Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOBULIN SUBCLASS 2

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665C
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 3

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665D
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 3

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665D
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 4

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665E
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 4

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665E
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

IMMUNOHIST 1ST STAIN/SPEC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061051
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOHIST 1ST STAIN/SPEC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061051
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397080021
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397080021
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$541.15
Rate for Payer: Aetna Commercial	$411.27
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$541.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$73.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397061381
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397061382
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397061381
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$541.15
Rate for Payer: Aetna Commercial	$411.27
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$541.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$73.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOHISTO AB SLIDE EA ADD

Facility

$1,082.30

Service Code	HCPCS 88341
Hospital Charge Code	397061382
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$541.15
Rate for Payer: Aetna Commercial	$411.27
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$541.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$73.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOPEROXIDASE 1 BK,ANT 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061050
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOPEROXIDASE 1 BK,ANT 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061050
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOPEROXIDASE STAIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	38474067
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMUNOPEROXIDASE STAIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	38474067
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOSUPPRESSIVE ACIDIC PROT

Facility

$224.00

Service Code	HCPCS 84199
Hospital Charge Code	3007549
Hospital Revenue Code	301
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

IMMUNOSUPPRESSIVE ACIDIC PROT

Facility

$224.00

Service Code	HCPCS 84199
Hospital Charge Code	3007549
Hospital Revenue Code	301
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

IMMUNOTYPING BONE MARROW 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	3005105
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOTYPING BONE MARROW 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	3005105
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

IMMU OTHER-INFECTIOUS AB OR AG

Facility

$77.95

Service Code	HCPCS 83516
Hospital Charge Code	38478112
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

IMMU OTHER-INFECTIOUS AB OR AG

Facility

$77.95

Service Code	HCPCS 83516
Hospital Charge Code	38478112
Hospital Revenue Code	301
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

IMN INST SYSTEM

Facility

$1,757.80

Hospital Charge Code	270703691
Hospital Revenue Code	272
Min. Negotiated Rate	$42.36
Max. Negotiated Rate	$878.90
Rate for Payer: Aetna Commercial	$667.96
Rate for Payer: Aetna Medicare Advantage	$527.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.24
Rate for Payer: Cigna Commercial	$878.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$527.34
Rate for Payer: Oxford Commercial	$351.56
Rate for Payer: Qualcare PPO/HMO/WC	$263.67
Rate for Payer: UnitedHealthcare Commercial	$351.56
Rate for Payer: UnitedHealthcare Community & State	$42.36
Rate for Payer: Wellpoint Medicaid Managed Care	$46.58

IMN INST SYSTEM

Facility

$1,757.80

Hospital Charge Code	270703691
Hospital Revenue Code	272
Min. Negotiated Rate	$263.67
Max. Negotiated Rate	$263.67
Rate for Payer: Qualcare PPO/HMO/WC	$263.67

Know your out-of-pocket cost for care.

All Charges