Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77402
Hospital Charge Code	85000690
Hospital Revenue Code	333
Min. Negotiated Rate	$92.91
Max. Negotiated Rate	$92.91
Rate for Payer: Qualcare PPO/HMO/WC	$92.91

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77402
Hospital Charge Code	85000690
Hospital Revenue Code	333
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$329.69
Rate for Payer: Aetna Medicare Advantage	$392.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$121.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.53
Rate for Payer: Cigna Commercial	$242.98
Rate for Payer: Cigna Medicare Advantage	$84.85
Rate for Payer: Clover Medicare Advantage	$115.15
Rate for Payer: EmblemHealth Commercial	$363.63
Rate for Payer: Humana Medicare Advantage	$124.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$121.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.81
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.91
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$14.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$121.21
Rate for Payer: Wellcare Medicare Advantage	$121.21
Rate for Payer: Wellpoint Medicaid Managed Care	$16.41

RADIATION TX DELIVERY

Facility

$1,164.28

Service Code	HCPCS 77412
Hospital Charge Code	85000740
Hospital Revenue Code	333
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$174.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.64

RADIATION TX DELIVERY

Facility

$1,164.28

Service Code	HCPCS 77412
Hospital Charge Code	85000740
Hospital Revenue Code	333
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,369.52
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.28
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.64
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$30.85

RADIATION TX DELIVERY

Facility

$1,164.28

Service Code	HCPCS 77412
Hospital Charge Code	85000735
Hospital Revenue Code	333
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,369.52
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.28
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.64
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$30.85

RADIATION TX DELIVERY

Facility

$1,164.28

Service Code	HCPCS 77412
Hospital Charge Code	85000735
Hospital Revenue Code	333
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$174.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.64

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77407
Hospital Charge Code	85000705
Hospital Revenue Code	333
Min. Negotiated Rate	$92.91
Max. Negotiated Rate	$92.91
Rate for Payer: Qualcare PPO/HMO/WC	$92.91

RADIATION TX DELIVERY

Facility

$1,164.28

Service Code	HCPCS 77412
Hospital Charge Code	85000730
Hospital Revenue Code	333
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$174.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.64

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77401
Hospital Charge Code	85000680
Hospital Revenue Code	333
Min. Negotiated Rate	$92.91
Max. Negotiated Rate	$92.91
Rate for Payer: Qualcare PPO/HMO/WC	$92.91

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77401
Hospital Charge Code	85000680
Hospital Revenue Code	333
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$235.36
Rate for Payer: Aetna Medicare Advantage	$185.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.94
Rate for Payer: Cigna Commercial	$309.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.81
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.91
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$14.93
Rate for Payer: Wellpoint Medicaid Managed Care	$16.41

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77402
Hospital Charge Code	85000695
Hospital Revenue Code	333
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$329.69
Rate for Payer: Aetna Medicare Advantage	$392.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$121.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.53
Rate for Payer: Cigna Commercial	$242.98
Rate for Payer: Cigna Medicare Advantage	$84.85
Rate for Payer: Clover Medicare Advantage	$115.15
Rate for Payer: EmblemHealth Commercial	$363.63
Rate for Payer: Humana Medicare Advantage	$124.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$121.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.81
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.91
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$14.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$121.21
Rate for Payer: Wellcare Medicare Advantage	$121.21
Rate for Payer: Wellpoint Medicaid Managed Care	$16.41

RADIATION TX DELIVERY

Facility

$619.37

Service Code	HCPCS 77402
Hospital Charge Code	85000700
Hospital Revenue Code	333
Min. Negotiated Rate	$92.91
Max. Negotiated Rate	$92.91
Rate for Payer: Qualcare PPO/HMO/WC	$92.91

RADIATION TX DOSE PLAN-GL

Facility

$711.65

Service Code	HCPCS 77300
Hospital Charge Code	85000445
Hospital Revenue Code	333
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$434.33
Rate for Payer: Aetna Medicare Advantage	$517.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$159.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.40
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: Cigna Medicare Advantage	$111.78
Rate for Payer: Clover Medicare Advantage	$151.70
Rate for Payer: EmblemHealth Commercial	$479.04
Rate for Payer: Humana Medicare Advantage	$164.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$159.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.50
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.75
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$17.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$18.86

RADIATION TX DOSE PLAN-GL

Facility

$711.65

Service Code	HCPCS 77300
Hospital Charge Code	85000445
Hospital Revenue Code	333
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Qualcare PPO/HMO/WC	$106.75

