Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIROLOGY

Facility

$90.65

Service Code	HCPCS 86695
Hospital Charge Code	39900241
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

VIROLOGY

Facility

$90.65

Service Code	HCPCS 86695
Hospital Charge Code	39900241
Hospital Revenue Code	302
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

VIROPTIC 1% OPHTH SOLN

Facility

$28.00

Hospital Charge Code	60634801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

VIROPTIC 1% OPHTH SOLN

Facility

$28.00

Hospital Charge Code	60634801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

VIROPTIC 1% OPHTH SOLN

Facility

$182.00

Hospital Charge Code	60634813
Hospital Revenue Code	250
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$27.30
Rate for Payer: Qualcare PPO/HMO/WC	$27.30

VIROPTIC 1% OPHTH SOLN

Facility

$182.00

Hospital Charge Code	60634813
Hospital Revenue Code	250
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$69.16
Rate for Payer: Aetna Medicare Advantage	$54.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.41
Rate for Payer: Cigna Commercial	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$36.40
Rate for Payer: Qualcare PPO/HMO/WC	$27.30
Rate for Payer: UnitedHealthcare Commercial	$36.40
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

VIRTU LORDOTIC 14X12X7MM

Facility

$12,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270685321
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

VIRTU LORDOTIC 14X12X7MM

Facility

$12,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270685321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

VIRUS ISOLATION CENTRIFUGE W I

Facility

$138.50

Service Code	HCPCS 87254
Hospital Charge Code	38477156
Hospital Revenue Code	309
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$69.25
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.67

VIRUS ISOLATION CENTRIFUGE W I

Facility

$138.50

Service Code	HCPCS 87254
Hospital Charge Code	38477156
Hospital Revenue Code	309
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$20.77
Rate for Payer: Qualcare PPO/HMO/WC	$20.77

VIRUS ISOL/OTHER THAN BY CYTO

Facility

$239.85

Service Code	HCPCS 87255
Hospital Charge Code	38477188
Hospital Revenue Code	309
Min. Negotiated Rate	$35.98
Max. Negotiated Rate	$35.98
Rate for Payer: Qualcare PPO/HMO/WC	$35.98

VIRUS ISOL/OTHER THAN BY CYTO

Facility

$239.85

Service Code	HCPCS 87255
Hospital Charge Code	38477188
Hospital Revenue Code	309
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.22
Rate for Payer: Cigna Commercial	$119.92
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.98
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

VIRUS TYPING, EACH

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3009255A
Hospital Revenue Code	302
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

VIRUS TYPING, EACH

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3009255B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$459.20
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	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$46.83
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	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
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	$2.48

VIRUS TYPING, EACH

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3009255B
Hospital Revenue Code	302
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

VIRUS TYPING, EACH

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3009255A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$459.20
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	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$46.83
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	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
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	$2.48

VISCERAL ARTERIO

Facility

$6,122.00

Hospital Charge Code	2009070
Hospital Revenue Code	323
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$2,326.36
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$147.54
Rate for Payer: Wellpoint Medicaid Managed Care	$162.23

VISCERAL ARTERIO

Facility

$6,122.00

Hospital Charge Code	2009070
Hospital Revenue Code	323
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	366875726L
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	321075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	411075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	366875726L
Hospital Revenue Code	323
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	2691875
Hospital Revenue Code	323
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	2691875
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$8,514.00

Service Code	HCPCS 75726LT
Hospital Charge Code	7412004
Hospital Revenue Code	323
Min. Negotiated Rate	$205.19
Max. Negotiated Rate	$4,257.00
Rate for Payer: Aetna Commercial	$3,235.32
Rate for Payer: Aetna Medicare Advantage	$2,554.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,171.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,171.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,171.07
Rate for Payer: Cigna Commercial	$4,257.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,554.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,277.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$205.19
Rate for Payer: Wellpoint Medicaid Managed Care	$225.62

Know your out-of-pocket cost for care.

All Charges