Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS B VACCINE

Facility

$101.00

Service Code	HCPCS 90744
Hospital Charge Code	60635271
Hospital Revenue Code	636
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$24.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

HEPATITIS B VACCINE 10MCG/.5ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631544
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

HEPATITIS B VACCINE 10MCG/.5ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631544
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

HEPATITIS B VACCINE 1ML

Facility

$349.45

Hospital Charge Code	6007025
Hospital Revenue Code	250
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$52.42
Rate for Payer: Qualcare PPO/HMO/WC	$52.42

HEPATITIS B VACCINE 1ML

Facility

$349.45

Hospital Charge Code	6007025
Hospital Revenue Code	250
Min. Negotiated Rate	$8.42
Max. Negotiated Rate	$174.72
Rate for Payer: Aetna Commercial	$132.79
Rate for Payer: Aetna Medicare Advantage	$104.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.11
Rate for Payer: Cigna Commercial	$174.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.83
Rate for Payer: Oxford Commercial	$69.89
Rate for Payer: Qualcare PPO/HMO/WC	$52.42
Rate for Payer: UnitedHealthcare Commercial	$69.89
Rate for Payer: UnitedHealthcare Community & State	$8.42
Rate for Payer: Wellpoint Medicaid Managed Care	$9.26

HEPATITIS B VACCINE 20MCG/ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631545
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

HEPATITIS B VACCINE 20MCG/ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631545
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

HEPATITIS B VACCINE PED 0.5ML

Facility

$270.75

Service Code	HCPCS 90744
Hospital Charge Code	6017875
Hospital Revenue Code	636
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$65.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.52
Rate for Payer: Qualcare PPO/HMO/WC	$40.61

HEPATITIS B VACCINE PED 0.5ML

Facility

$270.75

Service Code	HCPCS 90744
Hospital Charge Code	6017875
Hospital Revenue Code	636
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$135.38
Rate for Payer: Aetna Commercial	$102.89
Rate for Payer: Aetna Medicare Advantage	$81.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.04
Rate for Payer: Cigna Commercial	$135.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.52
Rate for Payer: Qualcare PPO/HMO/WC	$40.61
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.17

HEPATITIS B VACCINE PED 5MCG

Facility

$373.12

Service Code	HCPCS 90744
Hospital Charge Code	60628646
Hospital Revenue Code	636
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$186.56
Rate for Payer: Aetna Commercial	$141.79
Rate for Payer: Aetna Medicare Advantage	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.15
Rate for Payer: Cigna Commercial	$186.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.97
Rate for Payer: UnitedHealthcare Community & State	$8.99
Rate for Payer: Wellpoint Medicaid Managed Care	$9.89

HEPATITIS B VACCINE PED 5MCG

Facility

$373.12

Service Code	HCPCS 90744
Hospital Charge Code	60628646
Hospital Revenue Code	636
Min. Negotiated Rate	$55.97
Max. Negotiated Rate	$90.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.97

HEPATITIS B VIRAL DNA AMP PRB

Facility

$383.25

Service Code	HCPCS 87516
Hospital Charge Code	3000866
Hospital Revenue Code	306
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS B VIRAL DNA AMP PRB

Facility

$383.25

Service Code	HCPCS 87516
Hospital Charge Code	3000866
Hospital Revenue Code	306
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$191.62
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	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$191.62
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	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
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	$10.16

HEPATITIS B VIRAL PCR

Facility

$390.00

Service Code	HCPCS 87517
Hospital Charge Code	39900298
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS B VIRAL PCR

Facility

$390.00

Service Code	HCPCS 87517
Hospital Charge Code	39900298
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
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	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HEPATITIS C AB

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	8200344RS
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

HEPATITIS C AB

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	8200344RS
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

HEPATITIS C AB

Facility

$141.65

Service Code	HCPCS 86803CF
Hospital Charge Code	8200345RS
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

HEPATITIS C AB

Facility

$141.65

Service Code	HCPCS 86803CF
Hospital Charge Code	8200345RS
Hospital Revenue Code	302
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

HEPATITIS C AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3007481
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

HEPATITIS C AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3006442E
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

HEPATITIS C AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3006442E
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

HEPATITIS C AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3007481
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

HEPATITIS C AB (RIBA)

Facility

$873.00

Service Code	HCPCS 86804
Hospital Charge Code	38476254
Hospital Revenue Code	302
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna Commercial	$42.13
Rate for Payer: Aetna Medicare Advantage	$50.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.91
Rate for Payer: Cigna Commercial	$436.50
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Medicare Advantage	$15.49
Rate for Payer: Wellpoint Medicaid Managed Care	$23.13

HEPATITIS C AB (RIBA)

Facility

$873.00

Service Code	HCPCS 86804
Hospital Charge Code	38476254
Hospital Revenue Code	302
Min. Negotiated Rate	$130.95
Max. Negotiated Rate	$130.95
Rate for Payer: Qualcare PPO/HMO/WC	$130.95

Know your out-of-pocket cost for care.

All Charges