Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT RADIATION THRPY PLAN SIMPLE

Facility

$1.00

Service Code	HCPCS 77261
Hospital Charge Code	2205415
Hospital Revenue Code	333
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CT RECONSTRUCTION 3D

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200426
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RECONSTRUCTION 3D

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200426
Hospital Revenue Code	359
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$453.89
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$597.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$28.79
Rate for Payer: Wellpoint Medicaid Managed Care	$31.65

CT RECONSTRUCTION COR.SAG OBL

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200418
Hospital Revenue Code	359
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$453.89
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$597.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$28.79
Rate for Payer: Wellpoint Medicaid Managed Care	$31.65

CT RECONSTRUCTION COR.SAG OBL

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200418
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RECONSTRUCTION MULTIPLANNAR

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200434
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RECONSTRUCTION MULTIPLANNAR

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200434
Hospital Revenue Code	359
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$453.89
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$597.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$358.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$28.79
Rate for Payer: Wellpoint Medicaid Managed Care	$31.65

CT RENAL CYST ASPIRATION BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2250448
Hospital Revenue Code	361
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,119.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Community & State	$170.26
Rate for Payer: Wellpoint Medicaid Managed Care	$187.22

CT RENAL CYST ASPIRATION BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2250448
Hospital Revenue Code	361
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

CT RENAL CYST ASPIRATION LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2250449
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2250449
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

CT RENAL CYST ASPIRATION (PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2205185
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION (PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2205185
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

CT RENAL CYST ASPIRATION RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2250450
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

CT RENAL CYST ASPIRATION RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2250450
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT SCAN FOR THEARPY GUIDE-PC

Facility

$226.75

Service Code	HCPCS 7701426
Hospital Charge Code	85000010
Hospital Revenue Code	350
Min. Negotiated Rate	$34.01
Max. Negotiated Rate	$34.01
Rate for Payer: Qualcare PPO/HMO/WC	$34.01

CT SCAN FOR THEARPY GUIDE-PC

Facility

$226.75

Service Code	HCPCS 7701426
Hospital Charge Code	85000010
Hospital Revenue Code	350
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$86.17
Rate for Payer: Aetna Medicare Advantage	$68.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.82
Rate for Payer: Cigna Commercial	$113.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.03
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.01
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.01

CT SCAN FOR THEARPY GUIDE-TC

Facility

$603.25

Service Code	HCPCS 77014TC
Hospital Charge Code	85000005
Hospital Revenue Code	350
Min. Negotiated Rate	$90.49
Max. Negotiated Rate	$90.49
Rate for Payer: Qualcare PPO/HMO/WC	$90.49

CT SCAN FOR THEARPY GUIDE-TC

Facility

$603.25

Service Code	HCPCS 77014TC
Hospital Charge Code	85000005
Hospital Revenue Code	350
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$229.24
Rate for Payer: Aetna Medicare Advantage	$180.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.83
Rate for Payer: Cigna Commercial	$301.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.97
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.49
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$14.54
Rate for Payer: Wellpoint Medicaid Managed Care	$15.99

CT SCAN FOR THERAPY GUIDE-GL

Facility

$830.05

Service Code	HCPCS 77014
Hospital Charge Code	85000001
Hospital Revenue Code	350
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$315.42
Rate for Payer: Aetna Medicare Advantage	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.66
Rate for Payer: Cigna Commercial	$415.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.01
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.51
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

CT SCAN FOR THERAPY GUIDE-GL

Facility

$830.05

Service Code	HCPCS 77014
Hospital Charge Code	85000001
Hospital Revenue Code	350
Min. Negotiated Rate	$124.51
Max. Negotiated Rate	$124.51
Rate for Payer: Qualcare PPO/HMO/WC	$124.51

CT SCAN - MISCELLANEOUS

Facility

$643.00

Service Code	HCPCS 76499
Hospital Charge Code	2208025
Hospital Revenue Code	320
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

CT SCAN - MISCELLANEOUS

Facility

$643.00

Service Code	HCPCS 76499
Hospital Charge Code	2208025
Hospital Revenue Code	320
Min. Negotiated Rate	$96.45
Max. Negotiated Rate	$96.45
Rate for Payer: Qualcare PPO/HMO/WC	$96.45

CT SCANOGRAM

Facility

$1,219.00

Hospital Charge Code	2209005
Hospital Revenue Code	320
Min. Negotiated Rate	$182.85
Max. Negotiated Rate	$182.85
Rate for Payer: Qualcare PPO/HMO/WC	$182.85

CT SCANOGRAM

Facility

$1,219.00

Hospital Charge Code	2209005
Hospital Revenue Code	320
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$463.22
Rate for Payer: Aetna Medicare Advantage	$365.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.85
Rate for Payer: Cigna Commercial	$609.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.38
Rate for Payer: Wellpoint Medicaid Managed Care	$32.30

Know your out-of-pocket cost for care.

All Charges