Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SET RADIATION TX FIELD-PC

Facility

$186.20

Service Code	HCPCS 7728026
Hospital Charge Code	85000395
Hospital Revenue Code	333
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Qualcare PPO/HMO/WC	$27.93

SET RADIATION TX FIELD-PC

Facility

$1,218.20

Service Code	HCPCS 7729526
Hospital Charge Code	85000440
Hospital Revenue Code	333
Min. Negotiated Rate	$29.36
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$462.92
Rate for Payer: Aetna Medicare Advantage	$365.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.64
Rate for Payer: Cigna Commercial	$609.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.46
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.73
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$29.36
Rate for Payer: Wellpoint Medicaid Managed Care	$32.28

SET RADIATION TX FIELD-TC

Facility

$1,629.95

Service Code	HCPCS 77295TC
Hospital Charge Code	85000435
Hospital Revenue Code	333
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$619.38
Rate for Payer: Aetna Medicare Advantage	$488.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.64
Rate for Payer: Cigna Commercial	$814.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.99
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.49
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$39.28
Rate for Payer: Wellpoint Medicaid Managed Care	$43.19

SET RADIATION TX FIELD-TC

Facility

$1,629.95

Service Code	HCPCS 77295TC
Hospital Charge Code	85000435
Hospital Revenue Code	333
Min. Negotiated Rate	$244.49
Max. Negotiated Rate	$244.49
Rate for Payer: Qualcare PPO/HMO/WC	$244.49

SET RADIATION TX FIELD-TC

Facility

$908.05

Service Code	HCPCS 77280TC
Hospital Charge Code	85000390
Hospital Revenue Code	333
Min. Negotiated Rate	$136.21
Max. Negotiated Rate	$136.21
Rate for Payer: Qualcare PPO/HMO/WC	$136.21

SET RADIATION TX FIELD-TC

Facility

$2,724.65

Service Code	HCPCS 77290TC
Hospital Charge Code	85000420
Hospital Revenue Code	333
Min. Negotiated Rate	$408.70
Max. Negotiated Rate	$408.70
Rate for Payer: Qualcare PPO/HMO/WC	$408.70

SET RADIATION TX FIELD-TC

Facility

$1,656.90

Service Code	HCPCS 77285TC
Hospital Charge Code	85000405
Hospital Revenue Code	333
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$629.62
Rate for Payer: Aetna Medicare Advantage	$497.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.51
Rate for Payer: Cigna Commercial	$828.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.07
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.53
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$39.93
Rate for Payer: Wellpoint Medicaid Managed Care	$43.91

SET RADIATION TX FIELD-TC

Facility

$908.05

Service Code	HCPCS 77280TC
Hospital Charge Code	85000390
Hospital Revenue Code	333
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$345.06
Rate for Payer: Aetna Medicare Advantage	$272.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.55
Rate for Payer: Cigna Commercial	$454.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.42
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.21
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$21.88
Rate for Payer: Wellpoint Medicaid Managed Care	$24.06

SET RADIATION TX FIELD-TC

Facility

$1,656.90

Service Code	HCPCS 77285TC
Hospital Charge Code	85000405
Hospital Revenue Code	333
Min. Negotiated Rate	$248.53
Max. Negotiated Rate	$248.53
Rate for Payer: Qualcare PPO/HMO/WC	$248.53

SET RADIATION TX FIELD-TC

Facility

$2,724.65

Service Code	HCPCS 77290TC
Hospital Charge Code	85000420
Hospital Revenue Code	333
Min. Negotiated Rate	$65.66
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,035.37
Rate for Payer: Aetna Medicare Advantage	$817.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.79
Rate for Payer: Cigna Commercial	$1,362.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$817.39
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$408.70
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$65.66
Rate for Payer: Wellpoint Medicaid Managed Care	$72.20

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$315.20
Max. Negotiated Rate	$508.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.30
Rate for Payer: Qualcare PPO/HMO/WC	$315.20

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$50.64
Max. Negotiated Rate	$1,050.67
Rate for Payer: Aetna Commercial	$798.51
Rate for Payer: Aetna Medicare Advantage	$630.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.84
Rate for Payer: Cigna Commercial	$1,050.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.30
Rate for Payer: Qualcare PPO/HMO/WC	$315.20
Rate for Payer: UnitedHealthcare Community & State	$50.64
Rate for Payer: Wellpoint Medicaid Managed Care	$55.69

SET RESPIRATORY TRANSFER***

Facility

$8.00

Hospital Charge Code	9501131
Hospital Revenue Code	279
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SET RESPIRATORY TRANSFER***

Facility

$8.00

Hospital Charge Code	9501131
Hospital Revenue Code	279
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705429
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$68.56
Max. Negotiated Rate	$1,422.50
Rate for Payer: Aetna Commercial	$1,081.10
Rate for Payer: Aetna Medicare Advantage	$853.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.48
Rate for Payer: Cigna Commercial	$1,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.90
Rate for Payer: Qualcare PPO/HMO/WC	$426.75
Rate for Payer: UnitedHealthcare Community & State	$68.56
Rate for Payer: Wellpoint Medicaid Managed Care	$75.39

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.90
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705429
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

SET SCREW

Facility

$2,900.00

Hospital Charge Code	270662645
Hospital Revenue Code	278
Min. Negotiated Rate	$435.00
Max. Negotiated Rate	$701.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$638.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.00

Know your out-of-pocket cost for care.

All Charges