Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INFLUENZA VIRUS VACC/5ML

Facility

$99.36

Service Code	HCPCS Q2035
Hospital Charge Code	60634525
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$24.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

INFLUENZA VIRUS VACC/5ML

Facility

$99.36

Service Code	HCPCS Q2035
Hospital Charge Code	60634525
Hospital Revenue Code	636
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$49.68
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: Aetna Medicare Advantage	$29.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.34
Rate for Payer: Cigna Commercial	$49.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.63

INFLUENZA VIRUS VACCINE

Facility

$44.00

Service Code	HCPCS 90658
Hospital Charge Code	60628904
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$10.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

INFLUENZA VIRUS VACCINE

Facility

$44.00

Service Code	HCPCS 90658
Hospital Charge Code	60628904
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
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	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

INFLUENZA VIRUS VACCINE****

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	60628305
Hospital Revenue Code	259
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

INFLUENZA VIRUS VACCINE****

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	60628305
Hospital Revenue Code	259
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

INFLUENZA VIRUS VACCINE INJ

Facility

$54.00

Hospital Charge Code	6003065
Hospital Revenue Code	636
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$13.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

INFLUENZA VIRUS VACCINE INJ

Facility

$54.00

Hospital Charge Code	6003065
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

INFLUENZA VIRUS VACCINE-PEDS

Facility

$35.20

Service Code	HCPCS 90657
Hospital Charge Code	60628910
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$47.32
Rate for Payer: Aetna Commercial	$13.38
Rate for Payer: Aetna Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.98
Rate for Payer: Cigna Commercial	$17.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$5.28
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

INFLUENZA VIRUS VACCINE-PEDS

Facility

$35.20

Service Code	HCPCS 90657
Hospital Charge Code	60628910
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$8.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$5.28

INFLU PCR RFX

Facility

$704.70

Service Code	HCPCS 87502
Hospital Charge Code	3036001EX
Hospital Revenue Code	306
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$105.70
Rate for Payer: Qualcare PPO/HMO/WC	$105.70

INFLU PCR RFX

Facility

$704.70

Service Code	HCPCS 87502
Hospital Charge Code	3036001EX
Hospital Revenue Code	306
Min. Negotiated Rate	$18.67
Max. Negotiated Rate	$352.35
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	$352.35
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	$211.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.70
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	$18.67

INFLU PCR RFX 1

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$153.02
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	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$130.00
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	$78.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
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	$6.89

INFLU PCR RFX 1

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001A
Hospital Revenue Code	306
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

INFLU PCR RFX 2

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001B
Hospital Revenue Code	306
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

INFLU PCR RFX 2

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001B
Hospital Revenue Code	306
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$153.02
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	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$130.00
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	$78.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
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	$6.89

INFLUX DEMIN CORTICAL BONE FIB

Facility

$1,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270703817
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$451.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.30
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

INFLUX DEMIN CORTICAL BONE FIB

Facility

$1,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270703817
Hospital Revenue Code	278
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$932.50
Rate for Payer: Aetna Commercial	$708.70
Rate for Payer: Aetna Medicare Advantage	$559.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$475.57
Rate for Payer: Cigna Commercial	$932.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.30
Rate for Payer: Qualcare PPO/HMO/WC	$279.75
Rate for Payer: UnitedHealthcare Community & State	$44.95
Rate for Payer: Wellpoint Medicaid Managed Care	$49.42

INFLUX DEMINERALIZED CORTICAL

Facility

$6,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270703847
Hospital Revenue Code	278
Min. Negotiated Rate	$964.50
Max. Negotiated Rate	$1,556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.60
Rate for Payer: Qualcare PPO/HMO/WC	$964.50

INFLUX DEMINERALIZED CORTICAL

Facility

$910.00

Hospital Charge Code	270703472
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$220.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.20
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

INFLUX DEMINERALIZED CORTICAL

Facility

$6,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270703847
Hospital Revenue Code	278
Min. Negotiated Rate	$154.96
Max. Negotiated Rate	$3,215.00
Rate for Payer: Aetna Commercial	$2,443.40
Rate for Payer: Aetna Medicare Advantage	$1,929.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.65
Rate for Payer: Cigna Commercial	$3,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.60
Rate for Payer: Qualcare PPO/HMO/WC	$964.50
Rate for Payer: UnitedHealthcare Community & State	$154.96
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

INFLUX DEMINERALIZED CORTICAL

Facility

$910.00

Hospital Charge Code	270703472
Hospital Revenue Code	278
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$345.80
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.20
Rate for Payer: Qualcare PPO/HMO/WC	$136.50
Rate for Payer: UnitedHealthcare Community & State	$21.93
Rate for Payer: Wellpoint Medicaid Managed Care	$24.11

INFLUX PROTEIOS XL

Facility

$14,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270704461
Hospital Revenue Code	278
Min. Negotiated Rate	$354.87
Max. Negotiated Rate	$7,362.50
Rate for Payer: Aetna Commercial	$5,595.50
Rate for Payer: Aetna Medicare Advantage	$4,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,754.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,754.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,754.88
Rate for Payer: Cigna Commercial	$7,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,563.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,239.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,208.75
Rate for Payer: UnitedHealthcare Community & State	$354.87
Rate for Payer: Wellpoint Medicaid Managed Care	$390.21

INFLUX PROTEIOS XL

Facility

$14,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270704461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,208.75
Max. Negotiated Rate	$3,563.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,563.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,239.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,208.75

INFLUX SPARC 10CC

Facility

$17,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270705826
Hospital Revenue Code	279
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$2,662.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

Know your out-of-pocket cost for care.

All Charges