Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VABGUARD DCM TIBILA BEARING 16

Facility

$12,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270665906
Hospital Revenue Code	278
Min. Negotiated Rate	$302.82
Max. Negotiated Rate	$6,282.50
Rate for Payer: Aetna Commercial	$4,774.70
Rate for Payer: Aetna Medicare Advantage	$3,769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,204.07
Rate for Payer: Cigna Commercial	$6,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,764.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75
Rate for Payer: UnitedHealthcare Community & State	$302.82
Rate for Payer: Wellpoint Medicaid Managed Care	$332.97

VABGUARD DCM TIBILA BEARING 16

Facility

$12,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270665906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$3,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,764.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

VACC ADMIN < 18 YRS EA ADD VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	87502705
Hospital Revenue Code	771
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

VACC ADMIN < 18 YRS EA ADD VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	87502705
Hospital Revenue Code	771
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

VACC ADMIN < 18 YRS INIT VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	87502700
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

VACC ADMIN < 18 YRS INIT VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	87502700
Hospital Revenue Code	771
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

VACCESS POWER POR 8FR

Facility

$1,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270653938
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

VACCESS POWER POR 8FR

Facility

$1,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270653938
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

VACCINE ADMIN EA ADDL

Facility

$156.00

Service Code	HCPCS 90472
Hospital Charge Code	3408015
Hospital Revenue Code	771
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

VACCINE ADMIN EA ADDL

Facility

$156.00

Service Code	HCPCS 90472
Hospital Charge Code	3408015
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	100143
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	100143
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93500184
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	8200501
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	8200501
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93950063
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93950063
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83652297
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83652297
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$65.00

Service Code	HCPCS 90472
Hospital Charge Code	84206175
Hospital Revenue Code	771
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	5700810
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83090030
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83090030
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93500184
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	87502255
Hospital Revenue Code	771
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$33.85
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.72
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

Know your out-of-pocket cost for care.

All Charges