Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RT TX DELIVERY INTERM (11-19)

Facility

$682.90

Service Code	HCPCS 77409
Hospital Charge Code	4800231
Hospital Revenue Code	333
Min. Negotiated Rate	$102.44
Max. Negotiated Rate	$102.44
Rate for Payer: Qualcare PPO/HMO/WC	$102.44

RT TX DELIVERY INTERM (11-19)

Facility

$682.90

Service Code	HCPCS 77409
Hospital Charge Code	4800231
Hospital Revenue Code	333
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$259.50
Rate for Payer: Aetna Medicare Advantage	$204.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.14
Rate for Payer: Cigna Commercial	$341.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.87
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.44
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$16.46
Rate for Payer: Wellpoint Medicaid Managed Care	$18.10

RT TX DELIVERY INTERM (6-10)

Facility

$663.05

Service Code	HCPCS 77408
Hospital Charge Code	4800223
Hospital Revenue Code	333
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$251.96
Rate for Payer: Aetna Medicare Advantage	$198.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.08
Rate for Payer: Cigna Commercial	$331.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.91
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.46
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$15.98
Rate for Payer: Wellpoint Medicaid Managed Care	$17.57

RT TX DELIVERY INTERM (6-10)

Facility

$663.05

Service Code	HCPCS 77408
Hospital Charge Code	4800223
Hospital Revenue Code	333
Min. Negotiated Rate	$99.46
Max. Negotiated Rate	$99.46
Rate for Payer: Qualcare PPO/HMO/WC	$99.46

RT TX DELIVERY SIMPLE (11-19)

Facility

$440.35

Service Code	HCPCS 77404
Hospital Charge Code	4800215
Hospital Revenue Code	333
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$167.33
Rate for Payer: Aetna Medicare Advantage	$132.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.29
Rate for Payer: Cigna Commercial	$220.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.10
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.05
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.67

RT TX DELIVERY SIMPLE (11-19)

Facility

$440.35

Service Code	HCPCS 77404
Hospital Charge Code	4800215
Hospital Revenue Code	333
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$66.05
Rate for Payer: Qualcare PPO/HMO/WC	$66.05

RT TX DELIVERY SIMPLE (1-5)

Facility

$375.05

Service Code	HCPCS 77402
Hospital Charge Code	4800504
Hospital Revenue Code	333
Min. Negotiated Rate	$9.04
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	$112.52
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.26
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$121.21
Rate for Payer: Wellcare Medicare Advantage	$121.21
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

RT TX DELIVERY SIMPLE (1-5)

Facility

$375.05

Service Code	HCPCS 77402
Hospital Charge Code	4800504
Hospital Revenue Code	333
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$56.26
Rate for Payer: Qualcare PPO/HMO/WC	$56.26

RT TX DELIVERY SIMPLE (6-10)

Facility

$419.85

Service Code	HCPCS 77403
Hospital Charge Code	4800207
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 TX DELIVERY SIMPLE (6-10)

Facility

$419.85

Service Code	HCPCS 77403
Hospital Charge Code	4800207
Hospital Revenue Code	333
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

RT TX IMRT

Facility

$3,709.45

Service Code	HCPCS 77301
Hospital Charge Code	4800503
Hospital Revenue Code	333
Min. Negotiated Rate	$89.40
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$4,472.71
Rate for Payer: Aetna Medicare Advantage	$5,327.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,935.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,644.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,935.72
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: Cigna Medicare Advantage	$1,151.07
Rate for Payer: Clover Medicare Advantage	$1,562.16
Rate for Payer: EmblemHealth Commercial	$4,933.14
Rate for Payer: Humana Medicare Advantage	$1,693.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,644.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,112.84
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$556.42
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$89.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,644.38
Rate for Payer: Wellcare Medicare Advantage	$1,644.38
Rate for Payer: Wellpoint Medicaid Managed Care	$98.30

RT TX IMRT

Facility

$3,709.45

Service Code	HCPCS 77301
Hospital Charge Code	4800503
Hospital Revenue Code	333
Min. Negotiated Rate	$556.42
Max. Negotiated Rate	$556.42
Rate for Payer: Qualcare PPO/HMO/WC	$556.42

RT ZEVALIN Y 90

Facility

$26,880.00

Hospital Charge Code	4800850
Hospital Revenue Code	636
Min. Negotiated Rate	$647.81
Max. Negotiated Rate	$13,440.00
Rate for Payer: Aetna Commercial	$10,214.40
Rate for Payer: Aetna Medicare Advantage	$8,064.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,854.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,854.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,854.40
Rate for Payer: Cigna Commercial	$13,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,504.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,032.00
Rate for Payer: UnitedHealthcare Community & State	$647.81
Rate for Payer: Wellpoint Medicaid Managed Care	$712.32

RT ZEVALIN Y 90

Facility

$26,880.00

Hospital Charge Code	4800850
Hospital Revenue Code	636
Min. Negotiated Rate	$4,032.00
Max. Negotiated Rate	$6,504.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,504.96
Rate for Payer: Qualcare PPO/HMO/WC	$4,032.00

RUBBER BAND STERILE 3

Facility

$3.42

Hospital Charge Code	270649496
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Qualcare PPO/HMO/WC	$0.51

RUBBER BAND STERILE 3

Facility

$3.42

Hospital Charge Code	270649496
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.71
Rate for Payer: Aetna Commercial	$1.30
Rate for Payer: Aetna Medicare Advantage	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.87
Rate for Payer: Cigna Commercial	$1.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.03
Rate for Payer: Oxford Commercial	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.51
Rate for Payer: UnitedHealthcare Commercial	$0.68
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

RUBELLA AB, IGG

Facility

$583.00

Service Code	HCPCS 86762
Hospital Charge Code	38476032
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$291.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$291.50
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$15.45

RUBELLA AB, IGG

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3009552
Hospital Revenue Code	302
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

RUBELLA AB, IGG

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3009552
Hospital Revenue Code	302
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

RUBELLA AB, IGG

Facility

$583.00

Service Code	HCPCS 86762
Hospital Charge Code	38476032
Hospital Revenue Code	302
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

RUBELLA AB,IGG

Facility

$465.00

Service Code	HCPCS 86765
Hospital Charge Code	38479080
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

RUBELLA AB,IGG

Facility

$465.00

Service Code	HCPCS 86765
Hospital Charge Code	38479080
Hospital Revenue Code	302
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

RUBELLA AB (IGM)

Facility

$98.95

Service Code	HCPCS 86762
Hospital Charge Code	39900252
Hospital Revenue Code	302
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$14.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.84

RUBELLA AB (IGM)

Facility

$98.95

Service Code	HCPCS 86762
Hospital Charge Code	39900252
Hospital Revenue Code	302
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$49.48
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

RUBELLA AB, IGM

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3009271
Hospital Revenue Code	302
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

Know your out-of-pocket cost for care.

All Charges