RADIATION TX DOSE PLAN IMRT-GL

Facility

$6,384.91

Service Code	HCPCS 77301
Hospital Charge Code	85000460
Hospital Revenue Code	333
Min. Negotiated Rate	$957.74
Max. Negotiated Rate	$957.74
Rate for Payer: Qualcare PPO/HMO/WC	$957.74

RADIATION TX DOSE PLAN IMRT-GL

Facility

$6,384.91

Service Code	HCPCS 77301
Hospital Charge Code	85000460
Hospital Revenue Code	333
Min. Negotiated Rate	$153.88
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$4,472.71
Rate for Payer: Aetna Medicare Advantage	$5,327.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,644.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,935.72
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: Cigna Medicare Advantage	$1,151.07
Rate for Payer: Clover Medicare Advantage	$1,562.16
Rate for Payer: EmblemHealth Commercial	$4,933.14
Rate for Payer: Humana Medicare Advantage	$1,693.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,644.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.47
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$957.74
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$153.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,644.38
Rate for Payer: Wellcare Medicare Advantage	$1,644.38
Rate for Payer: Wellpoint Medicaid Managed Care	$169.20

RADIATION TX DOSE PLAN IMRT-PC

Facility

$2,132.40

Service Code	HCPCS 7730126
Hospital Charge Code	85000470
Hospital Revenue Code	333
Min. Negotiated Rate	$51.39
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$810.31
Rate for Payer: Aetna Medicare Advantage	$639.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.76
Rate for Payer: Cigna Commercial	$1,066.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.72
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.86
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$51.39
Rate for Payer: Wellpoint Medicaid Managed Care	$56.51

RADIATION TX DOSE PLAN IMRT-PC

Facility

$2,132.40

Service Code	HCPCS 7730126
Hospital Charge Code	85000470
Hospital Revenue Code	333
Min. Negotiated Rate	$319.86
Max. Negotiated Rate	$319.86
Rate for Payer: Qualcare PPO/HMO/WC	$319.86

RADIATION TX DOSE PLAN IMRT-TC

Facility

$9,428.85

Service Code	HCPCS 77301TC
Hospital Charge Code	85000465
Hospital Revenue Code	333
Min. Negotiated Rate	$1,414.33
Max. Negotiated Rate	$1,414.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,414.33

RADIATION TX DOSE PLAN IMRT-TC

Facility

$9,428.85

Service Code	HCPCS 77301TC
Hospital Charge Code	85000465
Hospital Revenue Code	333
Min. Negotiated Rate	$227.24
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$3,582.96
Rate for Payer: Aetna Medicare Advantage	$2,828.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,404.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,404.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,404.36
Rate for Payer: Cigna Commercial	$4,714.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,828.66
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,414.33
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$227.24
Rate for Payer: Wellpoint Medicaid Managed Care	$249.86

RADIATION TX DOSE PLAN-PC

Facility

$165.95

Service Code	HCPCS 7730026
Hospital Charge Code	85000455
Hospital Revenue Code	333
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$63.06
Rate for Payer: Aetna Medicare Advantage	$49.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.32
Rate for Payer: Cigna Commercial	$82.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.78
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.89
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

RADIATION TX DOSE PLAN-PC

Facility

$165.95

Service Code	HCPCS 7730026
Hospital Charge Code	85000455
Hospital Revenue Code	333
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$24.89
Rate for Payer: Qualcare PPO/HMO/WC	$24.89

RADIATION TX DOSE PLAN-TC

Facility

$219.75

Service Code	HCPCS 77300TC
Hospital Charge Code	85000450
Hospital Revenue Code	333
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$32.96
Rate for Payer: Qualcare PPO/HMO/WC	$32.96

RADIATION TX DOSE PLAN-TC

Facility

$219.75

Service Code	HCPCS 77300TC
Hospital Charge Code	85000450
Hospital Revenue Code	333
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$83.50
Rate for Payer: Aetna Medicare Advantage	$65.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.04
Rate for Payer: Cigna Commercial	$109.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.92
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.96
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	83000371
Hospital Revenue Code	333
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$217.53
Rate for Payer: Aetna Medicare Advantage	$171.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.97
Rate for Payer: Cigna Commercial	$286.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.74
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.87
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$13.80
Rate for Payer: Wellpoint Medicaid Managed Care	$15.17

Know your out-of-pocket cost for care.

All Charges