Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPSDT MUMPS VACCINE,SC

Facility

$590.75

Service Code	HCPCS 90704
Hospital Charge Code	9400350
Hospital Revenue Code	636
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$295.38
Rate for Payer: Aetna Commercial	$224.49
Rate for Payer: Aetna Medicare Advantage	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.64
Rate for Payer: Cigna Commercial	$295.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.96
Rate for Payer: Qualcare PPO/HMO/WC	$88.61
Rate for Payer: UnitedHealthcare Community & State	$14.24
Rate for Payer: Wellpoint Medicaid Managed Care	$15.65

EPSDT OFFICE CONSULTATION

Facility

$335.00

Service Code	HCPCS 99241
Hospital Charge Code	9400365
Hospital Revenue Code	510
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$167.50
Rate for Payer: Aetna Commercial	$127.30
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$50.25
Rate for Payer: UnitedHealthcare Community & State	$8.07
Rate for Payer: Wellpoint Medicaid Managed Care	$8.88

EPSDT OFFICE CONSULTATION

Facility

$335.00

Service Code	HCPCS 99241
Hospital Charge Code	9400365
Hospital Revenue Code	510
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

EPSDT PNEUMOCOCCAL VACCINE

Facility

$79.40

Service Code	HCPCS 90732
Hospital Charge Code	9400355
Hospital Revenue Code	636
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$90.99
Rate for Payer: Aetna Commercial	$30.17
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

EPSDT PNEUMOCOCCAL VACCINE

Facility

$79.40

Service Code	HCPCS 90732
Hospital Charge Code	9400355
Hospital Revenue Code	636
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$19.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

EPSDT PURE TONE HEARING TEST

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	9400360
Hospital Revenue Code	471
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

EPSDT PURE TONE HEARING TEST

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	9400360
Hospital Revenue Code	471
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

EP shield, Absirbent, Scoop Fe

Facility

$143.75

Hospital Charge Code	270667572
Hospital Revenue Code	270
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$71.88
Rate for Payer: Aetna Commercial	$54.62
Rate for Payer: Aetna Medicare Advantage	$43.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.66
Rate for Payer: Cigna Commercial	$71.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.12
Rate for Payer: Oxford Commercial	$28.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.56
Rate for Payer: UnitedHealthcare Commercial	$28.75
Rate for Payer: UnitedHealthcare Community & State	$3.46
Rate for Payer: Wellpoint Medicaid Managed Care	$3.81

EP shield, Absirbent, Scoop Fe

Facility

$143.75

Hospital Charge Code	270667572
Hospital Revenue Code	270
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$21.56
Rate for Payer: Qualcare PPO/HMO/WC	$21.56

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

EPSPT PSYCH SERVICE/THERAPY

Facility

$295.70

Service Code	HCPCS 90899
Hospital Charge Code	9400320
Hospital Revenue Code	900
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.71
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.35
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$7.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.84

EPSPT PSYCH SERVICE/THERAPY

Facility

$295.70

Service Code	HCPCS 90899
Hospital Charge Code	9400320
Hospital Revenue Code	900
Min. Negotiated Rate	$44.35
Max. Negotiated Rate	$44.35
Rate for Payer: Qualcare PPO/HMO/WC	$44.35

EPSTEIN-BARR AB PROFILE

Facility

$511.25

Hospital Charge Code	3004769
Hospital Revenue Code	302
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$255.62
Rate for Payer: Aetna Commercial	$194.28
Rate for Payer: Aetna Medicare Advantage	$153.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.37
Rate for Payer: Cigna Commercial	$255.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$13.55

EPSTEIN-BARR AB PROFILE

Facility

$511.25

Hospital Charge Code	3004769
Hospital Revenue Code	302
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$76.69
Rate for Payer: Qualcare PPO/HMO/WC	$76.69

EPSTEIN BARR EA AB IGG

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004769D
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN BARR EA AB IGG

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004769D
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.36
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

EPSTEIN BARR NUCL AG AB IGG

Facility

$127.85

Service Code	HCPCS 86664
Hospital Charge Code	3004769C
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN BARR NUCL AG AB IGG

Facility

$127.85

Service Code	HCPCS 86664
Hospital Charge Code	3004769C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.19
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.58
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769A
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.58
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

Know your out-of-pocket cost for care.

All Charges