Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RSS GLENOID BASEPLATE-S

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688776
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$290.59
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

RSS GLENOID BASEPLATE-S

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

RSS GLENOSPHERE ECCENTRI-S 2MM

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688778
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,752.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

RSS GLENOSPHERE ECCENTRI-S 2MM

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688778
Hospital Revenue Code	278
Min. Negotiated Rate	$301.47
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$4,753.52
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,752.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39
Rate for Payer: UnitedHealthcare Community & State	$301.47
Rate for Payer: Wellpoint Medicaid Managed Care	$331.50

RSS HXL LINER STD 0S

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691335
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.31
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

RSS HXL LINER STD 0S

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691335
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$2,442.91
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.31
Rate for Payer: Qualcare PPO/HMO/WC	$964.30
Rate for Payer: UnitedHealthcare Community & State	$154.93
Rate for Payer: Wellpoint Medicaid Managed Care	$170.36

RSV VIRUS IMMUNE GLOBULIN

Facility

$462.30

Service Code	NDC 49281057515
Hospital Charge Code	6064943022
Hospital Revenue Code	250
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$231.15
Rate for Payer: Aetna Commercial	$175.67
Rate for Payer: Aetna Medicare Advantage	$138.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.89
Rate for Payer: Cigna Commercial	$231.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.69
Rate for Payer: Oxford Commercial	$92.46
Rate for Payer: Qualcare PPO/HMO/WC	$69.34
Rate for Payer: UnitedHealthcare Commercial	$92.46
Rate for Payer: UnitedHealthcare Community & State	$11.14
Rate for Payer: Wellpoint Medicaid Managed Care	$12.25

RSV VIRUS IMMUNE GLOBULIN

Facility

$462.30

Service Code	NDC 49281057515
Hospital Charge Code	6064943022
Hospital Revenue Code	250
Min. Negotiated Rate	$69.34
Max. Negotiated Rate	$69.34
Rate for Payer: Qualcare PPO/HMO/WC	$69.34

RT BASIC DOSIMETRY

Facility

$353.95

Service Code	HCPCS 77300
Hospital Charge Code	4800058
Hospital Revenue Code	333
Min. Negotiated Rate	$53.09
Max. Negotiated Rate	$53.09
Rate for Payer: Qualcare PPO/HMO/WC	$53.09

RT BASIC DOSIMETRY

Facility

$353.95

Service Code	HCPCS 77300
Hospital Charge Code	4800058
Hospital Revenue Code	333
Min. Negotiated Rate	$8.53
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	$106.19
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.09
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9.38

RT BRACHY SEED NUCLETRON I 192

Facility

$1,265.65

Hospital Charge Code	4500896
Hospital Revenue Code	272
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$632.83
Rate for Payer: Aetna Commercial	$480.95
Rate for Payer: Aetna Medicare Advantage	$379.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.74
Rate for Payer: Cigna Commercial	$632.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.69
Rate for Payer: Oxford Commercial	$253.13
Rate for Payer: Qualcare PPO/HMO/WC	$189.85
Rate for Payer: UnitedHealthcare Commercial	$253.13
Rate for Payer: UnitedHealthcare Community & State	$30.50
Rate for Payer: Wellpoint Medicaid Managed Care	$33.54

RT BRACHY SEED NUCLETRON I 192

Facility

$1,265.65

Hospital Charge Code	4500896
Hospital Revenue Code	272
Min. Negotiated Rate	$189.85
Max. Negotiated Rate	$189.85
Rate for Payer: Qualcare PPO/HMO/WC	$189.85

RT BRACHYTH DOSE PLAN COMPLEX

Facility

$1,415.70

Service Code	HCPCS 77328
Hospital Charge Code	4800199
Hospital Revenue Code	333
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$537.97
Rate for Payer: Aetna Medicare Advantage	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.00
Rate for Payer: Cigna Commercial	$707.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.35
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$34.12
Rate for Payer: Wellpoint Medicaid Managed Care	$37.52

RT BRACHYTH DOSE PLAN COMPLEX

Facility

$1,415.70

Service Code	HCPCS 77328
Hospital Charge Code	4800199
Hospital Revenue Code	333
Min. Negotiated Rate	$212.35
Max. Negotiated Rate	$212.35
Rate for Payer: Qualcare PPO/HMO/WC	$212.35

RT BRACHYTH DOSE PLAN INTERM

Facility

$1,059.20

Service Code	HCPCS 77327
Hospital Charge Code	4800181
Hospital Revenue Code	333
Min. Negotiated Rate	$25.53
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$402.50
Rate for Payer: Aetna Medicare Advantage	$317.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.10
Rate for Payer: Cigna Commercial	$529.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.76
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.88
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$25.53
Rate for Payer: Wellpoint Medicaid Managed Care	$28.07

