Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM TC99 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NM TC99 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

NM TC99 PYP DOSE UP TO 25MCI

Facility

$116.85

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

NM TC99 PYP DOSE UP TO 25MCI

Facility

$116.85

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

NM TC99 SESTAMIBI, DOSE

Facility

$456.64

Service Code	HCPCS A9500
Hospital Charge Code	4500658
Hospital Revenue Code	343
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$68.50
Rate for Payer: Qualcare PPO/HMO/WC	$68.50

NM TC99 SESTAMIBI, DOSE

Facility

$456.64

Service Code	HCPCS A9500
Hospital Charge Code	4500658
Hospital Revenue Code	343
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$228.32
Rate for Payer: Aetna Commercial	$173.52
Rate for Payer: Aetna Medicare Advantage	$136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.44
Rate for Payer: Cigna Commercial	$228.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.99
Rate for Payer: Qualcare PPO/HMO/WC	$68.50
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

NM TC99 SULPHUR COLL DOSE UP T

Facility

$200.85

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$172.30
Rate for Payer: Aetna Commercial	$76.32
Rate for Payer: Aetna Medicare Advantage	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.22
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Community & State	$4.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.32

NM TC99 SULPHUR COLL DOSE UP T

Facility

$200.85

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

NM TESTICULAR IMAGING

Facility

$2,151.25

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$51.85
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	$108.42
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	$645.38
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$322.69
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$51.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$57.01

NM TESTICULAR IMAGING

Facility

$2,151.25

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$322.69
Max. Negotiated Rate	$322.69
Rate for Payer: Qualcare PPO/HMO/WC	$322.69

NM TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
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 TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
Hospital Revenue Code	341
Min. Negotiated Rate	$108.42
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	$108.42
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	$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	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM THERAPY CHRONIC LEUKEMIA

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4500999
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY CHRONIC LEUKEMIA

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4500999
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
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	$216.93
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	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THERAPY INTERSTITAL COLLOID

Facility

$1,374.25

Service Code	HCPCS 79300
Hospital Charge Code	4501002
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
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	$319.44
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	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THERAPY INTERSTITAL COLLOID

Facility

$1,374.25

Service Code	HCPCS 79300
Hospital Charge Code	4501002
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY INTRACAVITY COLLOID

Facility

$1,374.25

Service Code	HCPCS 79200
Hospital Charge Code	4501004
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
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	$95.83
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	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THERAPY INTRACAVITY COLLOID

Facility

$1,374.25

Service Code	HCPCS 79200
Hospital Charge Code	4501004
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY RADIOPHARMA OTHER

Facility

$1,374.25

Service Code	HCPCS 79999
Hospital Charge Code	4501008
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY RADIOPHARMA OTHER

Facility

$1,374.25

Service Code	HCPCS 79999
Hospital Charge Code	4501008
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
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) 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	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501009
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501009
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 THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501010
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501010
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 THERPY HYPERTHYROID INITIAL

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501000
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$522.22
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$687.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

Know your out-of-pocket cost for care.

All Charges