Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$45.11
Max. Negotiated Rate	$45.11
Rate for Payer: Qualcare PPO/HMO/WC	$45.11

RT EST PT VS LEVEL 2 - 10 MIN

Facility

$147.00

Service Code	HCPCS 99212
Hospital Charge Code	4800470
Hospital Revenue Code	510
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna Commercial	$55.86
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

RT EST PT VS LEVEL 2 - 10 MIN

Facility

$147.00

Service Code	HCPCS 99212
Hospital Charge Code	4800470
Hospital Revenue Code	510
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

RT EST PT VS LEVEL 3 - 15 MIN

Facility

$159.00

Service Code	HCPCS 99213
Hospital Charge Code	4800488
Hospital Revenue Code	510
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

RT EST PT VS LEVEL 3 - 15 MIN

Facility

$159.00

Service Code	HCPCS 99213
Hospital Charge Code	4800488
Hospital Revenue Code	510
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

RT EST PT VS LEVEL 4 - 25 MIN

Facility

$192.00

Service Code	HCPCS 99214
Hospital Charge Code	4800496
Hospital Revenue Code	510
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.80

RT EST PT VS LEVEL 4 - 25 MIN

Facility

$192.00

Service Code	HCPCS 99214
Hospital Charge Code	4800496
Hospital Revenue Code	510
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$72.96
Rate for Payer: Aetna Medicare Advantage	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.96
Rate for Payer: Cigna Commercial	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.80
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.09

RT EST PT VS LEVEL 5 - 40 MIN

Facility

$805.00

Service Code	HCPCS 99215
Hospital Charge Code	4800780
Hospital Revenue Code	510
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$120.75
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

RT EST PT VS LEVEL 5 - 40 MIN

Facility

$805.00

Service Code	HCPCS 99215
Hospital Charge Code	4800780
Hospital Revenue Code	510
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$402.50
Rate for Payer: Aetna Commercial	$305.90
Rate for Payer: Aetna Medicare Advantage	$241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.28
Rate for Payer: Cigna Commercial	$402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.50
Rate for Payer: Qualcare PPO/HMO/WC	$120.75
Rate for Payer: UnitedHealthcare Community & State	$19.40
Rate for Payer: Wellpoint Medicaid Managed Care	$21.33

RT HI >12 SOURCE POSITION/CATH

Facility

$4,881.95

Service Code	HCPCS 77784
Hospital Charge Code	4800355
Hospital Revenue Code	333
Min. Negotiated Rate	$732.29
Max. Negotiated Rate	$732.29
Rate for Payer: Qualcare PPO/HMO/WC	$732.29

RT HI >12 SOURCE POSITION/CATH

Facility

$4,881.95

Service Code	HCPCS 77784
Hospital Charge Code	4800355
Hospital Revenue Code	333
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,855.14
Rate for Payer: Aetna Medicare Advantage	$1,464.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.90
Rate for Payer: Cigna Commercial	$2,440.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.59
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.29
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$117.65
Rate for Payer: Wellpoint Medicaid Managed Care	$129.37

RT HI 1-4 SOURCE POSITION/CATH

Facility

$3,531.55

Service Code	HCPCS 77781
Hospital Charge Code	4800322
Hospital Revenue Code	333
Min. Negotiated Rate	$85.11
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,341.99
Rate for Payer: Aetna Medicare Advantage	$1,059.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.55
Rate for Payer: Cigna Commercial	$1,765.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,059.46
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$529.73
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$85.11
Rate for Payer: Wellpoint Medicaid Managed Care	$93.59

RT HI 1-4 SOURCE POSITION/CATH

Facility

$3,531.55

Service Code	HCPCS 77781
Hospital Charge Code	4800322
Hospital Revenue Code	333
Min. Negotiated Rate	$529.73
Max. Negotiated Rate	$529.73
Rate for Payer: Qualcare PPO/HMO/WC	$529.73

RT HI 5-8 SOURCE POSITION/CATH

Facility

$3,747.20

Service Code	HCPCS 77782
Hospital Charge Code	4800330
Hospital Revenue Code	333
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,423.94
Rate for Payer: Aetna Medicare Advantage	$1,124.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$955.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$955.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$955.54
Rate for Payer: Cigna Commercial	$1,873.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,124.16
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.08
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$90.31
Rate for Payer: Wellpoint Medicaid Managed Care	$99.30

