Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$2,892.00
Max. Negotiated Rate	$60,000.00
Rate for Payer: Aetna Commercial	$45,600.00
Rate for Payer: Aetna Medicare Advantage	$36,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,600.00
Rate for Payer: Cigna Commercial	$60,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00
Rate for Payer: UnitedHealthcare Community & State	$2,892.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,180.00

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$18,000.00
Max. Negotiated Rate	$29,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$19,500.00
Max. Negotiated Rate	$31,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$3,133.00
Max. Negotiated Rate	$65,000.00
Rate for Payer: Aetna Commercial	$49,400.00
Rate for Payer: Aetna Medicare Advantage	$39,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,150.00
Rate for Payer: Cigna Commercial	$65,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00
Rate for Payer: UnitedHealthcare Community & State	$3,133.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,445.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$566.35
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,170.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$566.35
Rate for Payer: Wellpoint Medicaid Managed Care	$622.75

IPPB TREATMENT W/WO MED

Facility

$154.25

Service Code	HCPCS 94664
Hospital Charge Code	9500109
Hospital Revenue Code	410
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.27
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.14
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.09

IPPB TREATMENT W/WO MED

Facility

$154.25

Service Code	HCPCS 94664
Hospital Charge Code	9500109
Hospital Revenue Code	410
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$23.14
Rate for Payer: Qualcare PPO/HMO/WC	$23.14

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IPRATROPIUM BROMIDE/ALBUTEROL

Facility

$1,155.85

Hospital Charge Code	60630186
Hospital Revenue Code	250
Min. Negotiated Rate	$27.86
Max. Negotiated Rate	$577.92
Rate for Payer: Aetna Commercial	$439.22
Rate for Payer: Aetna Medicare Advantage	$346.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.74
Rate for Payer: Cigna Commercial	$577.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.75
Rate for Payer: Oxford Commercial	$231.17
Rate for Payer: Qualcare PPO/HMO/WC	$173.38
Rate for Payer: UnitedHealthcare Commercial	$231.17
Rate for Payer: UnitedHealthcare Community & State	$27.86
Rate for Payer: Wellpoint Medicaid Managed Care	$30.63

IPRATROPIUM BROMIDE/ALBUTEROL

Facility

$1,155.85

Hospital Charge Code	60630186
Hospital Revenue Code	250
Min. Negotiated Rate	$173.38
Max. Negotiated Rate	$173.38
Rate for Payer: Qualcare PPO/HMO/WC	$173.38

IPRATROPIUM BROM INHAL 14GM

Facility

$204.80

Hospital Charge Code	6007132
Hospital Revenue Code	259
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna Commercial	$77.82
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.44
Rate for Payer: Oxford Commercial	$40.96
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$40.96
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

IPRATROPIUM BROM INHAL 14GM

Facility

$204.80

Hospital Charge Code	6007132
Hospital Revenue Code	259
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$313.43
Max. Negotiated Rate	$313.43
Rate for Payer: Qualcare PPO/HMO/WC	$313.43

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$1,044.77
Rate for Payer: Aetna Commercial	$794.02
Rate for Payer: Aetna Medicare Advantage	$626.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.83
Rate for Payer: Cigna Commercial	$1,044.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.86
Rate for Payer: Oxford Commercial	$417.91
Rate for Payer: Qualcare PPO/HMO/WC	$313.43
Rate for Payer: UnitedHealthcare Commercial	$417.91
Rate for Payer: UnitedHealthcare Community & State	$50.36
Rate for Payer: Wellpoint Medicaid Managed Care	$55.37

IPSATOL COUGH SYRUP/4OZ

Facility

$6.00

Hospital Charge Code	60634574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

IPSATOL COUGH SYRUP/4OZ

Facility

$6.00

Hospital Charge Code	60634574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ABD PARACENTESIS W/IMG

Facility

$4,459.55

Service Code	HCPCS 49083
Hospital Charge Code	321049083
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

Know your out-of-pocket cost for care.

All Charges