Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RT INFUSE/INSTILL RADIOELEMENT

Facility

$515.20

Service Code	HCPCS 77750
Hospital Charge Code	4800765
Hospital Revenue Code	333
Min. Negotiated Rate	$12.42
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	$154.56
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$12.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$458.22
Rate for Payer: Wellcare Medicare Advantage	$458.22
Rate for Payer: Wellpoint Medicaid Managed Care	$13.65

RT INFUSE/INSTILL RADIOELEMENT

Facility

$515.20

Service Code	HCPCS 77750
Hospital Charge Code	4800765
Hospital Revenue Code	333
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

RT INPT CONSULT COMPLEX

Facility

$922.00

Service Code	HCPCS 99254
Hospital Charge Code	4800840
Hospital Revenue Code	949
Min. Negotiated Rate	$22.22
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$350.36
Rate for Payer: Aetna Medicare Advantage	$276.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.11
Rate for Payer: Cigna Commercial	$461.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.60
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.30
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$22.22
Rate for Payer: Wellpoint Medicaid Managed Care	$24.43

RT INPT CONSULT COMPLEX

Facility

$922.00

Service Code	HCPCS 99254
Hospital Charge Code	4800840
Hospital Revenue Code	949
Min. Negotiated Rate	$138.30
Max. Negotiated Rate	$138.30
Rate for Payer: Qualcare PPO/HMO/WC	$138.30

RT INPT CONSULT HIGH COMPLEX

Facility

$1,272.00

Service Code	HCPCS 99255
Hospital Charge Code	4800845
Hospital Revenue Code	949
Min. Negotiated Rate	$30.66
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$483.36
Rate for Payer: Aetna Medicare Advantage	$381.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.36
Rate for Payer: Cigna Commercial	$636.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.60
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$190.80
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$30.66
Rate for Payer: Wellpoint Medicaid Managed Care	$33.71

RT INPT CONSULT HIGH COMPLEX

Facility

$1,272.00

Service Code	HCPCS 99255
Hospital Charge Code	4800845
Hospital Revenue Code	949
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Qualcare PPO/HMO/WC	$190.80

RT INPT CONSULT LOW SEVERITY

Facility

$471.00

Service Code	HCPCS 99252
Hospital Charge Code	4800830
Hospital Revenue Code	949
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$70.65
Rate for Payer: Qualcare PPO/HMO/WC	$70.65

RT INPT CONSULT LOW SEVERITY

Facility

$471.00

Service Code	HCPCS 99252
Hospital Charge Code	4800830
Hospital Revenue Code	949
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$178.98
Rate for Payer: Aetna Medicare Advantage	$141.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.11
Rate for Payer: Cigna Commercial	$235.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.30
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.65
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$11.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

RT INPT CONSULT MOD SEVERITY

Facility

$644.00

Service Code	HCPCS 99253
Hospital Charge Code	4800835
Hospital Revenue Code	949
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$244.72
Rate for Payer: Aetna Medicare Advantage	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.22
Rate for Payer: Cigna Commercial	$322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.20
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.60
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$15.52
Rate for Payer: Wellpoint Medicaid Managed Care	$17.07

RT INPT CONSULT MOD SEVERITY

Facility

$644.00

Service Code	HCPCS 99253
Hospital Charge Code	4800835
Hospital Revenue Code	949
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$96.60
Rate for Payer: Qualcare PPO/HMO/WC	$96.60

RT INPT CONSULT SIMPLE

Facility

$234.00

Service Code	HCPCS 99251
Hospital Charge Code	4800825
Hospital Revenue Code	949
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

RT INPT CONSULT SIMPLE

Facility

$234.00

Service Code	HCPCS 99251
Hospital Charge Code	4800825
Hospital Revenue Code	949
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

RT INPT FOLLOW UP EXTENDED

Facility

$330.25

Service Code	HCPCS 99233
Hospital Charge Code	4800820
Hospital Revenue Code	949
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$125.50
Rate for Payer: Aetna Medicare Advantage	$99.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.21
Rate for Payer: Cigna Commercial	$165.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.08
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.54
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$7.96
Rate for Payer: Wellpoint Medicaid Managed Care	$8.75

