Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INFLUENZA ANTIGENT

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38476205
Hospital Revenue Code	302
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

INFLUENZA B

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38479063
Hospital Revenue Code	302
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

INFLUENZA B

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38479063
Hospital Revenue Code	302
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.91
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$13.55
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Medicare Advantage	$13.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

INFLUENZA B ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314B
Hospital Revenue Code	302
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.91
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$13.55
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Medicare Advantage	$13.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

INFLUENZA B ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

INFLUENZA INJ TRIVALENT A&B

Facility

$35.00

Service Code	HCPCS 90658
Hospital Charge Code	60629160
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

INFLUENZA INJ TRIVALENT A&B

Facility

$35.00

Service Code	HCPCS 90658
Hospital Charge Code	60629160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

INFLUENZA TRIVALENT 0.5ML INJ

Facility

$36.00

Service Code	HCPCS 90658
Hospital Charge Code	60629256
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

INFLUENZA TRIVALENT 0.5ML INJ

Facility

$36.00

Service Code	HCPCS 90658
Hospital Charge Code	60629256
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

INFLUENZA TRIVALENT(A&B) 0.5ML

Facility

$59.97

Service Code	HCPCS 90656
Hospital Charge Code	60629317
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$29.98
Rate for Payer: Aetna Commercial	$22.79
Rate for Payer: Aetna Medicare Advantage	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.29
Rate for Payer: Cigna Commercial	$29.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

INFLUENZA TRIVALENT(A&B) 0.5ML

Facility

$59.97

Service Code	HCPCS 90656
Hospital Charge Code	60629317
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

INFLUENZA TYPE A/B RNA, RT-PCR

Facility

$479.00

Service Code	HCPCS 87502
Hospital Charge Code	401387502
Hospital Revenue Code	306
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

INFLUENZA TYPE A/B RNA, RT-PCR

Facility

$479.00

Service Code	HCPCS 87502
Hospital Charge Code	401387502
Hospital Revenue Code	306
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$345.81
Rate for Payer: Aetna Commercial	$260.58
Rate for Payer: Aetna Medicare Advantage	$310.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.81
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: Cigna Medicare Advantage	$95.80
Rate for Payer: Clover Medicare Advantage	$91.01
Rate for Payer: EmblemHealth Commercial	$287.40
Rate for Payer: Humana Medicare Advantage	$98.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$76.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.80
Rate for Payer: Wellcare Medicare Advantage	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$12.69

INFLUENZA VACCINE 1994-1995

Facility

$13.00

Hospital Charge Code	6010524
Hospital Revenue Code	251
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

INFLUENZA VACCINE 1994-1995

Facility

$13.00

Hospital Charge Code	6010524
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

INFLUENZA VA PRESERVAT FREE

Facility

$107.20

Service Code	HCPCS 90656
Hospital Charge Code	83652311
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

INFLUENZA VA PRESERVAT FREE

Facility

$107.20

Service Code	HCPCS 90656
Hospital Charge Code	83652311
Hospital Revenue Code	636
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

INFLUENZA VC-NO PRE <3YR

Facility

$76.92

Service Code	HCPCS 90655
Hospital Charge Code	83652603
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$18.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

INFLUENZA VC-NO PRE <3YR

Facility

$76.92

Service Code	HCPCS 90655
Hospital Charge Code	83652603
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$38.46
Rate for Payer: Aetna Commercial	$29.23
Rate for Payer: Aetna Medicare Advantage	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.61
Rate for Payer: Cigna Commercial	$38.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

INFLUENZA VIRUS I

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315A
Hospital Revenue Code	306
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.02
Rate for Payer: Aetna Medicare Advantage	$53.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: Cigna Medicare Advantage	$16.55
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Medicare Advantage	$16.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

INFLUENZA VIRUS I

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315A
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

INFLUENZA VIRUS II

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.02
Rate for Payer: Aetna Medicare Advantage	$53.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: Cigna Medicare Advantage	$16.55
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Medicare Advantage	$16.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

INFLUENZA VIRUS II

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315B
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

INFLUENZA VIRUS VACC 0.5ML INJ

Facility

$117.00

Service Code	HCPCS 90658
Hospital Charge Code	60629090
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

INFLUENZA VIRUS VACC 0.5ML INJ

Facility

$117.00

Service Code	HCPCS 90658
Hospital Charge Code	60629090
Hospital Revenue Code	636
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

Know your out-of-pocket cost for care.

All Charges