Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	85000371
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

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	85000371
Hospital Revenue Code	333
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$85.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.87

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	83000371
Hospital Revenue Code	333
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$85.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.87

RADIATION TX MANAGEMENT

Facility

$530.15

Service Code	HCPCS 77431
Hospital Charge Code	85000785
Hospital Revenue Code	333
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$201.46
Rate for Payer: Aetna Medicare Advantage	$159.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.19
Rate for Payer: Cigna Commercial	$265.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.04
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.52
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$12.78
Rate for Payer: Wellpoint Medicaid Managed Care	$14.05

RADIATION TX MANAGEMENT

Facility

$530.15

Service Code	HCPCS 77431
Hospital Charge Code	85000785
Hospital Revenue Code	333
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$79.52
Rate for Payer: Qualcare PPO/HMO/WC	$79.52

RADIATION TX MANAGEMENT x 5

Facility

$961.65

Service Code	HCPCS 77427
Hospital Charge Code	85000780
Hospital Revenue Code	333
Min. Negotiated Rate	$144.25
Max. Negotiated Rate	$144.25
Rate for Payer: Qualcare PPO/HMO/WC	$144.25

RADIATION TX MANAGEMENT x 5

Facility

$961.65

Service Code	HCPCS 77427
Hospital Charge Code	85000780
Hospital Revenue Code	333
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$365.43
Rate for Payer: Aetna Medicare Advantage	$288.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.22
Rate for Payer: Cigna Commercial	$480.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.50
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.25
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$23.18
Rate for Payer: Wellpoint Medicaid Managed Care	$25.48

RADIATION TX PLANNING

Facility

$856.45

Service Code	HCPCS 77263
Hospital Charge Code	85000380
Hospital Revenue Code	333
Min. Negotiated Rate	$128.47
Max. Negotiated Rate	$128.47
Rate for Payer: Qualcare PPO/HMO/WC	$128.47

RADIATION TX PLANNING

Facility

$856.45

Service Code	HCPCS 77263
Hospital Charge Code	85000380
Hospital Revenue Code	333
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$325.45
Rate for Payer: Aetna Medicare Advantage	$256.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.39
Rate for Payer: Cigna Commercial	$428.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.94
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.47
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: Wellpoint Medicaid Managed Care	$22.70

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$57.88
Rate for Payer: Qualcare PPO/HMO/WC	$57.88

RADIATION TX PLANNING

Facility

$578.50

Service Code	HCPCS 77262
Hospital Charge Code	85000375
Hospital Revenue Code	333
Min. Negotiated Rate	$86.78
Max. Negotiated Rate	$86.78
Rate for Payer: Qualcare PPO/HMO/WC	$86.78

RADIATION TX PLANNING

Facility

$578.50

Service Code	HCPCS 77262
Hospital Charge Code	85000375
Hospital Revenue Code	333
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$219.83
Rate for Payer: Aetna Medicare Advantage	$173.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.52
Rate for Payer: Cigna Commercial	$289.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.55
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.78
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$13.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.33

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$146.62
Rate for Payer: Aetna Medicare Advantage	$115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.39
Rate for Payer: Cigna Commercial	$192.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.75
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.88
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.23

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.88
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$4,761.50
Max. Negotiated Rate	$4,761.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$765.01
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,523.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$765.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$841.20

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RADIOFREQUENCY GROUNDING PODS

Facility

$69.75

Hospital Charge Code	270663641
Hospital Revenue Code	270
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$10.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.46

RADIOFREQUENCY GROUNDING PODS

Facility

$69.75

Hospital Charge Code	270663641
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: Aetna Medicare Advantage	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.79
Rate for Payer: Cigna Commercial	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.93
Rate for Payer: Oxford Commercial	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.46
Rate for Payer: UnitedHealthcare Commercial	$13.95
Rate for Payer: UnitedHealthcare Community & State	$1.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

RADIOLOGY PORT FILMS

Facility

$84.55

Service Code	HCPCS 77417
Hospital Charge Code	85000745
Hospital Revenue Code	333
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$32.13
Rate for Payer: Aetna Medicare Advantage	$25.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.56
Rate for Payer: Cigna Commercial	$42.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.68
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

RADIOLOGY PORT FILMS

Facility

$84.55

Service Code	HCPCS 77417
Hospital Charge Code	85000745
Hospital Revenue Code	333
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$12.68

RADIOPAQUE UMB TAPE WHIT 2 24

Facility

$12.29

Hospital Charge Code	270680989
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.14
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna Medicare Advantage	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.13
Rate for Payer: Cigna Commercial	$6.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.69
Rate for Payer: Oxford Commercial	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.84
Rate for Payer: UnitedHealthcare Commercial	$2.46
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

RADIOPAQUE UMB TAPE WHIT 2 24

Facility

$12.29

Hospital Charge Code	270680989
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.84

Know your out-of-pocket cost for care.

All Charges