Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RABIES VACCINE INJ 2.5IU/VIAL

Facility

$738.60

Hospital Charge Code	6004774
Hospital Revenue Code	250
Min. Negotiated Rate	$110.79
Max. Negotiated Rate	$110.79
Rate for Payer: Qualcare PPO/HMO/WC	$110.79

RABIES VACCINE INJ 2.5IU/VIAL

Facility

$738.60

Hospital Charge Code	6004774
Hospital Revenue Code	250
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$369.30
Rate for Payer: Aetna Commercial	$280.67
Rate for Payer: Aetna Medicare Advantage	$221.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.34
Rate for Payer: Cigna Commercial	$369.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.58
Rate for Payer: Oxford Commercial	$147.72
Rate for Payer: Qualcare PPO/HMO/WC	$110.79
Rate for Payer: UnitedHealthcare Commercial	$147.72
Rate for Payer: UnitedHealthcare Community & State	$17.80
Rate for Payer: Wellpoint Medicaid Managed Care	$19.57

RABIES VACCINE (RABAVERT)

Facility

$1,260.27

Service Code	HCPCS 90675
Hospital Charge Code	60639517
Hospital Revenue Code	636
Min. Negotiated Rate	$30.37
Max. Negotiated Rate	$1,137.85
Rate for Payer: Aetna Commercial	$857.40
Rate for Payer: Aetna Medicare Advantage	$1,021.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$315.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,137.85
Rate for Payer: Cigna Medicare Advantage	$315.22
Rate for Payer: Clover Medicare Advantage	$299.46
Rate for Payer: EmblemHealth Commercial	$945.66
Rate for Payer: Humana Medicare Advantage	$324.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$315.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.99
Rate for Payer: Qualcare PPO/HMO/WC	$189.04
Rate for Payer: UnitedHealthcare Community & State	$30.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$315.22
Rate for Payer: Wellcare Medicare Advantage	$315.22
Rate for Payer: Wellpoint Medicaid Managed Care	$33.40

RABIES VACCINE (RABAVERT)

Facility

$1,260.27

Service Code	HCPCS 90675
Hospital Charge Code	60639517
Hospital Revenue Code	636
Min. Negotiated Rate	$189.04
Max. Negotiated Rate	$304.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.99
Rate for Payer: Qualcare PPO/HMO/WC	$189.04

RABIES VACCINE (RABAVERT) EX

Facility

$2,048.26

Service Code	NDC 63851050101
Hospital Charge Code	60639517EX
Hospital Revenue Code	259
Min. Negotiated Rate	$49.36
Max. Negotiated Rate	$1,024.13
Rate for Payer: Aetna Commercial	$778.34
Rate for Payer: Aetna Medicare Advantage	$614.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.31
Rate for Payer: Cigna Commercial	$1,024.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$614.48
Rate for Payer: Oxford Commercial	$409.65
Rate for Payer: Qualcare PPO/HMO/WC	$307.24
Rate for Payer: UnitedHealthcare Commercial	$409.65
Rate for Payer: UnitedHealthcare Community & State	$49.36
Rate for Payer: Wellpoint Medicaid Managed Care	$54.28

RABIES VACCINE (RABAVERT) EX

Facility

$2,048.26

Service Code	NDC 63851050101
Hospital Charge Code	60639517EX
Hospital Revenue Code	259
Min. Negotiated Rate	$307.24
Max. Negotiated Rate	$307.24
Rate for Payer: Qualcare PPO/HMO/WC	$307.24

RACEMIC EPINEPH 2.25% ASTH

Facility

$82.00

Service Code	HCPCS J7640
Hospital Charge Code	6006316
Hospital Revenue Code	294
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

RACEMIC EPINEPH 2.25% ASTH

Facility

$82.00

Service Code	HCPCS J7640
Hospital Charge Code	6006316
Hospital Revenue Code	294
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

RACEMIC EPINEPH SOL 2.25% 15ML

Facility

$16.75

Service Code	NDC 487590199
Hospital Charge Code	60627447
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

RACEMIC EPINEPH SOL 2.25% 15ML

Facility

$16.75

Service Code	NDC 487590199
Hospital Charge Code	60627447
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

RACEPINEPHRINE SOL 2.25% 0.5ML

Facility

$5.15

Hospital Charge Code	60629190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

RACEPINEPHRINE SOL 2.25% 0.5ML

Facility

$5.15

Hospital Charge Code	60629190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna Medicare Advantage	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.31
Rate for Payer: Cigna Commercial	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.54
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

RACK F/7.3MM CANN SCREW

Facility

$1,523.35

Hospital Charge Code	270677620
Hospital Revenue Code	272
Min. Negotiated Rate	$228.50
Max. Negotiated Rate	$228.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.50

RACK F/7.3MM CANN SCREW

Facility

$1,523.35

Hospital Charge Code	270677620
Hospital Revenue Code	272
Min. Negotiated Rate	$36.71
Max. Negotiated Rate	$761.67
Rate for Payer: Aetna Commercial	$578.87
Rate for Payer: Aetna Medicare Advantage	$457.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.45
Rate for Payer: Cigna Commercial	$761.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.00
Rate for Payer: Oxford Commercial	$304.67
Rate for Payer: Qualcare PPO/HMO/WC	$228.50
Rate for Payer: UnitedHealthcare Commercial	$304.67
Rate for Payer: UnitedHealthcare Community & State	$36.71
Rate for Payer: Wellpoint Medicaid Managed Care	$40.37

RACK JURGAN PIN BALL .035****

Facility

$125.00

Hospital Charge Code	1604792
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

RACK JURGAN PIN BALL .035****

Facility

$125.00

Hospital Charge Code	1604792
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

RACK JURGAN PIN BALL .062*****

Facility

$125.00

Hospital Charge Code	1604768
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

RACK JURGAN PIN BALL .062*****

Facility

$125.00

Hospital Charge Code	1604768
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

RACK JURGAN PIN BALL 3/32****

Facility

$125.00

Hospital Charge Code	1604800
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

RACK JURGAN PIN BALL 3/32****

Facility

$125.00

Hospital Charge Code	1604800
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

RACK JURGAN PIN BALL 5/64****

Facility

$125.00

Hospital Charge Code	1604784
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

RACK JURGAN PIN BALL 5/64****

Facility

$125.00

Hospital Charge Code	1604784
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

RACK JURGAN PIN BL .045 W045**

Facility

$125.00

Hospital Charge Code	1604750
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

RACK JURGAN PIN BL .045 W045**

Facility

$125.00

Hospital Charge Code	1604750
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

RACK JURGN PIN BALL .028 W28**

Facility

$125.00

Hospital Charge Code	1604776
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

Know your out-of-pocket cost for care.

All Charges