Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM IODINE 131 PER CAP 20mCi

Facility

$390.00

Service Code	HCPCS C1188
Hospital Charge Code	4500773
Hospital Revenue Code	342
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

NM IODINE 131 PER CAP 20mCi

Facility

$390.00

Service Code	HCPCS C1188
Hospital Charge Code	4500773
Hospital Revenue Code	342
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$5,021.00
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	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

NM IODINE I-131/0.5 MCI

Facility

$1,637.00

Hospital Charge Code	4508050
Hospital Revenue Code	343
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$818.50
Rate for Payer: Aetna Commercial	$622.06
Rate for Payer: Aetna Medicare Advantage	$491.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.44
Rate for Payer: Cigna Commercial	$818.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.10
Rate for Payer: Qualcare PPO/HMO/WC	$245.55
Rate for Payer: UnitedHealthcare Community & State	$39.45
Rate for Payer: Wellpoint Medicaid Managed Care	$43.38

NM IODINE I-131/0.5 MCI

Facility

$1,637.00

Hospital Charge Code	4508050
Hospital Revenue Code	343
Min. Negotiated Rate	$245.55
Max. Negotiated Rate	$245.55
Rate for Payer: Qualcare PPO/HMO/WC	$245.55

NM KIDNEY FUNCT STUDY NON-IMAG

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500963
Hospital Revenue Code	341
Min. Negotiated Rate	$194.44
Max. Negotiated Rate	$194.44
Rate for Payer: Qualcare PPO/HMO/WC	$194.44

NM KIDNEY FUNCT STUDY NON-IMAG

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500963
Hospital Revenue Code	341
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$5,021.00
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	$58.08
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	$332.46
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	$388.88
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$31.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$34.35

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$5,021.00
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	$58.08
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	$332.46
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	$567.60
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.80
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$45.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$50.14

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$283.80
Rate for Payer: Qualcare PPO/HMO/WC	$283.80

NM KIDNEY IMAGING STATIC

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500964
Hospital Revenue Code	341
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$5,021.00
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	$77.44
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	$332.46
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	$406.50
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

NM KIDNEY IMAGING STATIC

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500964
Hospital Revenue Code	341
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

NM KIDNEY IMAGING W/FUNCTION

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500965
Hospital Revenue Code	341
Min. Negotiated Rate	$194.44
Max. Negotiated Rate	$194.44
Rate for Payer: Qualcare PPO/HMO/WC	$194.44

NM KIDNEY IMAGING W/FUNCTION

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500965
Hospital Revenue Code	341
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$5,021.00
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	$58.08
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	$332.46
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	$388.88
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$31.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$34.35

NM KIDNEY SCAN W VASCULAR FLOW

Facility

$1,717.65

Service Code	HCPCS 78701
Hospital Charge Code	4500930
Hospital Revenue Code	341
Min. Negotiated Rate	$257.65
Max. Negotiated Rate	$257.65
Rate for Payer: Qualcare PPO/HMO/WC	$257.65

NM KIDNEY SCAN W VASCULAR FLOW

Facility

$1,717.65

Service Code	HCPCS 78701
Hospital Charge Code	4500930
Hospital Revenue Code	341
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$5,021.00
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	$125.84
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	$332.46
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	$515.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$257.65
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$41.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$45.52

NM KIDNEY SPECT

Facility

$1,740.00

Service Code	HCPCS 78710
Hospital Charge Code	4500500
Hospital Revenue Code	341
Min. Negotiated Rate	$261.00
Max. Negotiated Rate	$261.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00

NM KIDNEY SPECT

Facility

$1,740.00

Service Code	HCPCS 78710
Hospital Charge Code	4500500
Hospital Revenue Code	341
Min. Negotiated Rate	$41.93
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$661.20
Rate for Payer: Aetna Medicare Advantage	$522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.70
Rate for Payer: Cigna Commercial	$870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$41.93
Rate for Payer: Wellpoint Medicaid Managed Care	$46.11

NM KIDNEY VASCULAR FLOW

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500966
Hospital Revenue Code	341
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

NM KIDNEY VASCULAR FLOW

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500966
Hospital Revenue Code	341
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$5,021.00
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	$77.44
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	$332.46
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	$406.50
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

NM KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
Hospital Revenue Code	341
Min. Negotiated Rate	$212.96
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
Hospital Revenue Code	341
Min. Negotiated Rate	$278.78
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
Hospital Revenue Code	341
Min. Negotiated Rate	$232.32
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM LIVER IMAGING STATIC ONLY

Facility

$1,146.45

Service Code	HCPCS 78201
Hospital Charge Code	4500936
Hospital Revenue Code	341
Min. Negotiated Rate	$171.97
Max. Negotiated Rate	$171.97
Rate for Payer: Qualcare PPO/HMO/WC	$171.97

Know your out-of-pocket cost for care.

All Charges