Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM TC99 ARCITUMOMAB DOSE UP TO

Facility

$65.65

Hospital Charge Code	4500856
Hospital Revenue Code	343
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

NM TC99 CERETEC DOSE UP TO 25M

Facility

$96.85

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$1,349.62
Rate for Payer: Aetna Commercial	$36.80
Rate for Payer: Aetna Medicare Advantage	$29.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,349.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.70
Rate for Payer: Cigna Commercial	$48.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.53
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

NM TC99 CERETEC DOSE UP TO 25M

Facility

$96.85

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$14.53
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$102.50

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$51.25
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.38
Rate for Payer: UnitedHealthcare Community & State	$2.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.72

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$102.50

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$15.38
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

NM TC99 LABELED RBC DOSE UP TO

Facility

$128.75

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$214.90
Rate for Payer: Aetna Commercial	$48.92
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.83
Rate for Payer: Cigna Commercial	$64.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

NM TC99 LABELED RBC DOSE UP TO

Facility

$128.75

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$314.02
Max. Negotiated Rate	$314.02
Rate for Payer: Qualcare PPO/HMO/WC	$314.02

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$1,046.75
Rate for Payer: Aetna Commercial	$795.53
Rate for Payer: Aetna Medicare Advantage	$628.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.84
Rate for Payer: Cigna Commercial	$1,046.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.05
Rate for Payer: Qualcare PPO/HMO/WC	$314.02
Rate for Payer: UnitedHealthcare Community & State	$50.45
Rate for Payer: Wellpoint Medicaid Managed Care	$55.48

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$133.58
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$481.65

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$240.82
Rate for Payer: Aetna Commercial	$183.03
Rate for Payer: Aetna Medicare Advantage	$144.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.82
Rate for Payer: Cigna Commercial	$240.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.50
Rate for Payer: Qualcare PPO/HMO/WC	$72.25
Rate for Payer: UnitedHealthcare Community & State	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$12.76

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$481.65

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$72.25
Rate for Payer: Qualcare PPO/HMO/WC	$72.25

NM TC99 MM/STUDY DOSE TO 30

Facility

$177.50

Service Code	HCPCS A9503
Hospital Charge Code	4501023
Hospital Revenue Code	343
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$123.90
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare Advantage	$53.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.26
Rate for Payer: Cigna Commercial	$88.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.62
Rate for Payer: UnitedHealthcare Community & State	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4.70

NM TC99 MM/STUDY DOSE TO 30

Facility

$177.50

Service Code	HCPCS A9503
Hospital Charge Code	4501023
Hospital Revenue Code	343
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

NM TC99M PENTETATE PER VIAL

Facility

$80.00

Service Code	HCPCS A9567
Hospital Charge Code	4509035
Hospital Revenue Code	343
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$42.59
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

NM TC99M PENTETATE PER VIAL

Facility

$80.00

Service Code	HCPCS A9567
Hospital Charge Code	4509035
Hospital Revenue Code	343
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$401.50
Rate for Payer: Aetna Commercial	$305.14
Rate for Payer: Aetna Medicare Advantage	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.76
Rate for Payer: Cigna Commercial	$401.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.90
Rate for Payer: Qualcare PPO/HMO/WC	$120.45
Rate for Payer: UnitedHealthcare Community & State	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$21.28

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$120.45
Max. Negotiated Rate	$120.45
Rate for Payer: Qualcare PPO/HMO/WC	$120.45

NM TC99 MYOVIEW, PER DOSE

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

NM TC99 MYOVIEW, PER DOSE

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$105.65

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$85.18
Rate for Payer: Aetna Commercial	$40.15
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$105.65

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

NM TC99 PENTETATE DTPA DOSE UP

Facility

$65.65

Service Code	HCPCS A9539
Hospital Charge Code	4500300
Hospital Revenue Code	343
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$34.85
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

NM TC99 PENTETATE DTPA DOSE UP

Facility

$65.65

Service Code	HCPCS A9539
Hospital Charge Code	4500300
Hospital Revenue Code	343
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

Know your out-of-pocket cost for care.

All Charges