Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IV INFUSION

Facility

$297.60

Service Code	HCPCS 90780
Hospital Charge Code	1001105
Hospital Revenue Code	260
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$44.64
Rate for Payer: Qualcare PPO/HMO/WC	$44.64

IV INFUSION

Facility

$297.60

Service Code	HCPCS 90780
Hospital Charge Code	1001105
Hospital Revenue Code	260
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$113.09
Rate for Payer: Aetna Medicare Advantage	$89.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.89
Rate for Payer: Cigna Commercial	$148.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.28
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.64
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$7.17
Rate for Payer: Wellpoint Medicaid Managed Care	$7.89

IV INFUSION IMMUNOGLOBULN

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500031
Hospital Revenue Code	260
Min. Negotiated Rate	$33.88
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.73
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$33.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$37.25

IV INFUSION IMMUNOGLOBULN

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500031
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INFUS MED 16-90-SUBSEQ

Facility

$613.00

Service Code	HCPCS 96366
Hospital Charge Code	93500039
Hospital Revenue Code	260
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

IV INFUS MED 16-90-SUBSEQ

Facility

$613.00

Service Code	HCPCS 96366
Hospital Charge Code	93500039
Hospital Revenue Code	260
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.90
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$14.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$16.24

IV LINE PROTECTOR STRIP

Facility

$347.63

Hospital Charge Code	270649665
Hospital Revenue Code	272
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna Commercial	$132.10
Rate for Payer: Aetna Medicare Advantage	$104.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.65
Rate for Payer: Cigna Commercial	$173.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.29
Rate for Payer: Oxford Commercial	$69.53
Rate for Payer: Qualcare PPO/HMO/WC	$52.14
Rate for Payer: UnitedHealthcare Commercial	$69.53
Rate for Payer: UnitedHealthcare Community & State	$8.38
Rate for Payer: Wellpoint Medicaid Managed Care	$9.21

IV LINE PROTECTOR STRIP

Facility

$347.63

Hospital Charge Code	270649665
Hospital Revenue Code	272
Min. Negotiated Rate	$52.14
Max. Negotiated Rate	$52.14
Rate for Payer: Qualcare PPO/HMO/WC	$52.14

IVP

Facility

$1,255.00

Service Code	HCPCS 74400
Hospital Charge Code	94061149
Hospital Revenue Code	320
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$188.25
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

IVP

Facility

$1,255.00

Service Code	HCPCS 74400
Hospital Charge Code	94061149
Hospital Revenue Code	320
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$30.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$33.26

IVPB ODD DOSE =<1G

Facility

$93.45

Hospital Charge Code	60627259
Hospital Revenue Code	258
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

IVPB ODD DOSE =<1G

Facility

$93.45

Hospital Charge Code	60627259
Hospital Revenue Code	258
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$46.73
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Oxford Commercial	$18.69
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$18.69
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

IV PREADMIN IMMUNOGLOBULIN

Facility

$259.30

Hospital Charge Code	3401108
Hospital Revenue Code	636
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$62.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.90

IV PREADMIN IMMUNOGLOBULIN

Facility

$259.30

Hospital Charge Code	3401108
Hospital Revenue Code	636
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$129.65
Rate for Payer: Aetna Commercial	$98.53
Rate for Payer: Aetna Medicare Advantage	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.12
Rate for Payer: Cigna Commercial	$129.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.90
Rate for Payer: UnitedHealthcare Community & State	$6.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

IV PUSH-1ST MED DUR INFUS

Facility

$465.14

Service Code	HCPCS 96375
Hospital Charge Code	93500071
Hospital Revenue Code	260
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.54
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.77
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$11.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$12.33

IV PUSH-1ST MED DUR INFUS

Facility

$465.14

Service Code	HCPCS 96375
Hospital Charge Code	93500071
Hospital Revenue Code	260
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$69.77
Rate for Payer: Qualcare PPO/HMO/WC	$69.77

IV PUSH-1STMED INITAL AVS

Facility

$394.88

Service Code	HCPCS 9637459
Hospital Charge Code	93500067
Hospital Revenue Code	260
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$150.05
Rate for Payer: Aetna Medicare Advantage	$118.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.69
Rate for Payer: Cigna Commercial	$197.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.46
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.23
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.46

IV PUSH-1STMED INITAL AVS

Facility

$394.88

Service Code	HCPCS 9637459
Hospital Charge Code	93500067
Hospital Revenue Code	260
Min. Negotiated Rate	$59.23
Max. Negotiated Rate	$59.23
Rate for Payer: Qualcare PPO/HMO/WC	$59.23

IV PUSH-1ST MED INITL 1VS

Facility

$394.88

Service Code	HCPCS 96374
Hospital Charge Code	93500063
Hospital Revenue Code	260
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.46
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.23
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$10.46

IV PUSH-1ST MED INITL 1VS

Facility

$394.88

Service Code	HCPCS 96374
Hospital Charge Code	93500063
Hospital Revenue Code	260
Min. Negotiated Rate	$59.23
Max. Negotiated Rate	$59.23
Rate for Payer: Qualcare PPO/HMO/WC	$59.23

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73190111
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	366896375
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	1600520
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	366896375
Hospital Revenue Code	260
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.27
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$10.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.68

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	7411253
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

Know your out-of-pocket cost for care.

All Charges