Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNE GLOBULIN 1GM

Facility

$378.00

Hospital Charge Code	60635367
Hospital Revenue Code	636
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$91.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

IMMUNE GLOBULIN/2.5GM

Facility

$1,032.00

Hospital Charge Code	60634512
Hospital Revenue Code	636
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$392.16
Rate for Payer: Aetna Medicare Advantage	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.16
Rate for Payer: Cigna Commercial	$516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.74
Rate for Payer: Qualcare PPO/HMO/WC	$154.80
Rate for Payer: UnitedHealthcare Community & State	$24.87
Rate for Payer: Wellpoint Medicaid Managed Care	$27.35

IMMUNE GLOBULIN/2.5GM

Facility

$1,032.00

Hospital Charge Code	60634512
Hospital Revenue Code	636
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$249.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.74
Rate for Payer: Qualcare PPO/HMO/WC	$154.80

IMMUNE GLOBULIN 2ML 1M

Facility

$112.00

Hospital Charge Code	60629094
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.10
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

IMMUNE GLOBULIN 2ML 1M

Facility

$112.00

Hospital Charge Code	60629094
Hospital Revenue Code	636
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$27.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.10
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

IMMUNE GLOBULIN/5GM

Facility

$1,892.00

Hospital Charge Code	60634513
Hospital Revenue Code	636
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$946.00
Rate for Payer: Aetna Commercial	$718.96
Rate for Payer: Aetna Medicare Advantage	$567.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$482.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$482.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$482.46
Rate for Payer: Cigna Commercial	$946.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.86
Rate for Payer: Qualcare PPO/HMO/WC	$283.80
Rate for Payer: UnitedHealthcare Community & State	$45.60
Rate for Payer: Wellpoint Medicaid Managed Care	$50.14

IMMUNE GLOBULIN/5GM

Facility

$1,892.00

Hospital Charge Code	60634513
Hospital Revenue Code	636
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$457.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.86
Rate for Payer: Qualcare PPO/HMO/WC	$283.80

IMMUNE GLOBULIN INJ 10ML

Facility

$22.00

Hospital Charge Code	6002620
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

IMMUNE GLOBULIN INJ 10ML

Facility

$22.00

Hospital Charge Code	6002620
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$4.40
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

IMMUNE GLOBULIN INJ 2ML

Facility

$52.00

Hospital Charge Code	6002612
Hospital Revenue Code	259
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

IMMUNE GLOBULIN INJ 2ML

Facility

$52.00

Hospital Charge Code	6002612
Hospital Revenue Code	259
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

IMMUNE GLOBULIN INJ IM

Facility

$2,912.00

Hospital Charge Code	60628288
Hospital Revenue Code	250
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$1,456.00
Rate for Payer: Aetna Commercial	$1,106.56
Rate for Payer: Aetna Medicare Advantage	$873.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.56
Rate for Payer: Cigna Commercial	$1,456.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$873.60
Rate for Payer: Oxford Commercial	$582.40
Rate for Payer: Qualcare PPO/HMO/WC	$436.80
Rate for Payer: UnitedHealthcare Commercial	$582.40
Rate for Payer: UnitedHealthcare Community & State	$70.18
Rate for Payer: Wellpoint Medicaid Managed Care	$77.17

IMMUNE GLOBULIN INJ IM

Facility

$2,912.00

Hospital Charge Code	60628288
Hospital Revenue Code	250
Min. Negotiated Rate	$436.80
Max. Negotiated Rate	$436.80
Rate for Payer: Qualcare PPO/HMO/WC	$436.80

IMMUNE GLOBULIN VL 10GM

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	6010516
Hospital Revenue Code	636
Min. Negotiated Rate	$1,058.85
Max. Negotiated Rate	$1,708.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,708.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,058.85

IMMUNE GLOBULIN VL 10GM

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	6010516
Hospital Revenue Code	636
Min. Negotiated Rate	$170.12
Max. Negotiated Rate	$3,529.50
Rate for Payer: Aetna Commercial	$2,682.42
Rate for Payer: Aetna Medicare Advantage	$2,117.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,800.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,800.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,800.05
Rate for Payer: Cigna Commercial	$3,529.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,708.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,058.85
Rate for Payer: UnitedHealthcare Community & State	$170.12
Rate for Payer: Wellpoint Medicaid Managed Care	$187.06

IMMUNE GLOBULIN VL 12.5GM

Facility

$1,362.00

Hospital Charge Code	6006985
Hospital Revenue Code	251
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$204.30
Rate for Payer: Qualcare PPO/HMO/WC	$204.30

IMMUNE GLOBULIN VL 12.5GM

Facility

$1,362.00

Hospital Charge Code	6006985
Hospital Revenue Code	251
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$681.00
Rate for Payer: Aetna Commercial	$517.56
Rate for Payer: Aetna Medicare Advantage	$408.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.31
Rate for Payer: Cigna Commercial	$681.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.60
Rate for Payer: Oxford Commercial	$272.40
Rate for Payer: Qualcare PPO/HMO/WC	$204.30
Rate for Payer: UnitedHealthcare Commercial	$272.40
Rate for Payer: UnitedHealthcare Community & State	$32.82
Rate for Payer: Wellpoint Medicaid Managed Care	$36.09

IMMUNE GLOBULIN VL 5GM

Facility

$761.00

Hospital Charge Code	6000319
Hospital Revenue Code	251
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$380.50
Rate for Payer: Aetna Commercial	$289.18
Rate for Payer: Aetna Medicare Advantage	$228.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.06
Rate for Payer: Cigna Commercial	$380.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.30
Rate for Payer: Oxford Commercial	$152.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.15
Rate for Payer: UnitedHealthcare Commercial	$152.20
Rate for Payer: UnitedHealthcare Community & State	$18.34
Rate for Payer: Wellpoint Medicaid Managed Care	$20.17

IMMUNE GLOBULIN VL 5GM

Facility

$761.00

Hospital Charge Code	6000319
Hospital Revenue Code	251
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$114.15
Rate for Payer: Qualcare PPO/HMO/WC	$114.15

IMMUNFIX E-PHORSIS/URINE/CSF

Facility

$390.00

Service Code	HCPCS 86335
Hospital Charge Code	401086335
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$79.83
Rate for Payer: Aetna Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$29.35
Rate for Payer: Clover Medicare Advantage	$27.88
Rate for Payer: EmblemHealth Commercial	$88.05
Rate for Payer: Humana Medicare Advantage	$30.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.35
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	$23.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.35
Rate for Payer: Wellcare Medicare Advantage	$29.35
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

IMMUNFIX E-PHORSIS/URINE/CSF

Facility

$390.00

Service Code	HCPCS 86335
Hospital Charge Code	401086335
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNIZA ADMIN-INTRANASAL ORAL

Facility

$201.60

Service Code	HCPCS 90473
Hospital Charge Code	260123
Hospital Revenue Code	771
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$308.77
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.24
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$4.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$5.34

IMMUNIZA ADMIN-INTRANASAL ORAL

Facility

$201.60

Service Code	HCPCS 90473
Hospital Charge Code	260123
Hospital Revenue Code	771
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$30.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.24

IMMUNIZATION ADM THROUG 18YRS

Facility

$55.00

Service Code	HCPCS 90460
Hospital Charge Code	5780270
Hospital Revenue Code	771
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

IMMUNIZATION ADM THROUG 18YRS

Facility

$55.00

Service Code	HCPCS 90460
Hospital Charge Code	5780270
Hospital Revenue Code	771
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

Know your out-of-pocket cost for care.

All Charges