Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MODERNACOV19BIVALADLDOSEADMADT

Facility

$50.00

Service Code	HCPCS 0134A
Hospital Charge Code	39500134A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COV19 VAC 100MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91301
Hospital Charge Code	606390387
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNA COV19 VAC 100MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91301
Hospital Charge Code	606390387
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MODERNA COV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0094A
Hospital Charge Code	39500094A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0094A
Hospital Charge Code	39500094A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNACOV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0064A
Hospital Charge Code	39500064A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNACOV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0064A
Hospital Charge Code	39500064A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0011A
Hospital Charge Code	39500011A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNA COVID19 VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0011A
Hospital Charge Code	39500011A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0012A
Hospital Charge Code	39500012A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNA COVID19 VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0012A
Hospital Charge Code	39500012A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0013A
Hospital Charge Code	39500013A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MODERNA COVID19 VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0013A
Hospital Charge Code	39500013A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	40100064A
Hospital Revenue Code	771
Min. Negotiated Rate	$21.81
Max. Negotiated Rate	$21.81
Rate for Payer: Qualcare PPO/HMO/WC	$21.81

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	40100064A
Hospital Revenue Code	771
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$55.24
Rate for Payer: Aetna Medicare Advantage	$43.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.07
Rate for Payer: Cigna Commercial	$72.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.61
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.81
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3.85

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	31700064A
Hospital Revenue Code	771
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$55.24
Rate for Payer: Aetna Medicare Advantage	$43.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.07
Rate for Payer: Cigna Commercial	$72.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.61
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.81
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3.85

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	31700064A
Hospital Revenue Code	771
Min. Negotiated Rate	$21.81
Max. Negotiated Rate	$21.81
Rate for Payer: Qualcare PPO/HMO/WC	$21.81

MOD HAND INSERTER

Facility

$3,756.00

Hospital Charge Code	270656690
Hospital Revenue Code	272
Min. Negotiated Rate	$90.52
Max. Negotiated Rate	$1,878.00
Rate for Payer: Aetna Commercial	$1,427.28
Rate for Payer: Aetna Medicare Advantage	$1,126.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$957.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$957.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$957.78
Rate for Payer: Cigna Commercial	$1,878.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,126.80
Rate for Payer: Oxford Commercial	$751.20
Rate for Payer: Qualcare PPO/HMO/WC	$563.40
Rate for Payer: UnitedHealthcare Commercial	$751.20
Rate for Payer: UnitedHealthcare Community & State	$90.52
Rate for Payer: Wellpoint Medicaid Managed Care	$99.53

MOD HAND INSERTER

Facility

$3,756.00

Hospital Charge Code	270656690
Hospital Revenue Code	272
Min. Negotiated Rate	$563.40
Max. Negotiated Rate	$563.40
Rate for Payer: Qualcare PPO/HMO/WC	$563.40

MOD HEAD-VARIABLE ONSET 42X21X

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Charge Code	270705538
Hospital Revenue Code	278
Min. Negotiated Rate	$42.20
Max. Negotiated Rate	$875.50
Rate for Payer: Aetna Commercial	$665.38
Rate for Payer: Aetna Medicare Advantage	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.50
Rate for Payer: Cigna Commercial	$875.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.22
Rate for Payer: Qualcare PPO/HMO/WC	$262.65
Rate for Payer: UnitedHealthcare Community & State	$42.20
Rate for Payer: Wellpoint Medicaid Managed Care	$46.40

MOD HEAD-VARIABLE ONSET 42X21X

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Charge Code	270705538
Hospital Revenue Code	278
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$423.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.22
Rate for Payer: Qualcare PPO/HMO/WC	$262.65

MOD HOOK 4FR 65CM

Facility

$58.50

Hospital Charge Code	270657618N
Hospital Revenue Code	272
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$8.78
Rate for Payer: Qualcare PPO/HMO/WC	$8.78

MOD HOOK 4FR 65CM

Facility

$558.50

Hospital Charge Code	270657618S
Hospital Revenue Code	272
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$279.25
Rate for Payer: Aetna Commercial	$212.23
Rate for Payer: Aetna Medicare Advantage	$167.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.42
Rate for Payer: Cigna Commercial	$279.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.55
Rate for Payer: Oxford Commercial	$111.70
Rate for Payer: Qualcare PPO/HMO/WC	$83.78
Rate for Payer: UnitedHealthcare Commercial	$111.70
Rate for Payer: UnitedHealthcare Community & State	$13.46
Rate for Payer: Wellpoint Medicaid Managed Care	$14.80

MOD HOOK 4FR 65CM

Facility

$558.50

Hospital Charge Code	270657618S
Hospital Revenue Code	272
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$83.78
Rate for Payer: Qualcare PPO/HMO/WC	$83.78

MOD HOOK 4FR 65CM

Facility

$58.50

Hospital Charge Code	270657618N
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$22.23
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.92
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.78
Rate for Payer: UnitedHealthcare Commercial	$11.70
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

Know your out-of-pocket cost for care.

All Charges