Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOBULIN IV 10GM/200ML

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	60628290
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

IMMUNOGLOBULIN IV 10GM/200ML

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	60628290
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

IMMUNOGLOBULIN IV 10GM/5GM(2)

Facility

$5,577.00

Service Code	HCPCS J1563
Hospital Charge Code	60628289
Hospital Revenue Code	636
Min. Negotiated Rate	$134.41
Max. Negotiated Rate	$2,788.50
Rate for Payer: Aetna Commercial	$2,119.26
Rate for Payer: Aetna Medicare Advantage	$1,673.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,422.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,422.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,422.13
Rate for Payer: Cigna Commercial	$2,788.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,349.63
Rate for Payer: Qualcare PPO/HMO/WC	$836.55
Rate for Payer: UnitedHealthcare Community & State	$134.41
Rate for Payer: Wellpoint Medicaid Managed Care	$147.79

IMMUNOGLOBULIN IV 10GM/5GM(2)

Facility

$5,577.00

Service Code	HCPCS J1563
Hospital Charge Code	60628289
Hospital Revenue Code	636
Min. Negotiated Rate	$836.55
Max. Negotiated Rate	$1,349.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,349.63
Rate for Payer: Qualcare PPO/HMO/WC	$836.55

IMMUNOGLOBULIN IV 2.5GM

Facility

$1,391.00

Service Code	HCPCS J1563
Hospital Charge Code	60628295
Hospital Revenue Code	636
Min. Negotiated Rate	$33.52
Max. Negotiated Rate	$695.50
Rate for Payer: Aetna Commercial	$528.58
Rate for Payer: Aetna Medicare Advantage	$417.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.70
Rate for Payer: Cigna Commercial	$695.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65
Rate for Payer: UnitedHealthcare Community & State	$33.52
Rate for Payer: Wellpoint Medicaid Managed Care	$36.86

IMMUNOGLOBULIN IV 2.5GM

Facility

$1,391.00

Service Code	HCPCS J1563
Hospital Charge Code	60628295
Hospital Revenue Code	636
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$336.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

IMMUNOGLOBULIN IV 5GM

Facility

$2,355.00

Service Code	HCPCS J1563
Hospital Charge Code	60628291
Hospital Revenue Code	636
Min. Negotiated Rate	$353.25
Max. Negotiated Rate	$569.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.91
Rate for Payer: Qualcare PPO/HMO/WC	$353.25

IMMUNOGLOBULIN IV 5GM

Facility

$2,355.00

Service Code	HCPCS J1563
Hospital Charge Code	60628291
Hospital Revenue Code	636
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$1,177.50
Rate for Payer: Aetna Commercial	$894.90
Rate for Payer: Aetna Medicare Advantage	$706.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.52
Rate for Payer: Cigna Commercial	$1,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.91
Rate for Payer: Qualcare PPO/HMO/WC	$353.25
Rate for Payer: UnitedHealthcare Community & State	$56.76
Rate for Payer: Wellpoint Medicaid Managed Care	$62.41

Immunoglobulin M

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888028
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 M

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888028
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009685
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

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

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009685
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 M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625D
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

IMMUNOGLOBULINS

Facility

$240.00

Service Code	HCPCS 82784
Hospital Charge Code	38472419
Hospital Revenue Code	301
Min. Negotiated Rate	$6.36
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	$120.00
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	$72.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
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	$6.36

IMMUNOGLOBULINS

Facility

$240.00

Service Code	HCPCS 82784
Hospital Charge Code	38472419
Hospital Revenue Code	301
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IMMUNOGLOBULINS(IGG,A,M),I

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULINS(IGG,A,M),I

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007A
Hospital Revenue Code	301
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.28
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

IMMUNOGLOBULINS(IGG,A,M),II

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULINS(IGG,A,M),II

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.28
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

IMMUNOGLOBULINS(IGG,A,M),III

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULINS(IGG,A,M),III

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.28
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

IMMUNOGLOBULIN SUBCLASS 1

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$21.81
Rate for Payer: Aetna Medicare Advantage	$25.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.95
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: Cigna Medicare Advantage	$8.02
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Medicare Advantage	$8.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

IMMUNOGLOBULIN SUBCLASS 1

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

IMMUNOGLOBULIN SUBCLASS 2

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$21.81
Rate for Payer: Aetna Medicare Advantage	$25.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.95
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: Cigna Medicare Advantage	$8.02
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Medicare Advantage	$8.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

Know your out-of-pocket cost for care.

All Charges