Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IGM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38479417
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

IgM, Mycoplasma pneumoniae

Facility

$79.19

Service Code	HCPCS 21130
Hospital Charge Code	3000079
Hospital Revenue Code	306
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.09
Rate for Payer: Aetna Medicare Advantage	$23.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.19
Rate for Payer: Cigna Commercial	$39.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

IgM, Mycoplasma pneumoniae

Facility

$79.19

Service Code	HCPCS 21130
Hospital Charge Code	3000079
Hospital Revenue Code	306
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

I-KNIFE II 15 DEGREE 5MM

Facility

$35.50

Hospital Charge Code	270655016
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.75
Rate for Payer: Aetna Commercial	$13.49
Rate for Payer: Aetna Medicare Advantage	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.05
Rate for Payer: Cigna Commercial	$17.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Oxford Commercial	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.33
Rate for Payer: UnitedHealthcare Commercial	$7.10
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

I-KNIFE II 15 DEGREE 5MM

Facility

$35.50

Hospital Charge Code	270655016
Hospital Revenue Code	272
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$5.33

IL ABC BLOOD GAS CONTROLS

Facility

$25.00

Hospital Charge Code	270331754
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

IL ABC BLOOD GAS CONTROLS

Facility

$25.00

Hospital Charge Code	270331754
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

ILETIN II NPH(PORK)/100U

Facility

$122.00

Hospital Charge Code	60633152
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

ILETIN II NPH(PORK)/100U

Facility

$122.00

Hospital Charge Code	60633152
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

ILETIN II REGULAR(PORK)/1

Facility

$122.00

Hospital Charge Code	60633153
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

ILETIN II REGULAR(PORK)/1

Facility

$122.00

Hospital Charge Code	60633153
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

ILETIN I NPH/100U/1ML

Facility

$71.00

Hospital Charge Code	60633150
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

ILETIN I NPH/100U/1ML

Facility

$71.00

Hospital Charge Code	60633150
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ILETIN I ULTRALENTE/100U

Facility

$71.00

Hospital Charge Code	60633151
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

ILETIN I ULTRALENTE/100U

Facility

$71.00

Hospital Charge Code	60633151
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

ILIAC ART ANGIO W CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	4046G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$683.04
Max. Negotiated Rate	$683.04
Rate for Payer: Qualcare PPO/HMO/WC	$683.04

ILIAC ART ANGIO W CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	4046G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$2,276.80
Rate for Payer: Aetna Commercial	$1,730.37
Rate for Payer: Aetna Medicare Advantage	$1,366.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,161.17
Rate for Payer: Cigna Commercial	$2,276.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,366.08
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$683.04
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$109.74
Rate for Payer: Wellpoint Medicaid Managed Care	$120.67

ILIAC CREST WEDGE 2.5

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270663599
Hospital Revenue Code	278
Min. Negotiated Rate	$814.50
Max. Negotiated Rate	$1,314.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,194.60
Rate for Payer: Qualcare PPO/HMO/WC	$814.50

ILIAC CREST WEDGE 2.5

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270663599
Hospital Revenue Code	278
Min. Negotiated Rate	$130.86
Max. Negotiated Rate	$2,715.00
Rate for Payer: Aetna Commercial	$2,063.40
Rate for Payer: Aetna Medicare Advantage	$1,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,384.65
Rate for Payer: Cigna Commercial	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,194.60
Rate for Payer: Qualcare PPO/HMO/WC	$814.50
Rate for Payer: UnitedHealthcare Community & State	$130.86
Rate for Payer: Wellpoint Medicaid Managed Care	$143.90

ILIAC EXTENSION 14X18X100mm 14

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270680532
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC EXTENSION 14X18X100mm 14

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270680532
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

Know your out-of-pocket cost for care.

All Charges