Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RADIOTHERAPY

Facility

$39,261.39

Service Code	APR-DRG 6924
Min. Negotiated Rate	$38,491.56
Max. Negotiated Rate	$39,261.39
Rate for Payer: UnitedHealthcare Community & State	$38,491.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,261.39
Rate for Payer: Wellpoint Medicaid Managed Care	$38,491.56

RADIOTHERAPY

Facility

$24,136.17

Service Code	APR-DRG 6923
Min. Negotiated Rate	$23,662.91
Max. Negotiated Rate	$24,136.17
Rate for Payer: UnitedHealthcare Community & State	$23,662.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,136.17
Rate for Payer: Wellpoint Medicaid Managed Care	$23,662.91

RADIOTHERAPY

Facility

$89,709.55

Service Code	MSDRG 849
Min. Negotiated Rate	$27,315.41
Max. Negotiated Rate	$89,709.55
Rate for Payer: Aetna Commercial	$61,898.00
Rate for Payer: Aetna Medicare Advantage	$89,709.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62,572.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62,572.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,753.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62,572.09
Rate for Payer: Cigna Commercial	$50,705.58
Rate for Payer: Cigna Medicare Advantage	$28,753.06
Rate for Payer: Clover Medicare Advantage	$27,315.41
Rate for Payer: EmblemHealth Commercial	$86,259.18
Rate for Payer: Humana Medicare Advantage	$29,615.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,753.06
Rate for Payer: Oxford Commercial	$36,442.78
Rate for Payer: UnitedHealthcare Commercial	$63,903.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,753.06
Rate for Payer: Wellcare Medicare Advantage	$28,753.06

RADIOTHERAPY

Facility

$14,744.69

Service Code	APR-DRG 6922
Min. Negotiated Rate	$14,455.58
Max. Negotiated Rate	$14,744.69
Rate for Payer: UnitedHealthcare Community & State	$14,455.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,744.69
Rate for Payer: Wellpoint Medicaid Managed Care	$14,455.58

RADIOTHERAPY

Facility

$7,689.64

Service Code	APR-DRG 6921
Min. Negotiated Rate	$7,538.86
Max. Negotiated Rate	$7,689.64
Rate for Payer: UnitedHealthcare Community & State	$7,538.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,689.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7,538.86

RAD JAW 4LC W/NDL 240cm 133340

Facility

$74.75

Hospital Charge Code	270638655
Hospital Revenue Code	272
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$11.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.21

RAD JAW 4LC W/NDL 240cm 133340

Facility

$74.75

Hospital Charge Code	270638655
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$37.38
Rate for Payer: Aetna Commercial	$28.41
Rate for Payer: Aetna Medicare Advantage	$22.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.06
Rate for Payer: Cigna Commercial	$37.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.43
Rate for Payer: Oxford Commercial	$14.95
Rate for Payer: Qualcare PPO/HMO/WC	$11.21
Rate for Payer: UnitedHealthcare Commercial	$14.95
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

RAD JAW 4LC W/O NDL240cm133240

Facility

$46.25

Hospital Charge Code	270638688
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

RAD JAW 4LC W/O NDL240cm133240

Facility

$46.25

Hospital Charge Code	270638688
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

RAD TREATMENT DEL INTERMEDIATE

Facility

$1,548.50

Service Code	HCPCS 77407
Hospital Charge Code	850000900
Hospital Revenue Code	333
Min. Negotiated Rate	$232.28
Max. Negotiated Rate	$232.28
Rate for Payer: Qualcare PPO/HMO/WC	$232.28

RAD TREATMENT DEL INTERMEDIATE

Facility

$1,548.50

Service Code	HCPCS 77407
Hospital Charge Code	850000900
Hospital Revenue Code	333
Min. Negotiated Rate	$37.32
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,246.36
Rate for Payer: Aetna Medicare Advantage	$1,484.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,654.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,654.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$458.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,654.04
Rate for Payer: Cigna Commercial	$918.50
Rate for Payer: Cigna Medicare Advantage	$320.75
Rate for Payer: Clover Medicare Advantage	$435.31
Rate for Payer: EmblemHealth Commercial	$1,374.66
Rate for Payer: Humana Medicare Advantage	$471.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$458.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$464.55
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.28
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$37.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$458.22
Rate for Payer: Wellcare Medicare Advantage	$458.22
Rate for Payer: Wellpoint Medicaid Managed Care	$41.04

RAD TREATMENT DELIVERY COMPLEX

Facility

$1,548.50

Service Code	HCPCS 77412
Hospital Charge Code	850000901
Hospital Revenue Code	333
Min. Negotiated Rate	$37.32
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	$464.55
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.28
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$37.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$41.04

