Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B PERTUSSIS IGG/M/A AB II

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$65.83
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

B PERTUSSIS IGG/M/A AB II

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.75
Max. Negotiated Rate	$19.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.75

B PERTUSSIS IGG/M/A AB III

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$65.83
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

B PERTUSSIS IGG/M/A AB III

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075C
Hospital Revenue Code	302
Min. Negotiated Rate	$19.75
Max. Negotiated Rate	$19.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.75

BPSY NDLE FRNSEN LUNG 22CM10CM

Facility

$24.35

Hospital Charge Code	270658318
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

BPSY NDLE FRNSEN LUNG 22CM10CM

Facility

$24.35

Hospital Charge Code	270658318
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$9.25
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Oxford Commercial	$4.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

BPSY NDLE FRNSEN LUNG 22CM15CM

Facility

$24.35

Hospital Charge Code	270658320
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$9.25
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Oxford Commercial	$4.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

BPSY NDLE FRNSEN LUNG 22CM15CM

Facility

$24.35

Hospital Charge Code	270658320
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

B.QUINTANA

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072B
Hospital Revenue Code	300
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$35.33
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

B.QUINTANA

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072B
Hospital Revenue Code	300
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$70.22
Max. Negotiated Rate	$1,456.80
Rate for Payer: Aetna Commercial	$1,107.17
Rate for Payer: Aetna Medicare Advantage	$874.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.97
Rate for Payer: Cigna Commercial	$1,456.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.04
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$70.22
Rate for Payer: Wellpoint Medicaid Managed Care	$77.21

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$3,595.35
Rate for Payer: Aetna Commercial	$2,732.47
Rate for Payer: Aetna Medicare Advantage	$2,157.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,833.63
Rate for Payer: Cigna Commercial	$3,595.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,157.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$173.30
Rate for Payer: Wellpoint Medicaid Managed Care	$190.55

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$1,078.61
Max. Negotiated Rate	$1,078.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$437.04
Max. Negotiated Rate	$437.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.04

BRACE AIR STIRRUP ******

Facility

$158.00

Hospital Charge Code	8003063
Hospital Revenue Code	279
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

Know your out-of-pocket cost for care.

All Charges