Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SET PROCESNG ANGEL ANGELKIT110

Facility

$1,170.00

Hospital Charge Code	270639730
Hospital Revenue Code	272
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$444.60
Rate for Payer: Aetna Medicare Advantage	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.35
Rate for Payer: Cigna Commercial	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$234.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.50
Rate for Payer: UnitedHealthcare Commercial	$234.00
Rate for Payer: UnitedHealthcare Community & State	$28.20
Rate for Payer: Wellpoint Medicaid Managed Care	$31.00

SET PT ADMIN CARDIOGEN-82 42

Facility

$80.85

Hospital Charge Code	270649330
Hospital Revenue Code	271
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.13

SET PT ADMIN CARDIOGEN-82 42

Facility

$80.85

Hospital Charge Code	270649330
Hospital Revenue Code	271
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.42
Rate for Payer: Aetna Commercial	$30.72
Rate for Payer: Aetna Medicare Advantage	$24.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.62
Rate for Payer: Cigna Commercial	$40.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.25
Rate for Payer: Oxford Commercial	$16.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.13
Rate for Payer: UnitedHealthcare Commercial	$16.17
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

SET PUMP KANGAROO N/STER

Facility

$10.88

Hospital Charge Code	270649489
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.44
Rate for Payer: Aetna Commercial	$4.13
Rate for Payer: Aetna Medicare Advantage	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.77
Rate for Payer: Cigna Commercial	$5.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.26
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.63
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SET PUMP KANGAROO N/STER

Facility

$10.88

Hospital Charge Code	270649489
Hospital Revenue Code	272
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.63

SET QUICK 8 CC

Facility

$9,975.00

Hospital Charge Code	270684009
Hospital Revenue Code	272
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$1,496.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

SET QUICK 8 CC

Facility

$9,975.00

Hospital Charge Code	270684009
Hospital Revenue Code	272
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,992.50
Rate for Payer: Oxford Commercial	$1,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Commercial	$1,995.00
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

SET RADIATION TX FIELD

Facility

$1,884.55

Service Code	HCPCS 77290
Hospital Charge Code	321077290
Hospital Revenue Code	333
Min. Negotiated Rate	$282.68
Max. Negotiated Rate	$282.68
Rate for Payer: Qualcare PPO/HMO/WC	$282.68

SET RADIATION TX FIELD

Facility

$1,884.55

Service Code	HCPCS 77290
Hospital Charge Code	321077290
Hospital Revenue Code	333
Min. Negotiated Rate	$45.42
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	$565.37
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.68
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$107.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.94

SET RADIATION TX FIELD

Facility

$1,884.55

Service Code	HCPCS 77290
Hospital Charge Code	404677290
Hospital Revenue Code	333
Min. Negotiated Rate	$282.68
Max. Negotiated Rate	$282.68
Rate for Payer: Qualcare PPO/HMO/WC	$282.68

SET RADIATION TX FIELD

Facility

$1,884.55

Service Code	HCPCS 77290
Hospital Charge Code	404677290
Hospital Revenue Code	333
Min. Negotiated Rate	$45.42
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	$565.37
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.68
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$107.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.94

SET RADIATION TX FIELD-GL

Facility

$711.65

Service Code	HCPCS 77280
Hospital Charge Code	85000385
Hospital Revenue Code	333
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Qualcare PPO/HMO/WC	$106.75

SET RADIATION TX FIELD-GL

Facility

$1,887.22

Service Code	HCPCS 77285
Hospital Charge Code	85000400
Hospital Revenue Code	333
Min. Negotiated Rate	$45.48
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	$566.17
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$50.01

SET RADIATION TX FIELD-GL

Facility

$1,887.22

Service Code	HCPCS 77285
Hospital Charge Code	85000400
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

SET RADIATION TX FIELD-GL

Facility

$711.65

Service Code	HCPCS 77280
Hospital Charge Code	85000385
Hospital Revenue Code	333
Min. Negotiated Rate	$17.15
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	$213.50
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.75
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$17.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$18.86

SET RADIATION TX FIELD-GL

Facility

$6,384.91

Service Code	HCPCS 77295
Hospital Charge Code	85000430
Hospital Revenue Code	333
Min. Negotiated Rate	$153.88
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	$1,915.47
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$957.74
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$153.88
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	$169.20

SET RADIATION TX FIELD-GL

Facility

$6,384.91

Service Code	HCPCS 77295
Hospital Charge Code	85000430
Hospital Revenue Code	333
Min. Negotiated Rate	$957.74
Max. Negotiated Rate	$957.74
Rate for Payer: Qualcare PPO/HMO/WC	$957.74

SET RADIATION TX FIELD-GL

Facility

$1,887.22

Service Code	HCPCS 77290
Hospital Charge Code	85000415
Hospital Revenue Code	333
Min. Negotiated Rate	$45.48
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	$566.17
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$107.30
Rate for Payer: Wellpoint Medicaid Managed Care	$50.01

SET RADIATION TX FIELD-GL

Facility

$1,887.22

Service Code	HCPCS 77290
Hospital Charge Code	85000415
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

SET RADIATION TX FIELD-PC

Facility

$280.25

Service Code	HCPCS 7728526
Hospital Charge Code	85000410
Hospital Revenue Code	333
Min. Negotiated Rate	$42.04
Max. Negotiated Rate	$42.04
Rate for Payer: Qualcare PPO/HMO/WC	$42.04

SET RADIATION TX FIELD-PC

Facility

$280.25

Service Code	HCPCS 7728526
Hospital Charge Code	85000410
Hospital Revenue Code	333
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$84.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.46
Rate for Payer: Cigna Commercial	$140.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.08
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.04
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.43

SET RADIATION TX FIELD-PC

Facility

$414.75

Service Code	HCPCS 7729026
Hospital Charge Code	85000425
Hospital Revenue Code	333
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$157.60
Rate for Payer: Aetna Medicare Advantage	$124.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.76
Rate for Payer: Cigna Commercial	$207.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.42
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.21
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

SET RADIATION TX FIELD-PC

Facility

$186.20

Service Code	HCPCS 7728026
Hospital Charge Code	85000395
Hospital Revenue Code	333
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$70.76
Rate for Payer: Aetna Medicare Advantage	$55.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.48
Rate for Payer: Cigna Commercial	$93.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.86
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.93
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

SET RADIATION TX FIELD-PC

Facility

$414.75

Service Code	HCPCS 7729026
Hospital Charge Code	85000425
Hospital Revenue Code	333
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$62.21
Rate for Payer: Qualcare PPO/HMO/WC	$62.21

SET RADIATION TX FIELD-PC

Facility

$1,218.20

Service Code	HCPCS 7729526
Hospital Charge Code	85000440
Hospital Revenue Code	333
Min. Negotiated Rate	$182.73
Max. Negotiated Rate	$182.73
Rate for Payer: Qualcare PPO/HMO/WC	$182.73

Know your out-of-pocket cost for care.

All Charges