Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$13.06
Max. Negotiated Rate	$271.00
Rate for Payer: Aetna Commercial	$205.96
Rate for Payer: Aetna Medicare Advantage	$162.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.21
Rate for Payer: Cigna Commercial	$271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.30
Rate for Payer: UnitedHealthcare Community & State	$13.06
Rate for Payer: Wellpoint Medicaid Managed Care	$14.36

RT NEW PT VS LEVEL 4 - 45 MIN

Facility

$675.00

Service Code	HCPCS 99204
Hospital Charge Code	4800439
Hospital Revenue Code	510
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$16.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17.89

RT NEW PT VS LEVEL 4 - 45 MIN

Facility

$675.00

Service Code	HCPCS 99204
Hospital Charge Code	4800439
Hospital Revenue Code	510
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

RT NEW PT VS LEVEL 5 - 60 MIN

Facility

$857.00

Service Code	HCPCS 99205
Hospital Charge Code	4800413
Hospital Revenue Code	510
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$428.50
Rate for Payer: Aetna Commercial	$325.66
Rate for Payer: Aetna Medicare Advantage	$257.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.53
Rate for Payer: Cigna Commercial	$428.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.10
Rate for Payer: Qualcare PPO/HMO/WC	$128.55
Rate for Payer: UnitedHealthcare Community & State	$20.65
Rate for Payer: Wellpoint Medicaid Managed Care	$22.71

RT NEW PT VS LEVEL 5 - 60 MIN

Facility

$857.00

Service Code	HCPCS 99205
Hospital Charge Code	4800413
Hospital Revenue Code	510
Min. Negotiated Rate	$128.55
Max. Negotiated Rate	$128.55
Rate for Payer: Qualcare PPO/HMO/WC	$128.55

RT NEW PT VS LEVEL LOW SEVRITY

Facility

$294.00

Service Code	HCPCS 99242
Hospital Charge Code	4800411
Hospital Revenue Code	510
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$111.72
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.20
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$7.79

RT NEW PT VS LEVEL LOW SEVRITY

Facility

$294.00

Service Code	HCPCS 99242
Hospital Charge Code	4800411
Hospital Revenue Code	510
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

RT NEW PT VS LEVEL SIMPLE

Facility

$294.00

Service Code	HCPCS 99241
Hospital Charge Code	4800410
Hospital Revenue Code	510
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

RT NEW PT VS LEVEL SIMPLE

Facility

$294.00

Service Code	HCPCS 99241
Hospital Charge Code	4800410
Hospital Revenue Code	510
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$111.72
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.20
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$7.79

RT P32 PER mCi

Facility

$285.45

Hospital Charge Code	4800686
Hospital Revenue Code	636
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$142.72
Rate for Payer: Aetna Commercial	$108.47
Rate for Payer: Aetna Medicare Advantage	$85.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.79
Rate for Payer: Cigna Commercial	$142.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.56

RT P32 PER mCi

Facility

$285.45

Hospital Charge Code	4800686
Hospital Revenue Code	636
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$69.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82

RT P32 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800702
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT P32 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800702
Hospital Revenue Code	342
Min. Negotiated Rate	$34.54
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$754.01
Rate for Payer: Aetna Medicare Advantage	$898.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$277.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,000.64
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: Cigna Medicare Advantage	$194.05
Rate for Payer: Clover Medicare Advantage	$263.35
Rate for Payer: EmblemHealth Commercial	$831.63
Rate for Payer: Humana Medicare Advantage	$285.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$277.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.90
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.95
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$34.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$37.97

RT PORT FILMS

Facility

$201.60

Service Code	HCPCS 77417
Hospital Charge Code	4800124
Hospital Revenue Code	333
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$30.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.24

RT PORT FILMS

Facility

$201.60

Service Code	HCPCS 77417
Hospital Charge Code	4800124
Hospital Revenue Code	333
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$76.61
Rate for Payer: Aetna Medicare Advantage	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.41
Rate for Payer: Cigna Commercial	$100.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.24
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$5.34

