Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74116066
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	74117066
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	74117066
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
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	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74115074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74116074
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74115074
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	94053151
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	94053151
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	5309020
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	5309020
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74117074
Hospital Revenue Code	343
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.25
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$24.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74116074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74117074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$85.18
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$29.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.93
Rate for Payer: Cigna Commercial	$48.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.33
Rate for Payer: Qualcare PPO/HMO/WC	$14.67
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$14.67
Rate for Payer: Qualcare PPO/HMO/WC	$14.67

TC99 PERTECHNETATE PER MCI

Facility

$78.62

Service Code	HCPCS A9512
Hospital Charge Code	4509088
Hospital Revenue Code	343
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$39.31
Rate for Payer: Aetna Commercial	$29.88
Rate for Payer: Aetna Medicare Advantage	$23.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.05
Rate for Payer: Cigna Commercial	$39.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.59
Rate for Payer: Qualcare PPO/HMO/WC	$11.79
Rate for Payer: UnitedHealthcare Community & State	$1.89
Rate for Payer: Wellpoint Medicaid Managed Care	$2.08

TC99 PERTECHNETATE PER MCI

Facility

$78.62

Service Code	HCPCS A9512
Hospital Charge Code	4509088
Hospital Revenue Code	343
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$11.79
Rate for Payer: Qualcare PPO/HMO/WC	$11.79

TC99 PERTECHNET PER MCI

Facility

$54.00

Service Code	HCPCS A9512
Hospital Charge Code	74116076
Hospital Revenue Code	343
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

TC99 PERTECHNET PER MCI

Facility

$54.00

Service Code	HCPCS A9512
Hospital Charge Code	74116076
Hospital Revenue Code	343
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

TC99 PERTECHNET PER MCI

Facility

$54.00

Service Code	HCPCS A9512
Hospital Charge Code	74115076
Hospital Revenue Code	343
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

TC99 PERTECHNET PER MCI

Facility

$54.00

Hospital Charge Code	74117076
Hospital Revenue Code	343
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

TC99 PERTECHNET PER MCI

Facility

$54.00

Hospital Charge Code	74117076
Hospital Revenue Code	343
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

Know your out-of-pocket cost for care.

All Charges