Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM I-123 MIBG PER 10 MCI

Facility

$9,923.00

Service Code	HCPCS A9582
Hospital Charge Code	4509045
Hospital Revenue Code	344
Min. Negotiated Rate	$1,488.45
Max. Negotiated Rate	$1,488.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.45

NM I-131 MIBG 0.5MCI

Facility

$6,202.00

Hospital Charge Code	4509020
Hospital Revenue Code	343
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

NM I-131 MIBG 0.5MCI

Facility

$6,202.00

Hospital Charge Code	4509020
Hospital Revenue Code	343
Min. Negotiated Rate	$149.47
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$2,356.76
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.60
Rate for Payer: Qualcare PPO/HMO/WC	$930.30
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$164.35

NM I 131 THERAPY INITIAL

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500013
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM I 131 THERAPY INITIAL

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500013
Hospital Revenue Code	342
Min. Negotiated Rate	$47.03
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$754.01
Rate for Payer: Aetna Medicare Advantage	$898.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$277.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,000.64
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: Cigna Medicare Advantage	$194.05
Rate for Payer: Clover Medicare Advantage	$263.35
Rate for Payer: EmblemHealth Commercial	$831.63
Rate for Payer: Humana Medicare Advantage	$285.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$277.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.38
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$47.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$51.71

NM IN-111 PENTETREOTIDE DOSE U

Facility

$11,533.70

Service Code	HCPCS A9572
Hospital Charge Code	4501021
Hospital Revenue Code	343
Min. Negotiated Rate	$277.96
Max. Negotiated Rate	$7,222.79
Rate for Payer: Aetna Commercial	$5,442.56
Rate for Payer: Aetna Medicare Advantage	$6,483.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,222.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,222.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,000.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,482.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,222.79
Rate for Payer: Cigna Medicare Advantage	$1,400.66
Rate for Payer: Clover Medicare Advantage	$1,900.89
Rate for Payer: EmblemHealth Commercial	$6,002.82
Rate for Payer: Humana Medicare Advantage	$2,060.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,000.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,460.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.06
Rate for Payer: UnitedHealthcare Community & State	$277.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,000.94
Rate for Payer: Wellcare Medicare Advantage	$2,000.94
Rate for Payer: Wellpoint Medicaid Managed Care	$305.64

NM IN-111 PENTETREOTIDE DOSE U

Facility

$11,533.70

Service Code	HCPCS A9572
Hospital Charge Code	4501021
Hospital Revenue Code	343
Min. Negotiated Rate	$1,730.06
Max. Negotiated Rate	$1,730.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.06

NM IN-111 ZEVALIN DOSE UP TO 5

Facility

$11,188.00

Hospital Charge Code	4500297
Hospital Revenue Code	343
Min. Negotiated Rate	$269.63
Max. Negotiated Rate	$5,594.00
Rate for Payer: Aetna Commercial	$4,251.44
Rate for Payer: Aetna Medicare Advantage	$3,356.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,852.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,852.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,852.94
Rate for Payer: Cigna Commercial	$5,594.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,356.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,678.20
Rate for Payer: UnitedHealthcare Community & State	$269.63
Rate for Payer: Wellpoint Medicaid Managed Care	$296.48

NM IN-111 ZEVALIN DOSE UP TO 5

Facility

$11,188.00

Hospital Charge Code	4500297
Hospital Revenue Code	343
Min. Negotiated Rate	$1,678.20
Max. Negotiated Rate	$1,678.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,678.20

NM INDIUM DTPA/0.5 MCI

Facility

$3,503.00

Hospital Charge Code	4508055
Hospital Revenue Code	343
Min. Negotiated Rate	$525.45
Max. Negotiated Rate	$525.45
Rate for Payer: Qualcare PPO/HMO/WC	$525.45

NM INDIUM DTPA/0.5 MCI

Facility

$3,503.00

Hospital Charge Code	4508055
Hospital Revenue Code	343
Min. Negotiated Rate	$84.42
Max. Negotiated Rate	$1,751.50
Rate for Payer: Aetna Commercial	$1,331.14
Rate for Payer: Aetna Medicare Advantage	$1,050.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.26
Rate for Payer: Cigna Commercial	$1,751.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.90
Rate for Payer: Qualcare PPO/HMO/WC	$525.45
Rate for Payer: UnitedHealthcare Community & State	$84.42
Rate for Payer: Wellpoint Medicaid Managed Care	$92.83

NM INDIUM III OXYQUIN / 5mCi

Facility

$1,306.45

Hospital Charge Code	4500815
Hospital Revenue Code	343
Min. Negotiated Rate	$31.49
Max. Negotiated Rate	$653.23
Rate for Payer: Aetna Commercial	$496.45
Rate for Payer: Aetna Medicare Advantage	$391.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$333.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$333.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$333.14
Rate for Payer: Cigna Commercial	$653.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.94
Rate for Payer: Qualcare PPO/HMO/WC	$195.97
Rate for Payer: UnitedHealthcare Community & State	$31.49
Rate for Payer: Wellpoint Medicaid Managed Care	$34.62