RT INPT FOLLOW UP EXTENDED

Facility

$330.25

Service Code	HCPCS 99233
Hospital Charge Code	4800820
Hospital Revenue Code	949
Min. Negotiated Rate	$49.54
Max. Negotiated Rate	$49.54
Rate for Payer: Qualcare PPO/HMO/WC	$49.54

RT INTERST RADIOELM TO PROSTAT

Facility

$10,881.00

Service Code	HCPCS 55875
Hospital Charge Code	4800805
Hospital Revenue Code	761
Min. Negotiated Rate	$262.23
Max. Negotiated Rate	$22,993.64
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,993.64
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,264.30
Rate for Payer: Oxford Commercial	$2,176.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.15
Rate for Payer: UnitedHealthcare Commercial	$2,176.20
Rate for Payer: UnitedHealthcare Community & State	$262.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$288.35

RT INTERST RADIOELM TO PROSTAT

Facility

$10,881.00

Service Code	HCPCS 55875
Hospital Charge Code	4800805
Hospital Revenue Code	761
Min. Negotiated Rate	$1,632.15
Max. Negotiated Rate	$1,632.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.15

RT LARYNGOSCOPY

Facility

$377.00

Service Code	HCPCS 31575
Hospital Charge Code	4800810
Hospital Revenue Code	360
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$56.55
Rate for Payer: Qualcare PPO/HMO/WC	$56.55

RT LARYNGOSCOPY

Facility

$377.00

Service Code	HCPCS 31575
Hospital Charge Code	4800810
Hospital Revenue Code	360
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$645.02
Rate for Payer: Aetna Medicare Advantage	$768.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$237.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.00
Rate for Payer: Cigna Commercial	$475.34
Rate for Payer: Cigna Medicare Advantage	$237.14
Rate for Payer: Clover Medicare Advantage	$225.28
Rate for Payer: EmblemHealth Commercial	$711.42
Rate for Payer: Humana Medicare Advantage	$244.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$237.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.55
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$237.14
Rate for Payer: Wellcare Medicare Advantage	$237.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$528.97
Rate for Payer: Wellpoint Medicaid Managed Care	$518.60

RT MTP PLATE MED 5

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270684669
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$1,858.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,689.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

RT MTP PLATE MED 5

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270684669
Hospital Revenue Code	278
Min. Negotiated Rate	$185.09
Max. Negotiated Rate	$3,840.00
Rate for Payer: Aetna Commercial	$2,918.40
Rate for Payer: Aetna Medicare Advantage	$2,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,958.40
Rate for Payer: Cigna Commercial	$3,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,689.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00
Rate for Payer: UnitedHealthcare Community & State	$185.09
Rate for Payer: Wellpoint Medicaid Managed Care	$203.52

RT NEW PT VS LEVEL 1 - 10 MIN

Facility

$216.00

Service Code	HCPCS 99201
Hospital Charge Code	4800770
Hospital Revenue Code	510
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

RT NEW PT VS LEVEL 1 - 10 MIN

Facility

$216.00

Service Code	HCPCS 99201
Hospital Charge Code	4800770
Hospital Revenue Code	510
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna Commercial	$82.08
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

RT NEW PT VS LEVEL 2 - 20 MIN

Facility

$416.00

Service Code	HCPCS 99202
Hospital Charge Code	4800775
Hospital Revenue Code	510
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

RT NEW PT VS LEVEL 2 - 20 MIN

Facility

$416.00

Service Code	HCPCS 99202
Hospital Charge Code	4800775
Hospital Revenue Code	510
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$158.08
Rate for Payer: Aetna Medicare Advantage	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.08
Rate for Payer: Cigna Commercial	$208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.40
Rate for Payer: UnitedHealthcare Community & State	$10.03
Rate for Payer: Wellpoint Medicaid Managed Care	$11.02

RT NEW PT VS LEVEL 3 - 30 MIN

Facility

$542.00

Service Code	HCPCS 99203
Hospital Charge Code	4800421
Hospital Revenue Code	510
Min. Negotiated Rate	$81.30
Max. Negotiated Rate	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$81.30

Know your out-of-pocket cost for care.

All Charges