Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMA INJ

Facility

$440.85

Service Code	HCPCS 93564
Hospital Charge Code	5100136
Hospital Revenue Code	481
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$167.52
Rate for Payer: Aetna Medicare Advantage	$132.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.42
Rate for Payer: Cigna Commercial	$220.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.13
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IMA INJ

Facility

$440.85

Service Code	HCPCS 93564
Hospital Charge Code	5100136
Hospital Revenue Code	481
Min. Negotiated Rate	$66.13
Max. Negotiated Rate	$66.13
Rate for Payer: Qualcare PPO/HMO/WC	$66.13

IMATINB MESYLATE 100MG CAPSULE

Facility

$123.00

Service Code	HCPCS J8999
Hospital Charge Code	6062947
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$46.74
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

IMATINB MESYLATE 100MG CAPSULE

Facility

$123.00

Service Code	HCPCS J8999
Hospital Charge Code	6062947
Hospital Revenue Code	636
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$29.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

IMATINIB MESYLATE 100 MG CAP

Facility

$98.45

Hospital Charge Code	60629247
Hospital Revenue Code	259
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$14.77
Rate for Payer: Qualcare PPO/HMO/WC	$14.77

IMATINIB MESYLATE 100 MG CAP

Facility

$98.45

Hospital Charge Code	60629247
Hospital Revenue Code	259
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$49.23
Rate for Payer: Aetna Commercial	$37.41
Rate for Payer: Aetna Medicare Advantage	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.10
Rate for Payer: Cigna Commercial	$49.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.54
Rate for Payer: Oxford Commercial	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$14.77
Rate for Payer: UnitedHealthcare Commercial	$19.69
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

IMDUR 120

Facility

$3.00

Hospital Charge Code	60635097
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IMDUR 120

Facility

$3.00

Hospital Charge Code	60635097
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

IMDUR 30

Facility

$4.00

Hospital Charge Code	60635096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IMDUR 30

Facility

$4.00

Hospital Charge Code	60635096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

IMDUR/60MG/TAB

Facility

$4.00

Hospital Charge Code	60634941
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IMDUR/60MG/TAB

Facility

$4.00

Hospital Charge Code	60634941
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

IMFERON/50MG/1ML

Facility

$711.00

Hospital Charge Code	60633157
Hospital Revenue Code	250
Min. Negotiated Rate	$106.65
Max. Negotiated Rate	$106.65
Rate for Payer: Qualcare PPO/HMO/WC	$106.65

IMFERON/50MG/1ML

Facility

$711.00

Hospital Charge Code	60633157
Hospital Revenue Code	250
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna Commercial	$270.18
Rate for Payer: Aetna Medicare Advantage	$213.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.31
Rate for Payer: Cigna Commercial	$355.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.30
Rate for Payer: Oxford Commercial	$142.20
Rate for Payer: Qualcare PPO/HMO/WC	$106.65
Rate for Payer: UnitedHealthcare Commercial	$142.20
Rate for Payer: UnitedHealthcare Community & State	$17.14
Rate for Payer: Wellpoint Medicaid Managed Care	$18.84

IMFERON 50MG/CC

Facility

$109.45

Hospital Charge Code	6010128
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

IMFERON 50MG/CC

Facility

$109.45

Hospital Charge Code	6010128
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

IMF SCREW 2MM SELFDRILLING12MM

Facility

$182.10

Hospital Charge Code	270628798
Hospital Revenue Code	278
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$44.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.06
Rate for Payer: Qualcare PPO/HMO/WC	$27.32

IMF SCREW 2MM SELFDRILLING12MM

Facility

$182.10

Hospital Charge Code	270628798
Hospital Revenue Code	278
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.05
Rate for Payer: Aetna Commercial	$69.20
Rate for Payer: Aetna Medicare Advantage	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.44
Rate for Payer: Cigna Commercial	$91.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.06
Rate for Payer: Qualcare PPO/HMO/WC	$27.32
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

IMF SCREW 2MM SELFDRILLING 8MM

Facility

$134.00

Hospital Charge Code	270628799
Hospital Revenue Code	278
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$32.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.48
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

IMF SCREW 2MM SELFDRILLING 8MM

Facility

$134.00

Hospital Charge Code	270628799
Hospital Revenue Code	278
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$50.92
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.48
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Community & State	$3.23
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.05
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.05
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

IM INS BREAST PROSTH S/P M

Facility

$42,601.70

Service Code	HCPCS 19340
Hospital Charge Code	16000665
Hospital Revenue Code	360
Min. Negotiated Rate	$1,016.00
Max. Negotiated Rate	$35,050.91
Rate for Payer: Aetna Commercial	$26,411.74
Rate for Payer: Aetna Medicare Advantage	$31,461.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,710.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,050.91
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: Cigna Medicare Advantage	$9,710.20
Rate for Payer: Clover Medicare Advantage	$9,224.69
Rate for Payer: EmblemHealth Commercial	$29,130.60
Rate for Payer: Humana Medicare Advantage	$10,001.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,710.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,780.51
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,026.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,710.20
Rate for Payer: Wellcare Medicare Advantage	$9,710.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,128.95

Know your out-of-pocket cost for care.

All Charges