RT BRACHYTH DOSE PLAN INTERM

Facility

$1,059.20

Service Code	HCPCS 77327
Hospital Charge Code	4800181
Hospital Revenue Code	333
Min. Negotiated Rate	$158.88
Max. Negotiated Rate	$158.88
Rate for Payer: Qualcare PPO/HMO/WC	$158.88

RT BRACHYTH DOSE PLAN SIMPLE

Facility

$908.20

Service Code	HCPCS 77326
Hospital Charge Code	4800755
Hospital Revenue Code	333
Min. Negotiated Rate	$136.23
Max. Negotiated Rate	$136.23
Rate for Payer: Qualcare PPO/HMO/WC	$136.23

RT BRACHYTH DOSE PLAN SIMPLE

Facility

$908.20

Service Code	HCPCS 77326
Hospital Charge Code	4800755
Hospital Revenue Code	333
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$345.12
Rate for Payer: Aetna Medicare Advantage	$272.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.59
Rate for Payer: Cigna Commercial	$454.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.46
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.23
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$21.89
Rate for Payer: Wellpoint Medicaid Managed Care	$24.07

RT BRACHYTH SEED PALLAD 103

Facility

$677.50

Hospital Charge Code	4800744
Hospital Revenue Code	278
Min. Negotiated Rate	$101.62
Max. Negotiated Rate	$163.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.62

RT BRACHYTH SEED PALLAD 103

Facility

$677.50

Hospital Charge Code	4800744
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$338.75
Rate for Payer: Aetna Commercial	$257.45
Rate for Payer: Aetna Medicare Advantage	$203.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.76
Rate for Payer: Cigna Commercial	$338.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.62
Rate for Payer: UnitedHealthcare Community & State	$16.33
Rate for Payer: Wellpoint Medicaid Managed Care	$17.95

RT BRONCH W/CATH FOR RADIOELEM

Facility

$1,148.80

Service Code	HCPCS 31643
Hospital Charge Code	4800785
Hospital Revenue Code	761
Min. Negotiated Rate	$172.32
Max. Negotiated Rate	$172.32
Rate for Payer: Qualcare PPO/HMO/WC	$172.32

RT BRONCH W/CATH FOR RADIOELEM

Facility

$1,148.80

Service Code	HCPCS 31643
Hospital Charge Code	4800785
Hospital Revenue Code	761
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$7,632.96
Rate for Payer: Aetna Commercial	$5,751.63
Rate for Payer: Aetna Medicare Advantage	$6,851.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,632.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,632.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,632.96
Rate for Payer: Cigna Commercial	$4,238.63
Rate for Payer: Cigna Medicare Advantage	$2,114.57
Rate for Payer: Clover Medicare Advantage	$2,008.84
Rate for Payer: EmblemHealth Commercial	$6,343.71
Rate for Payer: Humana Medicare Advantage	$2,178.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,114.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.64
Rate for Payer: Oxford Commercial	$229.76
Rate for Payer: Qualcare PPO/HMO/WC	$172.32
Rate for Payer: UnitedHealthcare Commercial	$229.76
Rate for Payer: UnitedHealthcare Community & State	$27.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,114.57
Rate for Payer: Wellcare Medicare Advantage	$2,114.57
Rate for Payer: Wellpoint Medicaid Managed Care	$30.44

RT CONTINUING PHYSICS COURSE

Facility

$644.50

Service Code	HCPCS 77336
Hospital Charge Code	4800132
Hospital Revenue Code	333
Min. Negotiated Rate	$96.67
Max. Negotiated Rate	$96.67
Rate for Payer: Qualcare PPO/HMO/WC	$96.67

RT CONTINUING PHYSICS COURSE

Facility

$644.50

Service Code	HCPCS 77336
Hospital Charge Code	4800132
Hospital Revenue Code	333
Min. Negotiated Rate	$15.53
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	$193.35
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.67
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$15.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$17.08

RT EST PT VS LEVEL 1 - 5 MIN**

Facility

$300.74

Service Code	HCPCS 99211
Hospital Charge Code	4800454
Hospital Revenue Code	510
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$150.37
Rate for Payer: Aetna Commercial	$114.28
Rate for Payer: Aetna Medicare Advantage	$90.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.69
Rate for Payer: Cigna Commercial	$150.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.22
Rate for Payer: Qualcare PPO/HMO/WC	$45.11
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

Know your out-of-pocket cost for care.

All Charges