negotiated Rate	$3,512.47
Max. Negotiated Rate	$3,512.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,512.47

Know your out-of-pocket cost for care.

All Charges