Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RT SR89 PER mCi

Facility

$1,607.05

Hospital Charge Code	4800660
Hospital Revenue Code	636
Min. Negotiated Rate	$38.73
Max. Negotiated Rate	$803.52
Rate for Payer: Aetna Commercial	$610.68
Rate for Payer: Aetna Medicare Advantage	$482.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.80
Rate for Payer: Cigna Commercial	$803.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.91
Rate for Payer: Qualcare PPO/HMO/WC	$241.06
Rate for Payer: UnitedHealthcare Community & State	$38.73
Rate for Payer: Wellpoint Medicaid Managed Care	$42.59

RT SR89 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800678
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 SR89 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800678
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT SR90 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800694
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT SR90 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800694
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 TECH BLOOD IRRADIATION

Facility

$320.00

Service Code	HCPCS 86945
Hospital Charge Code	4800652
Hospital Revenue Code	302
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$160.16
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.48

RT TECH BLOOD IRRADIATION

Facility

$320.00

Service Code	HCPCS 86945
Hospital Charge Code	4800652
Hospital Revenue Code	302
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

RT TELE-ISODOSE PLAN COMPLEX

Facility

$773.80

Service Code	HCPCS 77315
Hospital Charge Code	4800082
Hospital Revenue Code	333
Min. Negotiated Rate	$116.07
Max. Negotiated Rate	$116.07
Rate for Payer: Qualcare PPO/HMO/WC	$116.07

RT TELE-ISODOSE PLAN COMPLEX

Facility

$773.80

Service Code	HCPCS 77315
Hospital Charge Code	4800082
Hospital Revenue Code	333
Min. Negotiated Rate	$18.65
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$294.04
Rate for Payer: Aetna Medicare Advantage	$232.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.32
Rate for Payer: Cigna Commercial	$386.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.14
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.07
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$18.65
Rate for Payer: Wellpoint Medicaid Managed Care	$20.51

RT TELE-ISODOSE PLAN INTERMED

Facility

$429.45

Service Code	HCPCS 77310
Hospital Charge Code	4800074
Hospital Revenue Code	333
Min. Negotiated Rate	$64.42
Max. Negotiated Rate	$64.42
Rate for Payer: Qualcare PPO/HMO/WC	$64.42

RT TELE-ISODOSE PLAN INTERMED

Facility

$429.45

Service Code	HCPCS 77310
Hospital Charge Code	4800074
Hospital Revenue Code	333
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$163.19
Rate for Payer: Aetna Medicare Advantage	$128.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.51
Rate for Payer: Cigna Commercial	$214.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.84
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.42
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.35
Rate for Payer: Wellpoint Medicaid Managed Care	$11.38

RT TELE-ISODOSE PLAN SIMPLE

Facility

$400.00

Service Code	HCPCS 77305
Hospital Charge Code	4800066
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

RT TELE-ISODOSE PLAN SIMPLE

Facility

$400.00

Service Code	HCPCS 77305
Hospital Charge Code	4800066
Hospital Revenue Code	333
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

RT TREATMENT DEVICE COMPLEX

Facility

$1,020.80

Service Code	HCPCS 77334
Hospital Charge Code	4800165
Hospital Revenue Code	333
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.24
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.12
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$24.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$27.05

RT TREATMENT DEVICE COMPLEX

Facility

$1,020.80

Service Code	HCPCS 77334
Hospital Charge Code	4800165
Hospital Revenue Code	333
Min. Negotiated Rate	$153.12
Max. Negotiated Rate	$153.12
Rate for Payer: Qualcare PPO/HMO/WC	$153.12

RT TREATMENT DEVICE INTERMED

Facility

$451.85

Service Code	HCPCS 77333
Hospital Charge Code	4800157
Hospital Revenue Code	333
Min. Negotiated Rate	$67.78
Max. Negotiated Rate	$67.78
Rate for Payer: Qualcare PPO/HMO/WC	$67.78

RT TREATMENT DEVICE INTERMED

Facility

$451.85

Service Code	HCPCS 77333
Hospital Charge Code	4800157
Hospital Revenue Code	333
Min. Negotiated Rate	$10.89
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	$135.56
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.78
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.97

RT TREATMENT DEVICE SIMPLE

Facility

$331.55

Service Code	HCPCS 77332
Hospital Charge Code	4800140
Hospital Revenue Code	333
Min. Negotiated Rate	$7.99
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	$99.47
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

RT TREATMENT DEVICE SIMPLE

Facility

$331.55

Service Code	HCPCS 77332
Hospital Charge Code	4800140
Hospital Revenue Code	333
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

RT TX DELIVERY COMPLEX (11-19)

Facility

$842.25

Service Code	HCPCS 77414
Hospital Charge Code	4800256
Hospital Revenue Code	333
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$320.06
Rate for Payer: Aetna Medicare Advantage	$252.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.77
Rate for Payer: Cigna Commercial	$421.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.68
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.34
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$20.30
Rate for Payer: Wellpoint Medicaid Managed Care	$22.32

RT TX DELIVERY COMPLEX (11-19)

Facility

$842.25

Service Code	HCPCS 77414
Hospital Charge Code	4800256
Hospital Revenue Code	333
Min. Negotiated Rate	$126.34
Max. Negotiated Rate	$126.34
Rate for Payer: Qualcare PPO/HMO/WC	$126.34

RT TX DELIVERY COMPLEX 20+

Facility

$449.30

Service Code	HCPCS 77416
Hospital Charge Code	4800505
Hospital Revenue Code	333
Min. Negotiated Rate	$67.39
Max. Negotiated Rate	$67.39
Rate for Payer: Qualcare PPO/HMO/WC	$67.39

RT TX DELIVERY COMPLEX 20+

Facility

$449.30

Service Code	HCPCS 77416
Hospital Charge Code	4800505
Hospital Revenue Code	333
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$170.73
Rate for Payer: Aetna Medicare Advantage	$134.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.57
Rate for Payer: Cigna Commercial	$224.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.79
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.39
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.83
Rate for Payer: Wellpoint Medicaid Managed Care	$11.91

RT TX DELIVERY COMPLEX (6-10)

Facility

$821.80

Service Code	HCPCS 77413
Hospital Charge Code	4800249
Hospital Revenue Code	333
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$312.28
Rate for Payer: Aetna Medicare Advantage	$246.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.56
Rate for Payer: Cigna Commercial	$410.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.54
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.27
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$19.81
Rate for Payer: Wellpoint Medicaid Managed Care	$21.78

RT TX DELIVERY COMPLEX (6-10)

Facility

$821.80

Service Code	HCPCS 77413
Hospital Charge Code	4800249
Hospital Revenue Code	333
Min. Negotiated Rate	$123.27
Max. Negotiated Rate	$123.27
Rate for Payer: Qualcare PPO/HMO/WC	$123.27

Know your out-of-pocket cost for care.

All Charges