RT HI 5-8 SOURCE POSITION/CATH

Facility

$3,747.20

Service Code	HCPCS 77782
Hospital Charge Code	4800330
Hospital Revenue Code	333
Min. Negotiated Rate	$562.08
Max. Negotiated Rate	$562.08
Rate for Payer: Qualcare PPO/HMO/WC	$562.08

RT HI 9-12 SOURCE POSITION/CAT

Facility

$3,906.60

Service Code	HCPCS 77783
Hospital Charge Code	4800348
Hospital Revenue Code	333
Min. Negotiated Rate	$585.99
Max. Negotiated Rate	$585.99
Rate for Payer: Qualcare PPO/HMO/WC	$585.99

RT HI 9-12 SOURCE POSITION/CAT

Facility

$3,906.60

Service Code	HCPCS 77783
Hospital Charge Code	4800348
Hospital Revenue Code	333
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,484.51
Rate for Payer: Aetna Medicare Advantage	$1,171.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$996.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$996.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$996.18
Rate for Payer: Cigna Commercial	$1,953.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.98
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.99
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$94.15
Rate for Payer: Wellpoint Medicaid Managed Care	$103.52

RT I 125 SEEDS (10)****

Facility

$847.00

Service Code	HCPCS 79900
Hospital Charge Code	4800728
Hospital Revenue Code	342
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$127.05

RT I 125 SEEDS (10)****

Facility

$847.00

Service Code	HCPCS 79900
Hospital Charge Code	4800728
Hospital Revenue Code	342
Min. Negotiated Rate	$20.41
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$321.86
Rate for Payer: Aetna Medicare Advantage	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.99
Rate for Payer: Cigna Commercial	$423.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.05
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$20.41
Rate for Payer: Wellpoint Medicaid Managed Care	$22.45

RT I 125 SEEDS (5)****

Facility

$424.00

Service Code	HCPCS 79900
Hospital Charge Code	4800710
Hospital Revenue Code	342
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

RT I 125 SEEDS (5)****

Facility

$424.00

Service Code	HCPCS 79900
Hospital Charge Code	4800710
Hospital Revenue Code	342
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$161.12
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.20
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$10.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

RT I 125 SEEDS EACH

Facility

$252.50

Hospital Charge Code	4800736
Hospital Revenue Code	272
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$37.88
Rate for Payer: Qualcare PPO/HMO/WC	$37.88

RT I 125 SEEDS EACH

Facility

$252.50

Hospital Charge Code	4800736
Hospital Revenue Code	272
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$126.25
Rate for Payer: Aetna Commercial	$95.95
Rate for Payer: Aetna Medicare Advantage	$75.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.39
Rate for Payer: Cigna Commercial	$126.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.75
Rate for Payer: Oxford Commercial	$50.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.88
Rate for Payer: UnitedHealthcare Commercial	$50.50
Rate for Payer: UnitedHealthcare Community & State	$6.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.69

RT IB TR W FLIPCUTTER III DRIL

Facility

$5,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270693992
Hospital Revenue Code	278
Min. Negotiated Rate	$127.13
Max. Negotiated Rate	$2,637.50
Rate for Payer: Aetna Commercial	$2,004.50
Rate for Payer: Aetna Medicare Advantage	$1,582.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,345.12
Rate for Payer: Cigna Commercial	$2,637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,276.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,160.50
Rate for Payer: Qualcare PPO/HMO/WC	$791.25
Rate for Payer: UnitedHealthcare Community & State	$127.13
Rate for Payer: Wellpoint Medicaid Managed Care	$139.79

RT IB TR W FLIPCUTTER III DRIL

Facility

$5,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270693992
Hospital Revenue Code	278
Min. Negotiated Rate	$791.25
Max. Negotiated Rate	$1,276.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,276.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,160.50
Rate for Payer: Qualcare PPO/HMO/WC	$791.25

Know your out-of-pocket cost for care.

All Charges