Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TC99 PERTECHNET PER MCI

Facility

$54.00

Service Code	HCPCS A9512
Hospital Charge Code	74115076
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 PERTECHNETPERMCIUP TO 75

Facility

$54.00

Service Code	HCPCS A9567
Hospital Charge Code	5309030
Hospital Revenue Code	343
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$42.59
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	$42.59
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 PERTECHNETPERMCIUP TO 75

Facility

$54.00

Service Code	HCPCS A9567
Hospital Charge Code	5309030
Hospital Revenue Code	343
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

TC99 PYP UP TO 25 MCI

Facility

$106.00

Hospital Charge Code	94053145
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	5309035
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	5309035
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74116067
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74115067
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74116067
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74115067
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74117067
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TC99 PYP UP TO 25 MCI

Facility

$106.00

Service Code	HCPCS A9538
Hospital Charge Code	74117067
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TC99 PYP UP TO 25 MCI

Facility

$106.00

Hospital Charge Code	94053145
Hospital Revenue Code	343
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TC99 PYROPHOSPHATE UP TO 25MCI

Facility

$125.48

Service Code	HCPCS A9538
Hospital Charge Code	4509086
Hospital Revenue Code	343
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$62.74
Rate for Payer: Aetna Commercial	$47.68
Rate for Payer: Aetna Medicare Advantage	$37.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.00
Rate for Payer: Cigna Commercial	$62.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.64
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Community & State	$3.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

TC99 PYROPHOSPHATE UP TO 25MCI

Facility

$125.48

Service Code	HCPCS A9538
Hospital Charge Code	4509086
Hospital Revenue Code	343
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

TCAT INSJ/RPL PERM LDLS PM

Facility

$90,132.56

Service Code	HCPCS 33274
Hospital Charge Code	69008137
Hospital Revenue Code	481
Min. Negotiated Rate	$2,172.19
Max. Negotiated Rate	$82,602.21
Rate for Payer: Aetna Commercial	$62,242.85
Rate for Payer: Aetna Medicare Advantage	$74,142.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82,602.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82,602.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,883.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82,602.21
Rate for Payer: Cigna Commercial	$45,869.69
Rate for Payer: Cigna Medicare Advantage	$22,883.40
Rate for Payer: Clover Medicare Advantage	$21,739.23
Rate for Payer: EmblemHealth Commercial	$68,650.20
Rate for Payer: Humana Medicare Advantage	$23,569.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,883.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,039.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,519.88
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$2,172.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,883.40
Rate for Payer: Wellcare Medicare Advantage	$22,883.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2,388.51

TCAT INSJ/RPL PERM LDLS PM

Facility

$90,132.56

Service Code	HCPCS 33274
Hospital Charge Code	69008137
Hospital Revenue Code	481
Min. Negotiated Rate	$13,519.88
Max. Negotiated Rate	$13,519.88
Rate for Payer: Qualcare PPO/HMO/WC	$13,519.88

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385
Hospital Revenue Code	272
Min. Negotiated Rate	$58.78
Max. Negotiated Rate	$58.78
Rate for Payer: Qualcare PPO/HMO/WC	$58.78

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385
Hospital Revenue Code	272
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$195.95
Rate for Payer: Aetna Commercial	$148.92
Rate for Payer: Aetna Medicare Advantage	$117.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.93
Rate for Payer: Cigna Commercial	$195.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.57
Rate for Payer: Oxford Commercial	$78.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.78
Rate for Payer: UnitedHealthcare Commercial	$78.38
Rate for Payer: UnitedHealthcare Community & State	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$10.39

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385W
Hospital Revenue Code	272
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$195.95
Rate for Payer: Aetna Commercial	$148.92
Rate for Payer: Aetna Medicare Advantage	$117.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.93
Rate for Payer: Cigna Commercial	$195.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.57
Rate for Payer: Oxford Commercial	$78.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.78
Rate for Payer: UnitedHealthcare Commercial	$78.38
Rate for Payer: UnitedHealthcare Community & State	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$10.39

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385W
Hospital Revenue Code	272
Min. Negotiated Rate	$58.78
Max. Negotiated Rate	$58.78
Rate for Payer: Qualcare PPO/HMO/WC	$58.78

TCC-EZ CASTING SYSTEMS 4

Facility

$512.33

Hospital Charge Code	270674025
Hospital Revenue Code	272
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$256.17
Rate for Payer: Aetna Commercial	$194.69
Rate for Payer: Aetna Medicare Advantage	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.64
Rate for Payer: Cigna Commercial	$256.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.70
Rate for Payer: Oxford Commercial	$102.47
Rate for Payer: Qualcare PPO/HMO/WC	$76.85
Rate for Payer: UnitedHealthcare Commercial	$102.47
Rate for Payer: UnitedHealthcare Community & State	$12.35
Rate for Payer: Wellpoint Medicaid Managed Care	$13.58

TCC-EZ CASTING SYSTEMS 4

Facility

$512.33

Hospital Charge Code	270674025
Hospital Revenue Code	272
Min. Negotiated Rate	$76.85
Max. Negotiated Rate	$76.85
Rate for Payer: Qualcare PPO/HMO/WC	$76.85

TCC-EZ CASTING SYSTEMS 4

Facility

$512.33

Hospital Charge Code	270674025W
Hospital Revenue Code	272
Min. Negotiated Rate	$76.85
Max. Negotiated Rate	$76.85
Rate for Payer: Qualcare PPO/HMO/WC	$76.85

TCC-EZ CASTING SYSTEMS 4

Facility

$512.33

Hospital Charge Code	270674025W
Hospital Revenue Code	272
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$256.17
Rate for Payer: Aetna Commercial	$194.69
Rate for Payer: Aetna Medicare Advantage	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.64
Rate for Payer: Cigna Commercial	$256.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.70
Rate for Payer: Oxford Commercial	$102.47
Rate for Payer: Qualcare PPO/HMO/WC	$76.85
Rate for Payer: UnitedHealthcare Commercial	$102.47
Rate for Payer: UnitedHealthcare Community & State	$12.35
Rate for Payer: Wellpoint Medicaid Managed Care	$13.58

Know your out-of-pocket cost for care.

All Charges