RT PROSTATE VOL FR BRACHYTH TX

Facility

$810.25

Service Code	HCPCS 76873
Hospital Charge Code	4800795
Hospital Revenue Code	402
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.07
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.54
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$19.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$21.47

RT PROSTATE VOL FR BRACHYTH TX

Facility

$810.25

Service Code	HCPCS 76873
Hospital Charge Code	4800795
Hospital Revenue Code	402
Min. Negotiated Rate	$121.54
Max. Negotiated Rate	$121.54
Rate for Payer: Qualcare PPO/HMO/WC	$121.54

RT RADIOELEMENT HANDLING/LOAD

Facility

$419.85

Service Code	HCPCS 77790
Hospital Charge Code	4800371
Hospital Revenue Code	333
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

RT RADIOELEMENT HANDLING/LOAD

Facility

$419.85

Service Code	HCPCS 77790
Hospital Charge Code	4800371
Hospital Revenue Code	333
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$159.54
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.95
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

RT RADIOELEMENT SURFACE APPLIC

Facility

$419.85

Service Code	HCPCS 77789
Hospital Charge Code	4800363
Hospital Revenue Code	333
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

RT RADIOELEMENT SURFACE APPLIC

Facility

$419.85

Service Code	HCPCS 77789
Hospital Charge Code	4800363
Hospital Revenue Code	333
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$329.69
Rate for Payer: Aetna Medicare Advantage	$392.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$121.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.53
Rate for Payer: Cigna Commercial	$242.98
Rate for Payer: Cigna Medicare Advantage	$84.85
Rate for Payer: Clover Medicare Advantage	$115.15
Rate for Payer: EmblemHealth Commercial	$363.63
Rate for Payer: Humana Medicare Advantage	$124.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$121.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.95
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$121.21
Rate for Payer: Wellcare Medicare Advantage	$121.21
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

RT RADIOELEM INTERSTIT COMPLEX

Facility

$3,106.50

Service Code	HCPCS 77778
Hospital Charge Code	4800314
Hospital Revenue Code	342
Min. Negotiated Rate	$465.98
Max. Negotiated Rate	$465.98
Rate for Payer: Qualcare PPO/HMO/WC	$465.98

RT RADIOELEM INTERSTIT COMPLEX

Facility

$3,106.50

Service Code	HCPCS 77778
Hospital Charge Code	4800314
Hospital Revenue Code	342
Min. Negotiated Rate	$74.87
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$2,250.61
Rate for Payer: Aetna Medicare Advantage	$2,680.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,986.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,986.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$827.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,986.77
Rate for Payer: Cigna Commercial	$1,658.57
Rate for Payer: Cigna Medicare Advantage	$579.20
Rate for Payer: Clover Medicare Advantage	$786.06
Rate for Payer: EmblemHealth Commercial	$2,482.29
Rate for Payer: Humana Medicare Advantage	$852.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$827.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.95
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.98
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$74.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$827.43
Rate for Payer: Wellcare Medicare Advantage	$827.43
Rate for Payer: Wellpoint Medicaid Managed Care	$82.32

RT RADIOELEM INTERSTIT INTERM

Facility

$935.70

Service Code	HCPCS 77777
Hospital Charge Code	4800306
Hospital Revenue Code	333
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$355.57
Rate for Payer: Aetna Medicare Advantage	$280.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.60
Rate for Payer: Cigna Commercial	$467.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.71
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.35
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$22.55
Rate for Payer: Wellpoint Medicaid Managed Care	$24.80

RT RADIOELEM INTERSTIT INTERM

Facility

$935.70

Service Code	HCPCS 77777
Hospital Charge Code	4800306
Hospital Revenue Code	333
Min. Negotiated Rate	$140.35
Max. Negotiated Rate	$140.35
Rate for Payer: Qualcare PPO/HMO/WC	$140.35

Know your out-of-pocket cost for care.

All Charges