Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ILLIAC LEG IPSILL 16x71 258365

Facility

$13,392.00

Hospital Charge Code	270632727
Hospital Revenue Code	272
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$2,008.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

ILLIAC LEG IPSILL 16x71 258365

Facility

$13,392.00

Hospital Charge Code	270632727
Hospital Revenue Code	272
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.60
Rate for Payer: Oxford Commercial	$2,678.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Commercial	$2,678.40
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

ILLIAC LIMB 10X 100MM

Facility

$23,495.00

Hospital Charge Code	270683416
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

ILLIAC LIMB 10X 100MM

Facility

$23,495.00

Hospital Charge Code	270683416
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

ILLIAC LIMB 22 X 140 MM

Facility

$23,495.00

Hospital Charge Code	270683418
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

ILLIAC LIMB 22 X 140 MM

Facility

$23,495.00

Hospital Charge Code	270683418
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

IL LMB SYS OVAT iXPMA14-28-140

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679786
Hospital Revenue Code	278
Min. Negotiated Rate	$602.38
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$602.38
Rate for Payer: Wellpoint Medicaid Managed Care	$662.37

IL LMB SYS OVAT iXPMA14-28-140

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679786
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

ILLUMINATION SYSTEM

Facility

$1,418.45

Hospital Charge Code	270706018
Hospital Revenue Code	272
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$709.23
Rate for Payer: Aetna Commercial	$539.01
Rate for Payer: Aetna Medicare Advantage	$425.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.70
Rate for Payer: Cigna Commercial	$709.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.54
Rate for Payer: Oxford Commercial	$283.69
Rate for Payer: Qualcare PPO/HMO/WC	$212.77
Rate for Payer: UnitedHealthcare Commercial	$283.69
Rate for Payer: UnitedHealthcare Community & State	$34.18
Rate for Payer: Wellpoint Medicaid Managed Care	$37.59

ILLUMINATION SYSTEM

Facility

$1,418.45

Hospital Charge Code	270706018
Hospital Revenue Code	272
Min. Negotiated Rate	$212.77
Max. Negotiated Rate	$212.77
Rate for Payer: Qualcare PPO/HMO/WC	$212.77

ILLUMINATION SYSTEM 2 BLADE

Facility

$1,418.45

Hospital Charge Code	270706019
Hospital Revenue Code	279
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$709.23
Rate for Payer: Aetna Commercial	$539.01
Rate for Payer: Aetna Medicare Advantage	$425.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.70
Rate for Payer: Cigna Commercial	$709.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.54
Rate for Payer: Oxford Commercial	$283.69
Rate for Payer: Qualcare PPO/HMO/WC	$212.77
Rate for Payer: UnitedHealthcare Commercial	$283.69
Rate for Payer: UnitedHealthcare Community & State	$34.18
Rate for Payer: Wellpoint Medicaid Managed Care	$37.59

ILLUMINATION SYSTEM 2 BLADE

Facility

$1,418.45

Hospital Charge Code	270706019
Hospital Revenue Code	279
Min. Negotiated Rate	$212.77
Max. Negotiated Rate	$212.77
Rate for Payer: Qualcare PPO/HMO/WC	$212.77

ILLUMINATOR LITMAT SURG 004804

Facility

$395.90

Hospital Charge Code	270634203
Hospital Revenue Code	272
Min. Negotiated Rate	$59.38
Max. Negotiated Rate	$59.38
Rate for Payer: Qualcare PPO/HMO/WC	$59.38

ILLUMINATOR LITMAT SURG 004804

Facility

$395.90

Hospital Charge Code	270634203
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$197.95
Rate for Payer: Aetna Commercial	$150.44
Rate for Payer: Aetna Medicare Advantage	$118.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.95
Rate for Payer: Cigna Commercial	$197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.77
Rate for Payer: Oxford Commercial	$79.18
Rate for Payer: Qualcare PPO/HMO/WC	$59.38
Rate for Payer: UnitedHealthcare Commercial	$79.18
Rate for Payer: UnitedHealthcare Community & State	$9.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.49

ILLUMINATOR POST 26MM

Facility

$3,005.00

Hospital Charge Code	270703130
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$661.10
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

ILLUMINATOR POST 26MM

Facility

$3,005.00

Hospital Charge Code	270703130
Hospital Revenue Code	278
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$661.10
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$72.42
Rate for Payer: Wellpoint Medicaid Managed Care	$79.63

ILOPAN INJECTION/250MG/1M

Facility

$51.00

Hospital Charge Code	60633154
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

ILOPAN INJECTION/250MG/1M

Facility

$51.00

Hospital Charge Code	60633154
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

ILOSONE/100MG/1ML

Facility

$122.00

Hospital Charge Code	60633155
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

ILOSONE/100MG/1ML

Facility

$122.00

Hospital Charge Code	60633155
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

ILOTYCIN OPHTH/3.5GM

Facility

$32.00

Hospital Charge Code	60633156
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ILOTYCIN OPHTH/3.5GM

Facility

$32.00

Hospital Charge Code	60633156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

ILUMYA (TILDRAKIZUMAB) 1MG/ML

Facility

$111,876.60

Service Code	HCPCS J3245
Hospital Charge Code	606390483
Hospital Revenue Code	636
Min. Negotiated Rate	$16,781.49
Max. Negotiated Rate	$27,074.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,074.14
Rate for Payer: Qualcare PPO/HMO/WC	$16,781.49

ILUMYA (TILDRAKIZUMAB) 1MG/ML

Facility

$111,876.60

Service Code	HCPCS J3245
Hospital Charge Code	606390483
Hospital Revenue Code	636
Min. Negotiated Rate	$112.29
Max. Negotiated Rate	$27,074.14
Rate for Payer: Aetna Commercial	$321.50
Rate for Payer: Aetna Medicare Advantage	$382.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.67
Rate for Payer: Cigna Medicare Advantage	$118.20
Rate for Payer: Clover Medicare Advantage	$112.29
Rate for Payer: EmblemHealth Commercial	$354.60
Rate for Payer: Humana Medicare Advantage	$121.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$118.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,074.14
Rate for Payer: Qualcare PPO/HMO/WC	$16,781.49
Rate for Payer: UnitedHealthcare Community & State	$2,696.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$118.20
Rate for Payer: Wellcare Medicare Advantage	$118.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2,964.73

IMAGE CATH FLUID COLXN VISC

Facility

$5,392.12

Service Code	HCPCS 49405
Hospital Charge Code	16000386
Hospital Revenue Code	360
Min. Negotiated Rate	$129.95
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,617.64
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$808.82
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$129.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$142.89

Know your out-of-pocket cost for care.

All Charges