Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Immunoglobulin E

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888029
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOGLOBULIN E (IgE)

Facility

$390.00

Service Code	HCPCS 82785
Hospital Charge Code	401182785
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOGLOBULIN E (IgE)

Facility

$390.00

Service Code	HCPCS 82785
Hospital Charge Code	401182785
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.77
Rate for Payer: Aetna Medicare Advantage	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.46
Rate for Payer: Clover Medicare Advantage	$15.64
Rate for Payer: EmblemHealth Commercial	$49.38
Rate for Payer: Humana Medicare Advantage	$16.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.46
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	$13.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.46
Rate for Payer: Wellcare Medicare Advantage	$16.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

IMMUNOGLOBULIN E (IGE)

Facility

$91.25

Service Code	HCPCS 82785
Hospital Charge Code	3004736
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.77
Rate for Payer: Aetna Medicare Advantage	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$16.46
Rate for Payer: Clover Medicare Advantage	$15.64
Rate for Payer: EmblemHealth Commercial	$49.38
Rate for Payer: Humana Medicare Advantage	$16.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.46
Rate for Payer: Wellcare Medicare Advantage	$16.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

IMMUNOGLOBULIN E (IGE)

Facility

$91.25

Service Code	HCPCS 82785
Hospital Charge Code	3004736
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

Immunoglobulin G

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888027
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Immunoglobulin G

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888027
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

IMMUNOGLOBULIN G CSF

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009678
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$124.00
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	$40.62
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	$24.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
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	$2.15

IMMUNOGLOBULIN G CSF

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009678
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625B
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$124.00
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	$40.62
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	$24.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
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	$2.15

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009677
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$124.00
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	$40.62
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	$24.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
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	$2.15

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009677
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN INJ 10% 50ML

Facility

$17,237.00

Service Code	HCPCS J1563
Hospital Charge Code	60629087
Hospital Revenue Code	636
Min. Negotiated Rate	$2,585.55
Max. Negotiated Rate	$4,171.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.55

IMMUNOGLOBULIN INJ 10% 50ML

Facility

$17,237.00

Service Code	HCPCS J1563
Hospital Charge Code	60629087
Hospital Revenue Code	636
Min. Negotiated Rate	$415.41
Max. Negotiated Rate	$8,618.50
Rate for Payer: Aetna Commercial	$6,550.06
Rate for Payer: Aetna Medicare Advantage	$5,171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,395.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,395.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,395.44
Rate for Payer: Cigna Commercial	$8,618.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.55
Rate for Payer: UnitedHealthcare Community & State	$415.41
Rate for Payer: Wellpoint Medicaid Managed Care	$456.78

IMMUNOGLOBULIN INJ 12G

Facility

$9,481.00

Service Code	HCPCS J1563
Hospital Charge Code	60628787
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.15
Max. Negotiated Rate	$2,294.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.15

IMMUNOGLOBULIN INJ 12G

Facility

$4,828.00

Service Code	HCPCS J1563
Hospital Charge Code	60628293
Hospital Revenue Code	636
Min. Negotiated Rate	$116.35
Max. Negotiated Rate	$2,414.00
Rate for Payer: Aetna Commercial	$1,834.64
Rate for Payer: Aetna Medicare Advantage	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,231.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,231.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,231.14
Rate for Payer: Cigna Commercial	$2,414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,168.38
Rate for Payer: Qualcare PPO/HMO/WC	$724.20
Rate for Payer: UnitedHealthcare Community & State	$116.35
Rate for Payer: Wellpoint Medicaid Managed Care	$127.94

IMMUNOGLOBULIN INJ 12G

Facility

$9,481.00

Service Code	HCPCS J1563
Hospital Charge Code	60628787
Hospital Revenue Code	636
Min. Negotiated Rate	$228.49
Max. Negotiated Rate	$4,740.50
Rate for Payer: Aetna Commercial	$3,602.78
Rate for Payer: Aetna Medicare Advantage	$2,844.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,417.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,417.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,417.66
Rate for Payer: Cigna Commercial	$4,740.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.15
Rate for Payer: UnitedHealthcare Community & State	$228.49
Rate for Payer: Wellpoint Medicaid Managed Care	$251.25

