Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RW RATA TEQ 2 ML (ROTAVIRUS)

Facility

$168.00

Service Code	HCPCS 90680
Hospital Charge Code	84206400
Hospital Revenue Code	636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$40.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.66
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

RW RATA TEQ 2 ML (ROTAVIRUS)

Facility

$168.00

Service Code	HCPCS 90680
Hospital Charge Code	84206400
Hospital Revenue Code	636
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.66
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

RW ROCEPHIN 250MG

Facility

$12.00

Hospital Charge Code	83652633
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

RW ROCEPHIN 250MG

Facility

$12.00

Hospital Charge Code	83652633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

RW SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	87502870
Hospital Revenue Code	510
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

RW SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	87502870
Hospital Revenue Code	510
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

RW SILVER NITRATE APP

Facility

$16.00

Service Code	HCPCS 90710
Hospital Charge Code	84206390
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$25.17
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

RW SILVER NITRATE APP

Facility

$16.00

Service Code	HCPCS 90710
Hospital Charge Code	84206390
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

RW SKIN TAG REM @ ADDTL 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	87502265
Hospital Revenue Code	510
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

RW SKIN TAG REM @ ADDTL 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	87502265
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	87502155
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	84206045
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	84206045
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	87502155
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMVL @ ADD'L 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	84206050
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMVL @ ADD'L 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	84206050
Hospital Revenue Code	510
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

RW STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	84206155
Hospital Revenue Code	302
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$37.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.66
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: Cigna Medicare Advantage	$11.54
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Medicare Advantage	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

RW STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	84206155
Hospital Revenue Code	302
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

RW TDAP > 7 YRS

Facility

$181.15

Service Code	HCPCS 90715
Hospital Charge Code	87502860
Hospital Revenue Code	636
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$68.84
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

RW TDAP > 7 YRS

Facility

$181.15

Service Code	HCPCS 90715
Hospital Charge Code	87502860
Hospital Revenue Code	636
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$43.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	84206280
Hospital Revenue Code	471
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	87502270
Hospital Revenue Code	471
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.20
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$4.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	84206280
Hospital Revenue Code	471
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.20
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$4.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	87502270
Hospital Revenue Code	471
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

RW URINALYSIS ,DIP STICK TAB

Facility

$40.00

Service Code	HCPCS 81002
Hospital Charge Code	84206135
Hospital Revenue Code	307
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges