Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIRACEFT 250MG TABS

Facility

$21.00

Hospital Charge Code	60635141
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

VIRACEPT 625MG TAB

Facility

$65.26

Service Code	NDC 63010002770
Hospital Charge Code	60635517
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.63
Rate for Payer: Aetna Commercial	$24.80
Rate for Payer: Aetna Medicare Advantage	$19.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.64
Rate for Payer: Cigna Commercial	$32.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.58
Rate for Payer: Oxford Commercial	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.79
Rate for Payer: UnitedHealthcare Commercial	$13.05
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

VIRACEPT 625MG TAB

Facility

$65.26

Service Code	NDC 63010002770
Hospital Charge Code	60635517
Hospital Revenue Code	250
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$9.79
Rate for Payer: Qualcare PPO/HMO/WC	$9.79

VIRAL CULTURE

Facility

$489.00

Service Code	HCPCS 87250
Hospital Charge Code	38475053
Hospital Revenue Code	309
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$244.50
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$244.50
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$12.96

VIRAL CULTURE

Facility

$489.00

Service Code	HCPCS 87250
Hospital Charge Code	38475053
Hospital Revenue Code	309
Min. Negotiated Rate	$73.35
Max. Negotiated Rate	$73.35
Rate for Payer: Qualcare PPO/HMO/WC	$73.35

VIRAL CULTURE, RAPID FLU A/B I

Facility

$24.95

Service Code	HCPCS 87254
Hospital Charge Code	3038084A
Hospital Revenue Code	309
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$12.47
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.74
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

VIRAL CULTURE, RAPID FLU A/B I

Facility

$24.95

Service Code	HCPCS 87254
Hospital Charge Code	3038084B
Hospital Revenue Code	309
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.61
Rate for Payer: Cigna Commercial	$12.47
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.74
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

VIRAL CULTURE, RAPID FLU A/B I

Facility

$24.95

Service Code	HCPCS 87254
Hospital Charge Code	3038084B
Hospital Revenue Code	309
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.74

VIRAL CULTURE, RAPID FLU A/B I

Facility

$24.95

Service Code	HCPCS 87254
Hospital Charge Code	3038084A
Hospital Revenue Code	309
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.74

VIRAL ILLNESS

Facility

$20,377.58

Service Code	APR-DRG 7234
Min. Negotiated Rate	$19,978.02
Max. Negotiated Rate	$20,377.58
Rate for Payer: UnitedHealthcare Community & State	$19,978.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,377.58
Rate for Payer: Wellpoint Medicaid Managed Care	$19,978.02

VIRAL ILLNESS

Facility

$9,779.62

Service Code	APR-DRG 7233
Min. Negotiated Rate	$9,587.86
Max. Negotiated Rate	$9,779.62
Rate for Payer: UnitedHealthcare Community & State	$9,587.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,779.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9,587.86

VIRAL ILLNESS

Facility

$4,593.63

Service Code	APR-DRG 7231
Min. Negotiated Rate	$4,503.56
Max. Negotiated Rate	$4,593.63
Rate for Payer: UnitedHealthcare Community & State	$4,503.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,593.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4,503.56

VIRAL ILLNESS

Facility

$6,393.74

Service Code	APR-DRG 7232
Min. Negotiated Rate	$6,268.37
Max. Negotiated Rate	$6,393.74
Rate for Payer: UnitedHealthcare Community & State	$6,268.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,393.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6,268.37

VIRAL ILLNESS WITH MCC

Facility

$50,561.60

Service Code	MSDRG 865
Min. Negotiated Rate	$15,395.36
Max. Negotiated Rate	$50,561.60
Rate for Payer: Aetna Commercial	$34,998.92
Rate for Payer: Aetna Medicare Advantage	$50,561.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,205.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,148.04
Rate for Payer: Cigna Commercial	$28,039.19
Rate for Payer: Cigna Medicare Advantage	$16,205.64
Rate for Payer: Clover Medicare Advantage	$15,395.36
Rate for Payer: EmblemHealth Commercial	$48,616.92
Rate for Payer: Humana Medicare Advantage	$16,691.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,205.64
Rate for Payer: Oxford Commercial	$20,152.13
Rate for Payer: UnitedHealthcare Commercial	$35,337.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,205.64
Rate for Payer: Wellcare Medicare Advantage	$16,205.64

VIRAL ILLNESS WITHOUT MCC

Facility

$30,241.01

Service Code	MSDRG 866
Min. Negotiated Rate	$9,208.00
Max. Negotiated Rate	$30,241.01
Rate for Payer: Aetna Commercial	$21,036.36
Rate for Payer: Aetna Medicare Advantage	$30,241.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,692.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,400.12
Rate for Payer: Cigna Commercial	$16,273.69
Rate for Payer: Cigna Medicare Advantage	$9,692.63
Rate for Payer: Clover Medicare Advantage	$9,208.00
Rate for Payer: EmblemHealth Commercial	$29,077.89
Rate for Payer: Humana Medicare Advantage	$9,983.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,692.63
Rate for Payer: Oxford Commercial	$11,696.12
Rate for Payer: UnitedHealthcare Commercial	$20,509.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,692.63
Rate for Payer: Wellcare Medicare Advantage	$9,692.63

VIRAL MENINGITIS

Facility

$6,052.85

Service Code	APR-DRG 0511
Min. Negotiated Rate	$5,934.17
Max. Negotiated Rate	$6,052.85
Rate for Payer: UnitedHealthcare Community & State	$5,934.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,052.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5,934.17

VIRAL MENINGITIS

Facility

$8,989.31

Service Code	APR-DRG 0512
Min. Negotiated Rate	$8,813.05
Max. Negotiated Rate	$8,989.31
Rate for Payer: UnitedHealthcare Community & State	$8,813.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,989.31
Rate for Payer: Wellpoint Medicaid Managed Care	$8,813.05

VIRAL MENINGITIS

Facility

$15,197.95

Service Code	APR-DRG 0513
Min. Negotiated Rate	$14,899.95
Max. Negotiated Rate	$15,197.95
Rate for Payer: UnitedHealthcare Community & State	$14,899.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,197.95
Rate for Payer: Wellpoint Medicaid Managed Care	$14,899.95

VIRAL MENINGITIS

Facility

$27,787.55

Service Code	APR-DRG 0514
Min. Negotiated Rate	$27,242.70
Max. Negotiated Rate	$27,787.55
Rate for Payer: UnitedHealthcare Community & State	$27,242.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,787.55
Rate for Payer: Wellpoint Medicaid Managed Care	$27,242.70

VIRAL MENINGITIS WITH CC/MCC

Facility

$64,110.85

Service Code	MSDRG 075
Min. Negotiated Rate	$19,520.93
Max. Negotiated Rate	$64,110.85
Rate for Payer: Aetna Medicare Advantage	$64,110.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,428.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,428.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,548.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,428.51
Rate for Payer: Cigna Commercial	$35,884.10
Rate for Payer: Cigna Medicare Advantage	$20,548.35
Rate for Payer: Clover Medicare Advantage	$19,520.93
Rate for Payer: EmblemHealth Commercial	$61,645.05
Rate for Payer: Humana Medicare Advantage	$21,164.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,548.35
Rate for Payer: Oxford Commercial	$25,790.38
Rate for Payer: UnitedHealthcare Commercial	$45,224.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,548.35
Rate for Payer: Wellcare Medicare Advantage	$20,548.35

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$28,805.93

Service Code	MSDRG 076
Min. Negotiated Rate	$8,771.04
Max. Negotiated Rate	$28,805.93
Rate for Payer: Aetna Medicare Advantage	$28,805.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,232.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,400.12
Rate for Payer: Cigna Commercial	$14,013.04
Rate for Payer: Cigna Medicare Advantage	$9,232.67
Rate for Payer: Clover Medicare Advantage	$8,771.04
Rate for Payer: EmblemHealth Commercial	$27,698.01
Rate for Payer: Humana Medicare Advantage	$9,509.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,232.67
Rate for Payer: Oxford Commercial	$10,071.36
Rate for Payer: UnitedHealthcare Commercial	$17,660.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,232.67
Rate for Payer: Wellcare Medicare Advantage	$9,232.67

VIRAL RESP DFA SCREEN W/ REFLX

Facility

$183.25

Service Code	HCPCS 87299
Hospital Charge Code	3006773
Hospital Revenue Code	309
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$27.49
Rate for Payer: Qualcare PPO/HMO/WC	$27.49

VIRAL RESP DFA SCREEN W/ REFLX

Facility

$183.25

Service Code	HCPCS 87299
Hospital Charge Code	3006773
Hospital Revenue Code	309
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.79
Rate for Payer: Aetna Medicare Advantage	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.12
Rate for Payer: Cigna Commercial	$91.62
Rate for Payer: Cigna Medicare Advantage	$16.10
Rate for Payer: Clover Medicare Advantage	$15.29
Rate for Payer: EmblemHealth Commercial	$48.30
Rate for Payer: Humana Medicare Advantage	$16.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.10
Rate for Payer: Wellcare Medicare Advantage	$16.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.86

VIRAMUNE 200MG TAB

Facility

$72.63

Service Code	NDC 51991033106
Hospital Charge Code	60635185
Hospital Revenue Code	250
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.89

VIRAMUNE 200MG TAB

Facility

$72.63

Service Code	NDC 51991033106
Hospital Charge Code	60635185
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$36.31
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$21.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.52
Rate for Payer: Cigna Commercial	$36.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.79
Rate for Payer: Oxford Commercial	$14.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.89
Rate for Payer: UnitedHealthcare Commercial	$14.53
Rate for Payer: UnitedHealthcare Community & State	$1.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

Know your out-of-pocket cost for care.

All Charges