Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RW URINALYSIS ,DIP STICK TAB

Facility

$40.00

Service Code	HCPCS 81002
Hospital Charge Code	84206135
Hospital Revenue Code	307
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

RW URINALYSIS, DIP STICK TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502320
Hospital Revenue Code	307
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RW URINALYSIS, DIP STICK TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502320
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	84206140
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	87502325
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	87502325
Hospital Revenue Code	307
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.08
Rate for Payer: Cigna Commercial	$207.20
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	84206140
Hospital Revenue Code	307
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.08
Rate for Payer: Cigna Commercial	$207.20
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

RW VARICELLA

Facility

$504.00

Service Code	HCPCS 90716
Hospital Charge Code	87502856
Hospital Revenue Code	636
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$121.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.97
Rate for Payer: Qualcare PPO/HMO/WC	$75.60

RW VARICELLA

Facility

$504.00

Service Code	HCPCS 90716
Hospital Charge Code	87502856
Hospital Revenue Code	636
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna Commercial	$191.52
Rate for Payer: Aetna Medicare Advantage	$151.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.52
Rate for Payer: Cigna Commercial	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.97
Rate for Payer: Qualcare PPO/HMO/WC	$75.60
Rate for Payer: UnitedHealthcare Community & State	$12.15
Rate for Payer: Wellpoint Medicaid Managed Care	$13.36

RW VARIVAX (VARICELA) VIAL

Facility

$185.00

Service Code	HCPCS 90716
Hospital Charge Code	84206205
Hospital Revenue Code	636
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$44.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

RW VARIVAX (VARICELA) VIAL

Facility

$185.00

Service Code	HCPCS 90716
Hospital Charge Code	84206205
Hospital Revenue Code	636
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$160.26
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

RW VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502335
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

RW VENIPUNCTURE

Facility

$390.00

Service Code	HCPCS 36415
Hospital Charge Code	84206095
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW VENIPUNCTURE

Facility

$390.00

Service Code	HCPCS 36415
Hospital Charge Code	84206095
Hospital Revenue Code	300
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RW VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502335
Hospital Revenue Code	300
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$67.90
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

RW VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	87502885
Hospital Revenue Code	300
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

RW VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	87502885
Hospital Revenue Code	300
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	84206305
Hospital Revenue Code	920
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	87502001
Hospital Revenue Code	920
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	84206305
Hospital Revenue Code	920
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	87502001
Hospital Revenue Code	920
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

RW ZOSTER (SHINGLES) VAC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	87502855
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RW ZOSTER (SHINGLES) VAC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	87502855
Hospital Revenue Code	636
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

RW ZOSTER (SHINGLES) VACC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	84206215
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RW ZOSTER (SHINGLES) VACC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	84206215
Hospital Revenue Code	636
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

Know your out-of-pocket cost for care.

All Charges