Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	4512631
Hospital Revenue Code	911
Min. Negotiated Rate	$98.91
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna Commercial	$1,559.52
Rate for Payer: Aetna Medicare Advantage	$1,231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.52
Rate for Payer: Cigna Commercial	$2,052.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,231.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.60
Rate for Payer: UnitedHealthcare Community & State	$98.91
Rate for Payer: Wellpoint Medicaid Managed Care	$108.76

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	7500131
Hospital Revenue Code	911
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$615.60
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	7500131
Hospital Revenue Code	911
Min. Negotiated Rate	$98.91
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna Commercial	$1,559.52
Rate for Payer: Aetna Medicare Advantage	$1,231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.52
Rate for Payer: Cigna Commercial	$2,052.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,231.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.60
Rate for Payer: UnitedHealthcare Community & State	$98.91
Rate for Payer: Wellpoint Medicaid Managed Care	$108.76

PERS ONSITE EA ADD HR >24

Facility

$136.15

Hospital Charge Code	7500132
Hospital Revenue Code	911
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$68.08
Rate for Payer: Aetna Commercial	$51.74
Rate for Payer: Aetna Medicare Advantage	$40.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.72
Rate for Payer: Cigna Commercial	$68.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.42
Rate for Payer: UnitedHealthcare Community & State	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

PERS ONSITE EA ADD HR >24

Facility

$136.15

Hospital Charge Code	7500132
Hospital Revenue Code	911
Min. Negotiated Rate	$20.42
Max. Negotiated Rate	$20.42
Rate for Payer: Qualcare PPO/HMO/WC	$20.42

PERTECHNETATE FLOOD

Facility

$22.15

Hospital Charge Code	270658211
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.07
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna Medicare Advantage	$6.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.65
Rate for Payer: Cigna Commercial	$11.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.64
Rate for Payer: Oxford Commercial	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$4.43
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

PERTECHNETATE FLOOD

Facility

$22.15

Hospital Charge Code	270658211
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

PERTUZUMAB PER 10MG INJ

Facility

$510.45

Hospital Charge Code	60639600
Hospital Revenue Code	636
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$255.22
Rate for Payer: Aetna Commercial	$193.97
Rate for Payer: Aetna Medicare Advantage	$153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.16
Rate for Payer: Cigna Commercial	$255.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$76.57
Rate for Payer: UnitedHealthcare Community & State	$12.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.53

PERTUZUMAB PER 10MG INJ

Facility

$510.45

Hospital Charge Code	60639600
Hospital Revenue Code	636
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$123.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$76.57

PESSARY****

Facility

$30.00

Hospital Charge Code	1810035
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

PESSARY****

Facility

$30.00

Hospital Charge Code	1810035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

PESSARY HODGE SILICONE 2

Facility

$281.65

Hospital Charge Code	270610500
Hospital Revenue Code	272
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

PESSARY HODGE SILICONE 2

Facility

$281.65

Hospital Charge Code	270610500
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 3

Facility

$281.65

Hospital Charge Code	270610499
Hospital Revenue Code	272
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

PESSARY HODGE SILICONE 3

Facility

$281.65

Hospital Charge Code	270610499
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 4

Facility

$281.65

Hospital Charge Code	270610501
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 4

Facility

$281.65

Hospital Charge Code	270610501
Hospital Revenue Code	272
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

PESSARY HODGE SILICONE 6

Facility

$281.65

Hospital Charge Code	270610497
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 6

Facility

$281.65

Hospital Charge Code	270610497
Hospital Revenue Code	272
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	4501024
Hospital Revenue Code	404
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,090.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,117.27
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$330.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$363.69

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	4501024
Hospital Revenue Code	404
Min. Negotiated Rate	$2,058.64
Max. Negotiated Rate	$2,058.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	80000050
Hospital Revenue Code	404
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$16,027.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,090.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,132.23
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,117.27
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$330.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$363.69

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	80000050
Hospital Revenue Code	404
Min. Negotiated Rate	$2,058.64
Max. Negotiated Rate	$2,058.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64

PET BRAIN IMAG METAB EVAL - PI

Facility

$40,000.00

Service Code	HCPCS 78608PI
Hospital Charge Code	80000050PI
Hospital Revenue Code	404
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$16,027.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PET BRAIN IMAG METAB EVAL - PI

Facility

$40,000.00

Service Code	HCPCS 78608PI
Hospital Charge Code	80000050PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

Know your out-of-pocket cost for care.

All Charges