Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERFERON ALPHCN1 15MCG/MLINJ

Facility

$517.60

Hospital Charge Code	60628935
Hospital Revenue Code	636
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$258.80
Rate for Payer: Aetna Commercial	$196.69
Rate for Payer: Aetna Medicare Advantage	$155.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.99
Rate for Payer: Cigna Commercial	$258.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.26
Rate for Payer: Qualcare PPO/HMO/WC	$77.64
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.72

INTERFERON BETA 1A INJ 30MCG

Facility

$4,086.00

Hospital Charge Code	60628755
Hospital Revenue Code	636
Min. Negotiated Rate	$98.47
Max. Negotiated Rate	$2,043.00
Rate for Payer: Aetna Commercial	$1,552.68
Rate for Payer: Aetna Medicare Advantage	$1,225.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,041.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,041.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,041.93
Rate for Payer: Cigna Commercial	$2,043.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.81
Rate for Payer: Qualcare PPO/HMO/WC	$612.90
Rate for Payer: UnitedHealthcare Community & State	$98.47
Rate for Payer: Wellpoint Medicaid Managed Care	$108.28

INTERFERON BETA 1A INJ 30MCG

Facility

$4,086.00

Hospital Charge Code	60628755
Hospital Revenue Code	636
Min. Negotiated Rate	$612.90
Max. Negotiated Rate	$988.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.81
Rate for Payer: Qualcare PPO/HMO/WC	$612.90

INTERFERON GAMMA (PROFILE)

Facility

$265.00

Service Code	HCPCS 83520
Hospital Charge Code	401383520A
Hospital Revenue Code	306
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$132.50
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	$132.50
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	$79.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
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	$7.02

INTERFERON GAMMA (PROFILE)

Facility

$265.00

Service Code	HCPCS 83520
Hospital Charge Code	401383520A
Hospital Revenue Code	306
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

INTERFERON INJ 15 MG/ML ALPHA

Facility

$379.55

Hospital Charge Code	60628786
Hospital Revenue Code	636
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$189.78
Rate for Payer: Aetna Commercial	$144.23
Rate for Payer: Aetna Medicare Advantage	$113.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.79
Rate for Payer: Cigna Commercial	$189.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.93
Rate for Payer: UnitedHealthcare Community & State	$9.15
Rate for Payer: Wellpoint Medicaid Managed Care	$10.06

INTERFERON INJ 15 MG/ML ALPHA

Facility

$379.55

Hospital Charge Code	60628786
Hospital Revenue Code	636
Min. Negotiated Rate	$56.93
Max. Negotiated Rate	$91.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.93

INTERFERON INJ 30MCG/1ML

Facility

$994.60

Hospital Charge Code	60629149
Hospital Revenue Code	636
Min. Negotiated Rate	$149.19
Max. Negotiated Rate	$240.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.69
Rate for Payer: Qualcare PPO/HMO/WC	$149.19

INTERFERON INJ 30MCG/1ML

Facility

$994.60

Hospital Charge Code	60629149
Hospital Revenue Code	636
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$497.30
Rate for Payer: Aetna Commercial	$377.95
Rate for Payer: Aetna Medicare Advantage	$298.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.62
Rate for Payer: Cigna Commercial	$497.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.69
Rate for Payer: Qualcare PPO/HMO/WC	$149.19
Rate for Payer: UnitedHealthcare Community & State	$23.97
Rate for Payer: Wellpoint Medicaid Managed Care	$26.36

INTERGRA WND DRSG 2X2CM

Facility

$4,990.00

Hospital Charge Code	270332621
Hospital Revenue Code	636
Min. Negotiated Rate	$120.26
Max. Negotiated Rate	$2,495.00
Rate for Payer: Aetna Commercial	$1,896.20
Rate for Payer: Aetna Medicare Advantage	$1,497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,272.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,272.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,272.45
Rate for Payer: Cigna Commercial	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.58
Rate for Payer: Qualcare PPO/HMO/WC	$748.50
Rate for Payer: UnitedHealthcare Community & State	$120.26
Rate for Payer: Wellpoint Medicaid Managed Care	$132.24

INTERGRA WND DRSG 2X2CM

Facility

$4,990.00

Hospital Charge Code	270332621
Hospital Revenue Code	636
Min. Negotiated Rate	$748.50
Max. Negotiated Rate	$1,207.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.58
Rate for Payer: Qualcare PPO/HMO/WC	$748.50

INTERGRA WND DRSG 2X2CM/SQCMJW

Facility

$1,247.50

Hospital Charge Code	270332621W
Hospital Revenue Code	636
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$623.75
Rate for Payer: Aetna Commercial	$474.05
Rate for Payer: Aetna Medicare Advantage	$374.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.11
Rate for Payer: Cigna Commercial	$623.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.89
Rate for Payer: Qualcare PPO/HMO/WC	$187.12
Rate for Payer: UnitedHealthcare Community & State	$30.06
Rate for Payer: Wellpoint Medicaid Managed Care	$33.06

