Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMMOBILIZER SHOULDER MED

Facility

$30.00

Hospital Charge Code	270677149
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

IMMOBILIZER SHOULDER MED

Facility

$30.00

Hospital Charge Code	270677149
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER ONE SZ

Facility

$42.65

Service Code	HCPCS L3650
Hospital Charge Code	270302813
Hospital Revenue Code	274
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

IMMOBILIZER SHOULDER ONE SZ

Facility

$42.65

Service Code	HCPCS L3650
Hospital Charge Code	270302813
Hospital Revenue Code	274
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.32
Rate for Payer: Aetna Commercial	$16.21
Rate for Payer: Aetna Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.88
Rate for Payer: Cigna Commercial	$21.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.40
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

IMMOBILIZER SHOULDER SML

Facility

$30.00

Hospital Charge Code	270677148
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER SML

Facility

$30.00

Hospital Charge Code	270677148
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

IMMOBILIZER SHOULDER XL

Facility

$30.00

Hospital Charge Code	270677151
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER XL

Facility

$30.00

Hospital Charge Code	270677151
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

IMMUNE COMPETENCE

Facility

$414.45

Hospital Charge Code	3006673
Hospital Revenue Code	302
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IMMUNE COMPETENCE

Facility

$414.45

Hospital Charge Code	3006673
Hospital Revenue Code	302
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IMMUNE COMPETENCE PANEL A

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3006673A
Hospital Revenue Code	302
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

IMMUNE COMPETENCE PANEL A

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3006673A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

IMMUNE COMPETENCE PANEL B

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3006673B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

IMMUNE COMPETENCE PANEL B

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3006673B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

IMMUNE COMPLEX DETECTION(RALI

Facility

$348.00

Service Code	HCPCS 86332
Hospital Charge Code	38476216
Hospital Revenue Code	302
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$174.00
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$174.00
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$9.22

IMMUNE COMPLEX DETECTION(RALI

Facility

$348.00

Service Code	HCPCS 86332
Hospital Charge Code	38476216
Hospital Revenue Code	302
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$52.20

IMMUNE COMPLEX (RAJI CELL)

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3008307
Hospital Revenue Code	302
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

IMMUNE COMPLEX (RAJI CELL)

Facility

$105.65

Service Code	HCPCS 86332
Hospital Charge Code	3008307
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

IMMUNE GLOBULIN 10% 100ML

Facility

$4,783.80

Service Code	HCPCS J1568
Hospital Charge Code	6063943334
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$1,157.68
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.80
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,157.68
Rate for Payer: Qualcare PPO/HMO/WC	$717.57
Rate for Payer: UnitedHealthcare Community & State	$115.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$126.77

IMMUNE GLOBULIN 10% 100ML

Facility

$4,783.80

Service Code	HCPCS J1568
Hospital Charge Code	6063943334
Hospital Revenue Code	636
Min. Negotiated Rate	$717.57
Max. Negotiated Rate	$1,157.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,157.68
Rate for Payer: Qualcare PPO/HMO/WC	$717.57

IMMUNE GLOBULIN 10% 50ML

Facility

$2,391.90

Service Code	HCPCS J1568
Hospital Charge Code	6063943335
Hospital Revenue Code	636
Min. Negotiated Rate	$358.79
Max. Negotiated Rate	$578.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$578.84
Rate for Payer: Qualcare PPO/HMO/WC	$358.79

IMMUNE GLOBULIN 10% 50ML

Facility

$2,391.90

Service Code	HCPCS J1568
Hospital Charge Code	6063943335
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$578.84
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.80
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$578.84
Rate for Payer: Qualcare PPO/HMO/WC	$358.79
Rate for Payer: UnitedHealthcare Community & State	$57.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$63.39

IMMUNE GLOBULIN/10 G

Facility

$310.00

Hospital Charge Code	60634826
Hospital Revenue Code	636
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$75.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

IMMUNE GLOBULIN/10 G

Facility

$310.00

Hospital Charge Code	60634826
Hospital Revenue Code	636
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

IMMUNE GLOBULIN 1GM

Facility

$378.00

Hospital Charge Code	60635367
Hospital Revenue Code	636
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$143.64
Rate for Payer: Aetna Medicare Advantage	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.39
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Community & State	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.02

Know your out-of-pocket cost for care.

All Charges