Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TB TEST-QUANTIFERON/AG-GI RS

Facility

$438.95

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$223.73
Rate for Payer: Aetna Commercial	$168.59
Rate for Payer: Aetna Medicare Advantage	$200.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.73
Rate for Payer: Cigna Commercial	$219.47
Rate for Payer: Cigna Medicare Advantage	$61.98
Rate for Payer: Clover Medicare Advantage	$58.88
Rate for Payer: EmblemHealth Commercial	$185.94
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$49.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.98
Rate for Payer: Wellcare Medicare Advantage	$61.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.63

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$140.71
Max. Negotiated Rate	$2,919.37
Rate for Payer: Aetna Commercial	$2,218.72
Rate for Payer: Aetna Medicare Advantage	$1,751.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,349.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,488.88
Rate for Payer: Cigna Commercial	$2,919.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.62
Rate for Payer: Qualcare PPO/HMO/WC	$875.81
Rate for Payer: UnitedHealthcare Community & State	$140.71
Rate for Payer: Wellpoint Medicaid Managed Care	$154.73

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$875.81
Max. Negotiated Rate	$875.81
Rate for Payer: Qualcare PPO/HMO/WC	$875.81

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$3,371.93
Rate for Payer: Aetna Commercial	$2,540.83
Rate for Payer: Aetna Medicare Advantage	$3,026.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,371.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,371.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$934.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,371.93
Rate for Payer: Cigna Medicare Advantage	$653.89
Rate for Payer: Clover Medicare Advantage	$887.42
Rate for Payer: EmblemHealth Commercial	$2,802.39
Rate for Payer: Humana Medicare Advantage	$962.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$934.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.60
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$934.13
Rate for Payer: Wellcare Medicare Advantage	$934.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$278.50
Rate for Payer: Aetna Commercial	$211.66
Rate for Payer: Aetna Medicare Advantage	$167.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.03
Rate for Payer: Cigna Commercial	$278.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.10
Rate for Payer: Qualcare PPO/HMO/WC	$83.55
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$14.76

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.05

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$214.96
Max. Negotiated Rate	$214.96
Rate for Payer: Qualcare PPO/HMO/WC	$214.96

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.05

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$716.52
Rate for Payer: Aetna Commercial	$544.56
Rate for Payer: Aetna Medicare Advantage	$429.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.43
Rate for Payer: Cigna Commercial	$716.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.92
Rate for Payer: Qualcare PPO/HMO/WC	$214.96
Rate for Payer: UnitedHealthcare Community & State	$34.54
Rate for Payer: Wellpoint Medicaid Managed Care	$37.98

TC99 MERTIATIDE UP TO 15MCI

Facility

$1,024.34

Service Code	HCPCS A9562
Hospital Charge Code	4509083
Hospital Revenue Code	343
Min. Negotiated Rate	$24.69
Max. Negotiated Rate	$512.17
Rate for Payer: Aetna Commercial	$389.25
Rate for Payer: Aetna Medicare Advantage	$307.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.21
Rate for Payer: Cigna Commercial	$512.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.30
Rate for Payer: Qualcare PPO/HMO/WC	$153.65
Rate for Payer: UnitedHealthcare Community & State	$24.69
Rate for Payer: Wellpoint Medicaid Managed Care	$27.15

TC99 MERTIATIDE UP TO 15MCI

Facility

$1,024.34

Service Code	HCPCS A9562
Hospital Charge Code	4509083
Hospital Revenue Code	343
Min. Negotiated Rate	$153.65
Max. Negotiated Rate	$153.65
Rate for Payer: Qualcare PPO/HMO/WC	$153.65

TC99M MEBROFENIN UP TO 15MCI

Facility

$140.00

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

TC99M MEBROFENIN UP TO 15MCI

Facility

$140.00

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$123.90
Rate for Payer: Aetna Commercial	$25.14
Rate for Payer: Aetna Medicare Advantage	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.87
Rate for Payer: Cigna Commercial	$33.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.92
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$9.92
Rate for Payer: Qualcare PPO/HMO/WC	$9.92

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$278.25
Rate for Payer: Aetna Commercial	$211.47
Rate for Payer: Aetna Medicare Advantage	$166.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.91
Rate for Payer: Cigna Commercial	$278.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.95
Rate for Payer: Qualcare PPO/HMO/WC	$83.47
Rate for Payer: UnitedHealthcare Community & State	$13.41
Rate for Payer: Wellpoint Medicaid Managed Care	$14.75

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$83.47
Max. Negotiated Rate	$83.47
Rate for Payer: Qualcare PPO/HMO/WC	$83.47

TC99M SC FILTER/DOSE TO 20 MCI

Facility

$1,340.00

Service Code	HCPCS A9541
Hospital Charge Code	4509070
Hospital Revenue Code	343
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$670.00
Rate for Payer: Aetna Commercial	$509.20
Rate for Payer: Aetna Medicare Advantage	$402.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$341.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$341.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$341.70
Rate for Payer: Cigna Commercial	$670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.00
Rate for Payer: UnitedHealthcare Community & State	$32.29
Rate for Payer: Wellpoint Medicaid Managed Care	$35.51

TC99M SC FILTER/DOSE TO 20 MCI

Facility

$1,340.00

Service Code	HCPCS A9541
Hospital Charge Code	4509070
Hospital Revenue Code	343
Min. Negotiated Rate	$201.00
Max. Negotiated Rate	$201.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.00

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Service Code	HCPCS A9500
Hospital Charge Code	74115066
Hospital Revenue Code	343
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Community & State	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$9.46

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Service Code	HCPCS A9500
Hospital Charge Code	74115066
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$104.29
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	94053150
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74116066
Hospital Revenue Code	343
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Community & State	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$9.46

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	94053150
Hospital Revenue Code	343
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Community & State	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$9.46

Know your out-of-pocket cost for care.

All Charges