RAD TREATMENT DELIVERY COMPLEX

Facility

$1,548.50

Service Code	HCPCS 77412
Hospital Charge Code	850000901
Hospital Revenue Code	333
Min. Negotiated Rate	$232.28
Max. Negotiated Rate	$232.28
Rate for Payer: Qualcare PPO/HMO/WC	$232.28

RAFN NAIL 11 MM 300

Facility

$7,658.65

Service Code	HCPCS C1713
Hospital Charge Code	270687791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,148.80
Max. Negotiated Rate	$1,853.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,531.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,853.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,684.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,148.80

RAFN NAIL 11 MM 300

Facility

$7,658.65

Service Code	HCPCS C1713
Hospital Charge Code	270687791
Hospital Revenue Code	278
Min. Negotiated Rate	$184.57
Max. Negotiated Rate	$3,829.32
Rate for Payer: Aetna Commercial	$2,910.29
Rate for Payer: Aetna Medicare Advantage	$2,297.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,952.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,952.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,531.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,952.96
Rate for Payer: Cigna Commercial	$3,829.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,853.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,684.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,148.80
Rate for Payer: UnitedHealthcare Community & State	$184.57
Rate for Payer: Wellpoint Medicaid Managed Care	$202.95

RALLY MV AB BONE CEMENT 40 GRA

Facility

$2,334.50

Service Code	HCPCS C1713
Hospital Charge Code	270686906
Hospital Revenue Code	278
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$1,167.25
Rate for Payer: Aetna Commercial	$887.11
Rate for Payer: Aetna Medicare Advantage	$700.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$595.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$595.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$595.30
Rate for Payer: Cigna Commercial	$1,167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$564.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$513.59
Rate for Payer: Qualcare PPO/HMO/WC	$350.18
Rate for Payer: UnitedHealthcare Community & State	$56.26
Rate for Payer: Wellpoint Medicaid Managed Care	$61.86

RALLY MV AB BONE CEMENT 40 GRA

Facility

$2,334.50

Service Code	HCPCS C1713
Hospital Charge Code	270686906
Hospital Revenue Code	278
Min. Negotiated Rate	$350.18
Max. Negotiated Rate	$564.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$564.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$513.59
Rate for Payer: Qualcare PPO/HMO/WC	$350.18

RALOXIFENE 60 MG TAB

Facility

$53.06

Service Code	NDC 2418430
Hospital Charge Code	60629016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.53
Rate for Payer: Aetna Commercial	$20.16
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.53
Rate for Payer: Cigna Commercial	$26.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.92
Rate for Payer: Oxford Commercial	$10.61
Rate for Payer: Qualcare PPO/HMO/WC	$7.96
Rate for Payer: UnitedHealthcare Commercial	$10.61
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

RALOXIFENE 60 MG TAB

Facility

$53.06

Service Code	NDC 2418430
Hospital Charge Code	60629016
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.96

RALOXIFENE 60MG TAB

Facility

$47.77

Service Code	NDC 69097082502
Hospital Charge Code	6063943401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$23.89
Rate for Payer: Aetna Commercial	$18.15
Rate for Payer: Aetna Medicare Advantage	$14.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.18
Rate for Payer: Cigna Commercial	$23.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.33
Rate for Payer: Oxford Commercial	$9.55
Rate for Payer: Qualcare PPO/HMO/WC	$7.17
Rate for Payer: UnitedHealthcare Commercial	$9.55
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

RALOXIFENE 60MG TAB

Facility

$47.77

Service Code	NDC 69097082502
Hospital Charge Code	6063943401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$7.17

RALTEGRAVIR 100MG CHEWABLE

Facility

$40.33

Service Code	NDC 6047761
Hospital Charge Code	6000428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna Medicare Advantage	$12.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.28
Rate for Payer: Cigna Commercial	$20.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: Oxford Commercial	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$8.07
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

RALTEGRAVIR 100MG CHEWABLE

Facility

$40.33

Service Code	NDC 6047761
Hospital Charge Code	6000428
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

RALTEGRAVIR 400MG TAB

Facility

$161.40

Service Code	NDC 6022761
Hospital Charge Code	60630217
Hospital Revenue Code	250
Min. Negotiated Rate	$24.21
Max. Negotiated Rate	$24.21
Rate for Payer: Qualcare PPO/HMO/WC	$24.21

RALTEGRAVIR 400MG TAB

Facility

$161.40

Service Code	NDC 6022761
Hospital Charge Code	60630217
Hospital Revenue Code	250
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$80.70
Rate for Payer: Aetna Commercial	$61.33
Rate for Payer: Aetna Medicare Advantage	$48.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.16
Rate for Payer: Cigna Commercial	$80.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.42
Rate for Payer: Oxford Commercial	$32.28
Rate for Payer: Qualcare PPO/HMO/WC	$24.21
Rate for Payer: UnitedHealthcare Commercial	$32.28
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: Wellpoint Medicaid Managed Care	$4.28

Know your out-of-pocket cost for care.

All Charges