Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARDIOLIPIN AB (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARDIOLIPIN AB (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CARDIOLIPIN AB (IGG,A,M) II

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARDIOLIPIN AB (IGG,A,M) II

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CARDIOLIPIN AB (IGG,A,M) III

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARDIOLIPIN AB (IGG,A,M) III

Facility

$390.00

Service Code	HCPCS 8614791
Hospital Charge Code	39990023C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CARDIOLIPIN AB (IGM)

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900359
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
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	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CARDIOLIPIN AB (IGM)

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900359
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARDIOLIPIN IGA

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3004855
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

CARDIOLIPIN IGA

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3004855
Hospital Revenue Code	302
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

CARDIOLIPIN PANEL COMP***

Facility

$291.00

Service Code	HCPCS 86147
Hospital Charge Code	3032224
Hospital Revenue Code	302
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

CARDIOLIPIN PANEL COMP***

Facility

$291.00

Service Code	HCPCS 86147
Hospital Charge Code	3032224
Hospital Revenue Code	302
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

CARDIOMYOPATHY

Facility

$23,707.21

Service Code	APR-DRG 2054
Min. Negotiated Rate	$23,242.36
Max. Negotiated Rate	$23,707.21
Rate for Payer: UnitedHealthcare Community & State	$23,242.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,707.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23,242.36

CARDIOMYOPATHY

Facility

$6,005.67

Service Code	APR-DRG 2051
Min. Negotiated Rate	$5,887.91
Max. Negotiated Rate	$6,005.67
Rate for Payer: UnitedHealthcare Community & State	$5,887.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,005.67
Rate for Payer: Wellpoint Medicaid Managed Care	$5,887.91

CARDIOMYOPATHY

Facility

$11,177.56

Service Code	APR-DRG 2053
Min. Negotiated Rate	$10,958.39
Max. Negotiated Rate	$11,177.56
Rate for Payer: UnitedHealthcare Community & State	$10,958.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,177.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10,958.39

CARDIOMYOPATHY

Facility

$7,519.83

Service Code	APR-DRG 2052
Min. Negotiated Rate	$7,372.38
Max. Negotiated Rate	$7,519.83
Rate for Payer: UnitedHealthcare Community & State	$7,372.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,519.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7,372.38

CARDIOVERSION

Facility

$1,760.00

Service Code	HCPCS 92960
Hospital Charge Code	366892960
Hospital Revenue Code	480
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00

CARDIOVERSION

Facility

$1,760.00

Service Code	HCPCS 92960
Hospital Charge Code	366892960
Hospital Revenue Code	480
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$2,834.41
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,834.41
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$42.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$46.64

CARDIOVERSION

Facility

$1,760.00

Service Code	HCPCS 92960
Hospital Charge Code	7411181
Hospital Revenue Code	480
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$2,834.41
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,834.41
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$42.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$46.64

CARDIOVERSION

Facility

$1,760.00

Service Code	HCPCS 92960
Hospital Charge Code	7411181
Hospital Revenue Code	480
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00

CARDIOVERSION (ELECTIVE)

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	5309040
Hospital Revenue Code	480
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$2,834.41
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,834.41
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$328.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$52.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$58.03

CARDIOVERSION (ELECTIVE)

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	74110012
Hospital Revenue Code	480
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$2,834.41
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,834.41
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$328.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$52.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$58.03

CARDIOVERSION (ELECTIVE)

Facility

$6,070.00

Service Code	HCPCS 92960
Hospital Charge Code	5100078
Hospital Revenue Code	480
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$2,834.41
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,002.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,834.41
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,821.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

CARDIOVERSION (ELECTIVE)

Facility

$6,070.00

Service Code	HCPCS 92960
Hospital Charge Code	5100078
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

CARDIOVERSION (ELECTIVE)

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	5309040
Hospital Revenue Code	480
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$328.50
Rate for Payer: Qualcare PPO/HMO/WC	$328.50

Know your out-of-pocket cost for care.

All Charges