Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

I-123 PER UNIT OF 100UCI

Facility

$193.83

Service Code	HCPCS A9516
Hospital Charge Code	4509075
Hospital Revenue Code	343
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$29.07
Rate for Payer: Qualcare PPO/HMO/WC	$29.07

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$150.39
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.73
Rate for Payer: Qualcare PPO/HMO/WC	$59.37
Rate for Payer: UnitedHealthcare Community & State	$9.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.49

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$150.39
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.73
Rate for Payer: Qualcare PPO/HMO/WC	$59.37
Rate for Payer: UnitedHealthcare Community & State	$9.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.49

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.08
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
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	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IABP INSERTION PERC

Facility

$4,732.00

Service Code	HCPCS 33967
Hospital Charge Code	5100086
Hospital Revenue Code	481
Min. Negotiated Rate	$709.80
Max. Negotiated Rate	$709.80
Rate for Payer: Qualcare PPO/HMO/WC	$709.80

IABP INSERTION PERC

Facility

$4,732.00

Service Code	HCPCS 33967
Hospital Charge Code	5100086
Hospital Revenue Code	481
Min. Negotiated Rate	$114.04
Max. Negotiated Rate	$20,074.00
Rate for Payer: Aetna Commercial	$1,798.16
Rate for Payer: Aetna Medicare Advantage	$1,419.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,206.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,206.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,206.66
Rate for Payer: Cigna Commercial	$2,366.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,419.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$709.80
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$114.04
Rate for Payer: Wellpoint Medicaid Managed Care	$125.40

IAC W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200178
Hospital Revenue Code	351
Min. Negotiated Rate	$86.94
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

IAC W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200178
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

IBANDRONATE SODIUM 1MG INJ

Facility

$3,530.83

Service Code	HCPCS J1740
Hospital Charge Code	60632241
Hospital Revenue Code	636
Min. Negotiated Rate	$85.09
Max. Negotiated Rate	$1,765.41
Rate for Payer: Aetna Commercial	$1,341.72
Rate for Payer: Aetna Medicare Advantage	$1,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.36
Rate for Payer: Cigna Commercial	$1,765.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.46
Rate for Payer: Qualcare PPO/HMO/WC	$529.62
Rate for Payer: UnitedHealthcare Community & State	$85.09
Rate for Payer: Wellpoint Medicaid Managed Care	$93.57

IBANDRONATE SODIUM 1MG INJ

Facility

$3,530.83

Service Code	HCPCS J1740
Hospital Charge Code	60632241
Hospital Revenue Code	636
Min. Negotiated Rate	$529.62
Max. Negotiated Rate	$854.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.46
Rate for Payer: Qualcare PPO/HMO/WC	$529.62

IBD DIAG INDIRECT IMM FL ASSAY

Facility

$636.00

Hospital Charge Code	3009986
Hospital Revenue Code	301
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

IBD DIAG INDIRECT IMM FL ASSAY

Facility

$636.00

Hospital Charge Code	3009986
Hospital Revenue Code	301
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

IBD DIAG INDIRECT IMM FL ASSAY

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3009986A
Hospital Revenue Code	312
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$122.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

IBD DIAG INDIRECT IMM FL ASSAY

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3009986A
Hospital Revenue Code	312
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

IBD DIFFERENTIATION PANEL

Facility

$390.00

Service Code	HCPCS 8667191
Hospital Charge Code	39990078D
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

IBD DIFFERENTIATION PANEL

Facility

$390.00

Service Code	HCPCS 8667191
Hospital Charge Code	39990078D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078C
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

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078B
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

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078A
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

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IBD DIFFERENTIATION PANEL I

Facility

$390.00

Service Code	HCPCS 8602191
Hospital Charge Code	39990078C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges