Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPOETIN INJ 7,000U/1ML

Facility

$515.20

Service Code	HCPCS J0886
Hospital Charge Code	60628896
Hospital Revenue Code	250
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$257.60
Rate for Payer: Aetna Commercial	$195.78
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$257.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.56
Rate for Payer: Oxford Commercial	$103.04
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$103.04
Rate for Payer: UnitedHealthcare Community & State	$12.42
Rate for Payer: Wellpoint Medicaid Managed Care	$13.65

EPOETIN INJ 7,000U/1ML

Facility

$515.20

Service Code	HCPCS J0886
Hospital Charge Code	60628896
Hospital Revenue Code	250
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

EPOETIN INJ 8,000U/1ML

Facility

$590.10

Hospital Charge Code	60628897
Hospital Revenue Code	636
Min. Negotiated Rate	$88.52
Max. Negotiated Rate	$142.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$88.52

EPOETIN INJ 8,000U/1ML

Facility

$590.10

Hospital Charge Code	60628897
Hospital Revenue Code	636
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$295.05
Rate for Payer: Aetna Commercial	$224.24
Rate for Payer: Aetna Medicare Advantage	$177.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.48
Rate for Payer: Cigna Commercial	$295.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$88.52
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

EPOETIN INJ 9,000U/1ML

Facility

$663.05

Hospital Charge Code	60628898
Hospital Revenue Code	250
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$331.52
Rate for Payer: Aetna Commercial	$251.96
Rate for Payer: Aetna Medicare Advantage	$198.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.08
Rate for Payer: Cigna Commercial	$331.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.91
Rate for Payer: Oxford Commercial	$132.61
Rate for Payer: Qualcare PPO/HMO/WC	$99.46
Rate for Payer: UnitedHealthcare Commercial	$132.61
Rate for Payer: UnitedHealthcare Community & State	$15.98
Rate for Payer: Wellpoint Medicaid Managed Care	$17.57

EPOETIN INJ 9,000U/1ML

Facility

$663.05

Hospital Charge Code	60628898
Hospital Revenue Code	250
Min. Negotiated Rate	$99.46
Max. Negotiated Rate	$99.46
Rate for Payer: Qualcare PPO/HMO/WC	$99.46

EPOGEN 1000U

Facility

$51.00

Hospital Charge Code	60635391
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.34
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

EPOGEN 1000U

Facility

$51.00

Hospital Charge Code	60635391
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.34
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

EPOGEN 3000

Facility

$230.00

Hospital Charge Code	60634778
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

EPOGEN 3000

Facility

$230.00

Hospital Charge Code	60634778
Hospital Revenue Code	636
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

EPO INJ40MU NONRENAL

Facility

$3,821.65

Hospital Charge Code	60629084
Hospital Revenue Code	636
Min. Negotiated Rate	$92.10
Max. Negotiated Rate	$1,910.83
Rate for Payer: Aetna Commercial	$1,452.23
Rate for Payer: Aetna Medicare Advantage	$1,146.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$974.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$974.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$974.52
Rate for Payer: Cigna Commercial	$1,910.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$924.84
Rate for Payer: Qualcare PPO/HMO/WC	$573.25
Rate for Payer: UnitedHealthcare Community & State	$92.10
Rate for Payer: Wellpoint Medicaid Managed Care	$101.27

EPO INJ40MU NONRENAL

Facility

$3,821.65

Hospital Charge Code	60629084
Hospital Revenue Code	636
Min. Negotiated Rate	$573.25
Max. Negotiated Rate	$924.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$924.84
Rate for Payer: Qualcare PPO/HMO/WC	$573.25

EPSDT ASSAY OF LEAD

Facility

$111.25

Service Code	HCPCS 83655
Hospital Charge Code	9400340
Hospital Revenue Code	301
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

EPSDT ASSAY OF LEAD

Facility

$111.25

Service Code	HCPCS 83655
Hospital Charge Code	9400340
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

EPSDT CLINICAL CHEMISTRY TEST

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	9400345
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

EPSDT CLINICAL CHEMISTRY TEST

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	9400345
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

EPSDT COMPREHENSIVE ORAL EVAL

Facility

$165.65

Hospital Charge Code	9400370
Hospital Revenue Code	510
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$24.85
Rate for Payer: Qualcare PPO/HMO/WC	$24.85

EPSDT COMPREHENSIVE ORAL EVAL

Facility

$165.65

Hospital Charge Code	9400370
Hospital Revenue Code	510
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$82.83
Rate for Payer: Aetna Commercial	$62.95
Rate for Payer: Aetna Medicare Advantage	$49.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.24
Rate for Payer: Cigna Commercial	$82.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.70
Rate for Payer: Qualcare PPO/HMO/WC	$24.85
Rate for Payer: UnitedHealthcare Community & State	$3.99
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

EPSDT DTAP HEP B IPV VACCINE

Facility

$166.40

Service Code	HCPCS 90723
Hospital Charge Code	9400315
Hospital Revenue Code	636
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$40.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.27
Rate for Payer: Qualcare PPO/HMO/WC	$24.96

EPSDT DTAP HEP B IPV VACCINE

Facility

$166.40

Service Code	HCPCS 90723
Hospital Charge Code	9400315
Hospital Revenue Code	636
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$194.72
Rate for Payer: Aetna Commercial	$63.23
Rate for Payer: Aetna Medicare Advantage	$49.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.43
Rate for Payer: Cigna Commercial	$83.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.27
Rate for Payer: Qualcare PPO/HMO/WC	$24.96
Rate for Payer: UnitedHealthcare Community & State	$4.01
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

EPSDT ENT PROCEDURE/SERVICE

Facility

$128.85

Service Code	HCPCS 92700
Hospital Charge Code	9400330
Hospital Revenue Code	471
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.66
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.33
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

EPSDT ENT PROCEDURE/SERVICE

Facility

$128.85

Service Code	HCPCS 92700
Hospital Charge Code	9400330
Hospital Revenue Code	471
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$19.33
Rate for Payer: Qualcare PPO/HMO/WC	$19.33

EPSDT EYE SERVICE OR PROCEDURE

Facility

$220.00

Service Code	HCPCS 92499
Hospital Charge Code	9400325
Hospital Revenue Code	510
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

EPSDT EYE SERVICE OR PROCEDURE

Facility

$220.00

Service Code	HCPCS 92499
Hospital Charge Code	9400325
Hospital Revenue Code	510
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

EPSDT MUMPS VACCINE,SC

Facility

$590.75

Service Code	HCPCS 90704
Hospital Charge Code	9400350
Hospital Revenue Code	636
Min. Negotiated Rate	$88.61
Max. Negotiated Rate	$142.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.96
Rate for Payer: Qualcare PPO/HMO/WC	$88.61

Know your out-of-pocket cost for care.

All Charges