IMMUNOGLOBULIN INJ 12G

Facility

$4,828.00

Service Code	HCPCS J1563
Hospital Charge Code	60628293
Hospital Revenue Code	636
Min. Negotiated Rate	$724.20
Max. Negotiated Rate	$1,168.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,168.38
Rate for Payer: Qualcare PPO/HMO/WC	$724.20

IMMUNOGLOBULIN INJ 6G

Facility

$4,742.00

Service Code	HCPCS J1563
Hospital Charge Code	60629112
Hospital Revenue Code	636
Min. Negotiated Rate	$114.28
Max. Negotiated Rate	$2,371.00
Rate for Payer: Aetna Commercial	$1,801.96
Rate for Payer: Aetna Medicare Advantage	$1,422.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,209.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,209.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,209.21
Rate for Payer: Cigna Commercial	$2,371.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.56
Rate for Payer: Qualcare PPO/HMO/WC	$711.30
Rate for Payer: UnitedHealthcare Community & State	$114.28
Rate for Payer: Wellpoint Medicaid Managed Care	$125.66

IMMUNOGLOBULIN INJ 6G

Facility

$4,742.00

Service Code	HCPCS J1563
Hospital Charge Code	60629112
Hospital Revenue Code	636
Min. Negotiated Rate	$711.30
Max. Negotiated Rate	$1,147.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.56
Rate for Payer: Qualcare PPO/HMO/WC	$711.30

IMMUNOGLOBULIN INJ 6G

Facility

$2,918.00

Service Code	HCPCS J1563
Hospital Charge Code	60628906
Hospital Revenue Code	636
Min. Negotiated Rate	$437.70
Max. Negotiated Rate	$706.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.16
Rate for Payer: Qualcare PPO/HMO/WC	$437.70

IMMUNOGLOBULIN INJ 6G

Facility

$2,918.00

Service Code	HCPCS J1563
Hospital Charge Code	60628906
Hospital Revenue Code	636
Min. Negotiated Rate	$70.32
Max. Negotiated Rate	$1,459.00
Rate for Payer: Aetna Commercial	$1,108.84
Rate for Payer: Aetna Medicare Advantage	$875.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$744.09
Rate for Payer: Cigna Commercial	$1,459.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.16
Rate for Payer: Qualcare PPO/HMO/WC	$437.70
Rate for Payer: UnitedHealthcare Community & State	$70.32
Rate for Payer: Wellpoint Medicaid Managed Care	$77.33

IMMUNOGLOBULIN IV 10GM/10GM(1)

Facility

$5,556.00

Service Code	HCPCS J1563
Hospital Charge Code	60628292
Hospital Revenue Code	636
Min. Negotiated Rate	$133.90
Max. Negotiated Rate	$2,778.00
Rate for Payer: Aetna Commercial	$2,111.28
Rate for Payer: Aetna Medicare Advantage	$1,666.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.78
Rate for Payer: Cigna Commercial	$2,778.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.55
Rate for Payer: Qualcare PPO/HMO/WC	$833.40
Rate for Payer: UnitedHealthcare Community & State	$133.90
Rate for Payer: Wellpoint Medicaid Managed Care	$147.23

IMMUNOGLOBULIN IV 10GM/10GM(1)

Facility

$5,556.00

Service Code	HCPCS J1563
Hospital Charge Code	60628292
Hospital Revenue Code	636
Min. Negotiated Rate	$833.40
Max. Negotiated Rate	$1,344.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.55
Rate for Payer: Qualcare PPO/HMO/WC	$833.40

Know your out-of-pocket cost for care.

All Charges