Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPECIAL MED PHYSICS CONSULT

Facility

$515.20

Service Code	HCPCS 77370
Hospital Charge Code	4800546
Hospital Revenue Code	333
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

SPECIAL PROCEDURES

Facility

$22.50

Hospital Charge Code	270636399+
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

SPECIAL PROCEDURES

Facility

$1,295.00

Hospital Charge Code	270640732C
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

SPECIAL PROCEDURES

Facility

$22.50

Hospital Charge Code	270636399+
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.75
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

SPECIAL PROCEDURES

Facility

$1,295.00

Hospital Charge Code	270640732C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

SPECIAL RADIATION DOSIMETRY-GL

Facility

$711.65

Service Code	HCPCS 77331
Hospital Charge Code	85000580
Hospital Revenue Code	333
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Qualcare PPO/HMO/WC	$106.75

SPECIAL RADIATION DOSIMETRY-GL

Facility

$711.65

Service Code	HCPCS 77331
Hospital Charge Code	85000580
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

SPECIAL RADIATION DOSIMETRY-PC

Facility

$232.35

Service Code	HCPCS 7733126
Hospital Charge Code	85000590
Hospital Revenue Code	333
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$34.85
Rate for Payer: Qualcare PPO/HMO/WC	$34.85

SPECIAL RADIATION DOSIMETRY-PC

Facility

$232.35

Service Code	HCPCS 7733126
Hospital Charge Code	85000590
Hospital Revenue Code	333
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$88.29
Rate for Payer: Aetna Medicare Advantage	$69.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.25
Rate for Payer: Cigna Commercial	$116.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.70
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.85
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$6.16

SPECIAL RADIATION DOSIMETRY-TC

Facility

$112.80

Service Code	HCPCS 77331TC
Hospital Charge Code	85000585
Hospital Revenue Code	333
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$16.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.92

SPECIAL RADIATION DOSIMETRY-TC

Facility

$112.80

Service Code	HCPCS 77331TC
Hospital Charge Code	85000585
Hospital Revenue Code	333
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$42.86
Rate for Payer: Aetna Medicare Advantage	$33.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.76
Rate for Payer: Cigna Commercial	$56.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.84
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.92
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

SPECIAL RADIATION TREATMENT

Facility

$2,544.98

Service Code	HCPCS 77470
Hospital Charge Code	85000805
Hospital Revenue Code	333
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,369.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,369.52
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.49
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$381.75
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$61.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$67.44

SPECIAL RADIATION TREATMENT

Facility

$2,544.98

Service Code	HCPCS 77470
Hospital Charge Code	85000805
Hospital Revenue Code	333
Min. Negotiated Rate	$381.75
Max. Negotiated Rate	$381.75
Rate for Payer: Qualcare PPO/HMO/WC	$381.75

SPECIAL RADIATION TREATMENT-PC

Facility

$556.65

Service Code	HCPCS 7747026
Hospital Charge Code	85000815
Hospital Revenue Code	333
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$83.50

SPECIAL RADIATION TREATMENT-PC

Facility

$556.65

Service Code	HCPCS 7747026
Hospital Charge Code	85000815
Hospital Revenue Code	333
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$211.53
Rate for Payer: Aetna Medicare Advantage	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.95
Rate for Payer: Cigna Commercial	$278.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.00
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.50
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$14.75

SPECIAL RADIATION TREATMENT-TC

Facility

$419.60

Service Code	HCPCS 77470TC
Hospital Charge Code	85000810
Hospital Revenue Code	333
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$62.94
Rate for Payer: Qualcare PPO/HMO/WC	$62.94

SPECIAL RADIATION TREATMENT-TC

Facility

$419.60

Service Code	HCPCS 77470TC
Hospital Charge Code	85000810
Hospital Revenue Code	333
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$159.45
Rate for Payer: Aetna Medicare Advantage	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.00
Rate for Payer: Cigna Commercial	$209.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.88
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.94
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$10.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.12

SPECIAL STAIN I

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	3005238
Hospital Revenue Code	312
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.96
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$92.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$13.95

SPECIAL STAIN I

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	3005238
Hospital Revenue Code	312
Min. Negotiated Rate	$78.96
Max. Negotiated Rate	$78.96
Rate for Payer: Qualcare PPO/HMO/WC	$78.96

SPECIAL STAIN II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005246
Hospital Revenue Code	312
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

SPECIAL STAIN II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005246
Hospital Revenue Code	312
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

SPECIAL STAINS - GROUP II

Facility

$459.00

Service Code	HCPCS 88313
Hospital Charge Code	38474064
Hospital Revenue Code	310
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.85
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.16

SPECIAL STAINS - GROUP II

Facility

$459.00

Service Code	HCPCS 88313
Hospital Charge Code	38474064
Hospital Revenue Code	310
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$68.85
Rate for Payer: Qualcare PPO/HMO/WC	$68.85

SPECIAL STAINS HISTOCHEM/FROZE

Facility

$101.00

Service Code	HCPCS 88314
Hospital Charge Code	38477123
Hospital Revenue Code	312
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

SPECIAL STAINS HISTOCHEM/FROZE

Facility

$101.00

Service Code	HCPCS 88314
Hospital Charge Code	38477123
Hospital Revenue Code	312
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$72.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

Know your out-of-pocket cost for care.

All Charges