Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INFLIXIMAB ANTI-DRUG AB(SERUM)

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520J
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

INFLIXIMAB ANTI-DRUG AB(SERUM)

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520J
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

INFLIXIMAB-DYYB 100MG VIAL

Facility

$3,567.01

Service Code	HCPCS Q5103
Hospital Charge Code	606390259
Hospital Revenue Code	636
Min. Negotiated Rate	$24.74
Max. Negotiated Rate	$863.22
Rate for Payer: Aetna Commercial	$70.83
Rate for Payer: Aetna Medicare Advantage	$84.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.00
Rate for Payer: Cigna Medicare Advantage	$26.04
Rate for Payer: Clover Medicare Advantage	$24.74
Rate for Payer: EmblemHealth Commercial	$78.12
Rate for Payer: Humana Medicare Advantage	$26.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.22
Rate for Payer: Qualcare PPO/HMO/WC	$535.05
Rate for Payer: UnitedHealthcare Community & State	$85.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.04
Rate for Payer: Wellcare Medicare Advantage	$26.04
Rate for Payer: Wellpoint Medicaid Managed Care	$94.53

INFLIXIMAB-DYYB 100MG VIAL

Facility

$3,567.01

Service Code	HCPCS Q5103
Hospital Charge Code	606390259
Hospital Revenue Code	636
Min. Negotiated Rate	$535.05
Max. Negotiated Rate	$863.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.22
Rate for Payer: Qualcare PPO/HMO/WC	$535.05

INFLIXIMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80230
Hospital Charge Code	401180230
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

INFLIXIMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80230
Hospital Charge Code	401180230
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Commercial	$104.91
Rate for Payer: Aetna Medicare Advantage	$124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$38.57
Rate for Payer: Clover Medicare Advantage	$36.64
Rate for Payer: EmblemHealth Commercial	$115.71
Rate for Payer: Humana Medicare Advantage	$39.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.57
Rate for Payer: Wellcare Medicare Advantage	$38.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

INFLOW & OUTFLOW TUBING

Facility

$6,250.00

Hospital Charge Code	270662954
Hospital Revenue Code	270
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Commercial	$1,250.00
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

INFLOW & OUTFLOW TUBING

Facility

$6,250.00

Hospital Charge Code	270662954
Hospital Revenue Code	270
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

INFLOW TUBING

Facility

$630.00

Hospital Charge Code	270666124
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

INFLOW TUBING

Facility

$630.00

Hospital Charge Code	270666124
Hospital Revenue Code	270
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.00
Rate for Payer: Oxford Commercial	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Commercial	$126.00
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

INFLU A AND B RNA PCR

Facility

$584.80

Service Code	HCPCS 87502
Hospital Charge Code	39900297
Hospital Revenue Code	306
Min. Negotiated Rate	$87.72
Max. Negotiated Rate	$87.72
Rate for Payer: Qualcare PPO/HMO/WC	$87.72

INFLU A AND B RNA PCR

Facility

$584.80

Service Code	HCPCS 87502
Hospital Charge Code	39900297
Hospital Revenue Code	306
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$345.81
Rate for Payer: Aetna Commercial	$260.58
Rate for Payer: Aetna Medicare Advantage	$310.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.81
Rate for Payer: Cigna Commercial	$292.40
Rate for Payer: Cigna Medicare Advantage	$95.80
Rate for Payer: Clover Medicare Advantage	$91.01
Rate for Payer: EmblemHealth Commercial	$287.40
Rate for Payer: Humana Medicare Advantage	$98.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.72
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$76.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.80
Rate for Payer: Wellcare Medicare Advantage	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$15.50

INFLUENZA A ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314A
Hospital Revenue Code	302
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.91
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$13.55
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Medicare Advantage	$13.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

INFLUENZA A ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314A
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

INFLUENZA A/B/RSV RNA QL RTPCR

Facility

$791.90

Service Code	HCPCS 87631
Hospital Charge Code	401391989
Hospital Revenue Code	306
Min. Negotiated Rate	$118.78
Max. Negotiated Rate	$118.78
Rate for Payer: Qualcare PPO/HMO/WC	$118.78

INFLUENZA A/B/RSV RNA QL RTPCR

Facility

$791.90

Service Code	HCPCS 87631
Hospital Charge Code	401391989
Hospital Revenue Code	306
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$514.85
Rate for Payer: Aetna Commercial	$387.95
Rate for Payer: Aetna Medicare Advantage	$462.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$514.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$514.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$514.85
Rate for Payer: Cigna Commercial	$395.95
Rate for Payer: Cigna Medicare Advantage	$142.63
Rate for Payer: Clover Medicare Advantage	$135.50
Rate for Payer: EmblemHealth Commercial	$427.89
Rate for Payer: Humana Medicare Advantage	$146.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$142.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$114.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$142.63
Rate for Payer: Wellcare Medicare Advantage	$142.63
Rate for Payer: Wellpoint Medicaid Managed Care	$20.99

INFLUENZA AB,TYPE A & B I

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INFLUENZA AB,TYPE A & B I

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INFLUENZA AB,TYPE A & B II

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INFLUENZA AB,TYPE A & B II

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INFLUENZA ADLT INJ 00-01 0.5ML

Facility

$46.75

Service Code	HCPCS 90658
Hospital Charge Code	60629088
Hospital Revenue Code	636
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$11.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

INFLUENZA ADLT INJ 00-01 0.5ML

Facility

$46.75

Service Code	HCPCS 90658
Hospital Charge Code	60629088
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
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	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

INFLUENZA ADULT VACC 0.5ML INJ

Facility

$90.90

Service Code	HCPCS 90658
Hospital Charge Code	60629089
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
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	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

INFLUENZA ADULT VACC 0.5ML INJ

Facility

$90.90

Service Code	HCPCS 90658
Hospital Charge Code	60629089
Hospital Revenue Code	636
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

INFLUENZA ANTIGENT

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38476205
Hospital Revenue Code	302
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.91
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$13.55
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Medicare Advantage	$13.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

Know your out-of-pocket cost for care.

All Charges