Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WESTCORT 0.2%/45GM

Facility

$107.00

Hospital Charge Code	60634170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

WEST NILE AB

Facility

$565.60

Service Code	HCPCS 86789
Hospital Charge Code	397040002
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$282.80
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$282.80
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$14.99

WEST NILE AB

Facility

$565.60

Service Code	HCPCS 86789
Hospital Charge Code	397040002
Hospital Revenue Code	302
Min. Negotiated Rate	$84.84
Max. Negotiated Rate	$84.84
Rate for Payer: Qualcare PPO/HMO/WC	$84.84

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$57.88
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.36
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$17.36
Rate for Payer: Qualcare PPO/HMO/WC	$17.36

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$49.48
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$14.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.84

WEST NILE CSF I

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990108A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
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	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

WEST NILE CSF I

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990108A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE CSF II

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990108B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE CSF II

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990108B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
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	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

WEST NILE IGG/IGM II

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990107A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
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	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

WEST NILE IGG/IGM II

Facility

$390.00

Service Code	HCPCS 86788
Hospital Charge Code	39990107A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE IGG/IGM III

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990107B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE IGG/IGM III

Facility

$390.00

Service Code	HCPCS 86789
Hospital Charge Code	39990107B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
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	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

WEST NILE,RNA, RT-PCR (CSF)

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	3990521
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WEST NILE,RNA, RT-PCR (CSF)

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	3990521
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

WEST NILE VIRS ANBD SERM I

Facility

$119.30

Service Code	HCPCS 86788
Hospital Charge Code	3037045A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.82
Rate for Payer: Cigna Commercial	$59.65
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

WEST NILE VIRS ANBD SERM I

Facility

$119.30

Service Code	HCPCS 86788
Hospital Charge Code	3037045A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

WEST NILE VIRS ANBD SERM II

Facility

$101.95

Service Code	HCPCS 86789
Hospital Charge Code	3037045B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$50.98
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

WEST NILE VIRS ANBD SERM II

Facility

$101.95

Service Code	HCPCS 86789
Hospital Charge Code	3037045B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$15.29
Rate for Payer: Qualcare PPO/HMO/WC	$15.29

WEST NILE VIRUS AB CSF

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035040A
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

WEST NILE VIRUS AB CSF

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035040A
Hospital Revenue Code	302
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

WEST NILE VIRUS AB CSF

Facility

$496.00

Hospital Charge Code	3035040
Hospital Revenue Code	302
Min. Negotiated Rate	$11.95
Max. Negotiated Rate	$248.00
Rate for Payer: Aetna Commercial	$188.48
Rate for Payer: Aetna Medicare Advantage	$148.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.48
Rate for Payer: Cigna Commercial	$248.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.95
Rate for Payer: Wellpoint Medicaid Managed Care	$13.14

WEST NILE VIRUS AB CSF

Facility

$496.00

Hospital Charge Code	3035040
Hospital Revenue Code	302
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$74.40

Know your out-of-pocket cost for care.

All Charges