Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM TUMOR WHOLE BODY 2+DAYS IMG

Facility

$12,000.00

Service Code	HCPCS 78804
Hospital Charge Code	406078804
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 URETERAL REFLUX STUDY

Facility

$1,148.00

Service Code	HCPCS 78740
Hospital Charge Code	4500609
Hospital Revenue Code	341
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$172.20
Rate for Payer: Qualcare PPO/HMO/WC	$172.20

NM URETERAL REFLUX STUDY

Facility

$1,148.00

Service Code	HCPCS 78740
Hospital Charge Code	4500609
Hospital Revenue Code	341
Min. Negotiated Rate	$27.67
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	$96.80
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	$344.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$27.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$30.42

NM URNARY BLDDER RESIDUAL STDY

Facility

$217.60

Service Code	HCPCS 78730
Hospital Charge Code	4501016
Hospital Revenue Code	341
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$32.64

NM URNARY BLDDER RESIDUAL STDY

Facility

$217.60

Service Code	HCPCS 78730
Hospital Charge Code	4501016
Hospital Revenue Code	341
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$82.69
Rate for Payer: Aetna Medicare Advantage	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.49
Rate for Payer: Cigna Commercial	$108.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.28
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.64
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$5.24
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

NM VENA CAVA

Facility

$12,000.00

Service Code	HCPCS 78445
Hospital Charge Code	4500369
Hospital Revenue Code	341
Min. Negotiated Rate	$116.16
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	$116.16
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 VENA CAVA

Facility

$12,000.00

Service Code	HCPCS 78445
Hospital Charge Code	4500369
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 VENOGRAM FLOW

Facility

$1,132.85

Service Code	HCPCS 78445
Hospital Charge Code	4500294
Hospital Revenue Code	341
Min. Negotiated Rate	$27.30
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	$116.16
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	$339.86
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.93
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$27.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$30.02

NM VENOGRAM FLOW

Facility

$1,132.85

Service Code	HCPCS 78445
Hospital Charge Code	4500294
Hospital Revenue Code	341
Min. Negotiated Rate	$169.93
Max. Negotiated Rate	$169.93
Rate for Payer: Qualcare PPO/HMO/WC	$169.93

NM VENOUS THROMBO VENOGRAM BI

Facility

$1,941.65

Service Code	HCPCS 78458
Hospital Charge Code	4500916
Hospital Revenue Code	341
Min. Negotiated Rate	$291.25
Max. Negotiated Rate	$291.25
Rate for Payer: Qualcare PPO/HMO/WC	$291.25

NM VENOUS THROMBO VENOGRAM BI

Facility

$1,941.65

Service Code	HCPCS 78458
Hospital Charge Code	4500916
Hospital Revenue Code	341
Min. Negotiated Rate	$46.79
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	$319.44
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	$582.50
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.25
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$46.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$51.45

NM VENOUS THROMBO VENOGRAM UNI

Facility

$1,288.00

Service Code	HCPCS 78457
Hospital Charge Code	4500914
Hospital Revenue Code	341
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$193.20
Rate for Payer: Qualcare PPO/HMO/WC	$193.20

NM VENOUS THROMBO VENOGRAM UNI

Facility

$1,288.00

Service Code	HCPCS 78457
Hospital Charge Code	4500914
Hospital Revenue Code	341
Min. Negotiated Rate	$31.04
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	$386.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$31.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$34.13

NM VENOUS THROMBSIS IMAGE RGHT

Facility

$1,288.00

Service Code	HCPCS 78457
Hospital Charge Code	4501017
Hospital Revenue Code	341
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$193.20
Rate for Payer: Qualcare PPO/HMO/WC	$193.20

NM VENOUS THROMBSIS IMAGE RGHT

Facility

$1,288.00

Service Code	HCPCS 78457
Hospital Charge Code	4501017
Hospital Revenue Code	341
Min. Negotiated Rate	$31.04
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	$386.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$31.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$34.13

NM VENTRICULOGRAM

Facility

$1,242.20

Service Code	HCPCS 78635
Hospital Charge Code	4501018
Hospital Revenue Code	341
Min. Negotiated Rate	$29.94
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	$181.02
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	$372.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.33
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

NM VENTRICULOGRAM

Facility

$1,242.20

Service Code	HCPCS 78635
Hospital Charge Code	4501018
Hospital Revenue Code	341
Min. Negotiated Rate	$186.33
Max. Negotiated Rate	$186.33
Rate for Payer: Qualcare PPO/HMO/WC	$186.33

NM VIT B 12 ABSORP W & WO INTR

Facility

$1,124.85

Service Code	HCPCS 78272
Hospital Charge Code	4500912
Hospital Revenue Code	341
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$427.44
Rate for Payer: Aetna Medicare Advantage	$337.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.84
Rate for Payer: Cigna Commercial	$562.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.45
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.73
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

NM VIT B 12 ABSORP W & WO INTR

Facility

$1,124.85

Service Code	HCPCS 78272
Hospital Charge Code	4500912
Hospital Revenue Code	341
Min. Negotiated Rate	$168.73
Max. Negotiated Rate	$168.73
Rate for Payer: Qualcare PPO/HMO/WC	$168.73

NM WHOLE BLOOD VOLUME

Facility

$1,222.15

Service Code	HCPCS 78122
Hospital Charge Code	4501019
Hospital Revenue Code	341
Min. Negotiated Rate	$29.45
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	$180.49
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	$366.64
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.32
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$29.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$32.39

NM WHOLE BLOOD VOLUME

Facility

$1,222.15

Service Code	HCPCS 78122
Hospital Charge Code	4501019
Hospital Revenue Code	341
Min. Negotiated Rate	$183.32
Max. Negotiated Rate	$183.32
Rate for Payer: Qualcare PPO/HMO/WC	$183.32

NM XE133 PER 10 MCI

Facility

$9.00

Service Code	HCPCS A9558
Hospital Charge Code	4509030
Hospital Revenue Code	343
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$225.21
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

NM XE133 PER 10 MCI

Facility

$9.00

Service Code	HCPCS A9558
Hospital Charge Code	4509030
Hospital Revenue Code	343
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

Facility

$0.65

Hospital Charge Code	71010
Hospital Revenue Code	320
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$0.25
Rate for Payer: Aetna Medicare Advantage	$0.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.17
Rate for Payer: Cigna Commercial	$0.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

Facility

$0.65

Hospital Charge Code	71010
Hospital Revenue Code	320
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

Know your out-of-pocket cost for care.

All Charges