Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3046M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3500M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3047M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3047M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3050M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3082M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3950M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3950M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3034M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3042M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3246M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3190M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3240M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3500M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3248M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	4229M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3246M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3121M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3043M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3049M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3043M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3190M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3237M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3237M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3037M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

Know your out-of-pocket cost for care.

All Charges