INTERGRA WND DRSG 2X2CM/SQCMJW

Facility

$1,247.50

Hospital Charge Code	270332621W
Hospital Revenue Code	636
Min. Negotiated Rate	$187.12
Max. Negotiated Rate	$301.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.89
Rate for Payer: Qualcare PPO/HMO/WC	$187.12

INTERGRA WND DRSG 4X5CM

Facility

$4,332.00

Hospital Charge Code	270332611
Hospital Revenue Code	636
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$2,166.00
Rate for Payer: Aetna Commercial	$1,646.16
Rate for Payer: Aetna Medicare Advantage	$1,299.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.66
Rate for Payer: Cigna Commercial	$2,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,048.34
Rate for Payer: Qualcare PPO/HMO/WC	$649.80
Rate for Payer: UnitedHealthcare Community & State	$104.40
Rate for Payer: Wellpoint Medicaid Managed Care	$114.80

INTERGRA WND DRSG 4X5CM

Facility

$4,332.00

Hospital Charge Code	270332611
Hospital Revenue Code	636
Min. Negotiated Rate	$649.80
Max. Negotiated Rate	$1,048.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,048.34
Rate for Payer: Qualcare PPO/HMO/WC	$649.80

INTERGRA WND DRSG 4X5CM/SQCMJW

Facility

$216.60

Hospital Charge Code	270332611W
Hospital Revenue Code	636
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$52.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Qualcare PPO/HMO/WC	$32.49

INTERGRA WND DRSG 4X5CM/SQCMJW

Facility

$216.60

Hospital Charge Code	270332611W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$108.30
Rate for Payer: Aetna Commercial	$82.31
Rate for Payer: Aetna Medicare Advantage	$64.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Qualcare PPO/HMO/WC	$32.49
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

INTERGRO DBM 10cc DBM010

Facility

$5,456.00

Hospital Charge Code	270636951
Hospital Revenue Code	272
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$2,728.00
Rate for Payer: Aetna Commercial	$2,073.28
Rate for Payer: Aetna Medicare Advantage	$1,636.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,391.28
Rate for Payer: Cigna Commercial	$2,728.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,636.80
Rate for Payer: Oxford Commercial	$1,091.20
Rate for Payer: Qualcare PPO/HMO/WC	$818.40
Rate for Payer: UnitedHealthcare Commercial	$1,091.20
Rate for Payer: UnitedHealthcare Community & State	$131.49
Rate for Payer: Wellpoint Medicaid Managed Care	$144.58

INTERGRO DBM 10cc DBM010

Facility

$5,456.00

Hospital Charge Code	270636951
Hospital Revenue Code	272
Min. Negotiated Rate	$818.40
Max. Negotiated Rate	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$818.40

INTERGRO DBM 5cc DBM005

Facility

$3,125.00

Hospital Charge Code	270636731
Hospital Revenue Code	272
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

INTERGRO DBM 5cc DBM005

Facility

$3,125.00

Hospital Charge Code	270636731
Hospital Revenue Code	272
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Commercial	$625.00
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

INTERGRO DBM PLUS 10cc DBMW10

Facility

$6,375.00

Hospital Charge Code	270637165
Hospital Revenue Code	272
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,912.50
Rate for Payer: Oxford Commercial	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Commercial	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

INTERGRO DBM PLUS 10cc DBMW10

Facility

$6,375.00

Hospital Charge Code	270637165
Hospital Revenue Code	272
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$956.25
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

INTERGRO DBM PLUS 2cc DBMW002

Facility

$2,405.65

Hospital Charge Code	270636733
Hospital Revenue Code	272
Min. Negotiated Rate	$360.85
Max. Negotiated Rate	$360.85
Rate for Payer: Qualcare PPO/HMO/WC	$360.85

INTERGRO DBM PLUS 2cc DBMW002

Facility

$2,405.65

Hospital Charge Code	270636733
Hospital Revenue Code	272
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$1,202.83
Rate for Payer: Aetna Commercial	$914.15
Rate for Payer: Aetna Medicare Advantage	$721.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$613.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$613.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$613.44
Rate for Payer: Cigna Commercial	$1,202.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.70
Rate for Payer: Oxford Commercial	$481.13
Rate for Payer: Qualcare PPO/HMO/WC	$360.85
Rate for Payer: UnitedHealthcare Commercial	$481.13
Rate for Payer: UnitedHealthcare Community & State	$57.98
Rate for Payer: Wellpoint Medicaid Managed Care	$63.75

Know your out-of-pocket cost for care.

All Charges