NM INDIUM III OXYQUIN / 5mCi

Facility

$1,306.45

Hospital Charge Code	4500815
Hospital Revenue Code	343
Min. Negotiated Rate	$195.97
Max. Negotiated Rate	$195.97
Rate for Payer: Qualcare PPO/HMO/WC	$195.97

NM INDIUM III PENT PER 1.5mCi

Facility

$1,972.85

Service Code	HCPCS A9507
Hospital Charge Code	4500296
Hospital Revenue Code	343
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$6,245.83
Rate for Payer: Aetna Commercial	$4,706.39
Rate for Payer: Aetna Medicare Advantage	$5,606.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,245.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,245.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,730.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,181.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,245.83
Rate for Payer: Cigna Medicare Advantage	$1,211.20
Rate for Payer: Clover Medicare Advantage	$1,643.78
Rate for Payer: EmblemHealth Commercial	$5,190.87
Rate for Payer: Humana Medicare Advantage	$1,782.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,730.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.86
Rate for Payer: Qualcare PPO/HMO/WC	$295.93
Rate for Payer: UnitedHealthcare Community & State	$47.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,730.29
Rate for Payer: Wellcare Medicare Advantage	$1,730.29
Rate for Payer: Wellpoint Medicaid Managed Care	$52.28

NM INDIUM III PENT PER 1.5mCi

Facility

$1,972.85

Service Code	HCPCS A9507
Hospital Charge Code	4500296
Hospital Revenue Code	343
Min. Negotiated Rate	$295.93
Max. Negotiated Rate	$295.93
Rate for Payer: Qualcare PPO/HMO/WC	$295.93

NM INDIUM II,UP TO 6 MCI

Facility

$3,503.00

Hospital Charge Code	4508065
Hospital Revenue Code	343
Min. Negotiated Rate	$84.42
Max. Negotiated Rate	$1,751.50
Rate for Payer: Aetna Commercial	$1,331.14
Rate for Payer: Aetna Medicare Advantage	$1,050.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.26
Rate for Payer: Cigna Commercial	$1,751.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.90
Rate for Payer: Qualcare PPO/HMO/WC	$525.45
Rate for Payer: UnitedHealthcare Community & State	$84.42
Rate for Payer: Wellpoint Medicaid Managed Care	$92.83

NM INDIUM II,UP TO 6 MCI

Facility

$3,503.00

Hospital Charge Code	4508065
Hospital Revenue Code	343
Min. Negotiated Rate	$525.45
Max. Negotiated Rate	$525.45
Rate for Payer: Qualcare PPO/HMO/WC	$525.45

NM INJECTION KIT

Facility

$134.45

Hospital Charge Code	4500865
Hospital Revenue Code	272
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$67.22
Rate for Payer: Aetna Commercial	$51.09
Rate for Payer: Aetna Medicare Advantage	$40.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.28
Rate for Payer: Cigna Commercial	$67.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.34
Rate for Payer: Oxford Commercial	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.17
Rate for Payer: UnitedHealthcare Commercial	$26.89
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.56

NM INJECTION KIT

Facility

$134.45

Hospital Charge Code	4500865
Hospital Revenue Code	272
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.17

NM INJ LYMPH/SENTINEL NODE

Facility

$598.75

Service Code	HCPCS 38792
Hospital Charge Code	4500886
Hospital Revenue Code	361
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
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	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$474.94
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.81
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.87

NM INJ LYMPH/SENTINEL NODE

Facility

$598.75

Service Code	HCPCS 38792
Hospital Charge Code	4500886
Hospital Revenue Code	361
Min. Negotiated Rate	$89.81
Max. Negotiated Rate	$89.81
Rate for Payer: Qualcare PPO/HMO/WC	$89.81

NM IODINE 131CAP PERmCi THERAP

Facility

$382.45

Service Code	HCPCS A9517
Hospital Charge Code	4500799
Hospital Revenue Code	344
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$114.73
Rate for Payer: Aetna Commercial	$65.47
Rate for Payer: Aetna Medicare Advantage	$77.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.89
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$22.87
Rate for Payer: EmblemHealth Commercial	$72.21
Rate for Payer: Humana Medicare Advantage	$24.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.73
Rate for Payer: Qualcare PPO/HMO/WC	$57.37
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.07
Rate for Payer: Wellcare Medicare Advantage	$24.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.13

NM IODINE 131CAP PERmCi THERAP

Facility

$382.45

Service Code	HCPCS A9517
Hospital Charge Code	4500799
Hospital Revenue Code	344
Min. Negotiated Rate	$57.37
Max. Negotiated Rate	$57.37
Rate for Payer: Qualcare PPO/HMO/WC	$57.37

NM IODINE 131 PER CAP 15mCi**

Facility

$156.00

Service Code	HCPCS C1188
Hospital Charge Code	4500781
Hospital Revenue Code	342
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

NM IODINE 131 PER CAP 15mCi**

Facility

$156.00

Service Code	HCPCS C1188
Hospital Charge Code	4500781
Hospital Revenue Code	342
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

Know your out-of-pocket cost for care.

All Charges