Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BRACHYTX ISODOSE COMPLEX

Facility

$1,867.31

Service Code	HCPCS 77318
Hospital Charge Code	85000895
Hospital Revenue Code	333
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.19
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.10
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$49.48

BRACHYTX ISODOSE COMPLEX

Facility

$1,867.31

Service Code	HCPCS 77318
Hospital Charge Code	85000895
Hospital Revenue Code	333
Min. Negotiated Rate	$280.10
Max. Negotiated Rate	$280.10
Rate for Payer: Qualcare PPO/HMO/WC	$280.10

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$280.10
Max. Negotiated Rate	$280.10
Rate for Payer: Qualcare PPO/HMO/WC	$280.10

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.19
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.10
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$49.48

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.54
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$17.80

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

BRACHYTX, NON-STR,YTTRIUM-90

Facility

$82,538.65

Service Code	HCPCS C2616
Hospital Charge Code	5701123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,989.18
Max. Negotiated Rate	$74,593.87
Rate for Payer: Aetna Commercial	$56,208.36
Rate for Payer: Aetna Medicare Advantage	$66,954.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74,593.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74,593.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,664.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,507.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74,593.87
Rate for Payer: Cigna Commercial	$41,422.60
Rate for Payer: Cigna Medicare Advantage	$20,664.84
Rate for Payer: Clover Medicare Advantage	$19,631.60
Rate for Payer: EmblemHealth Commercial	$61,994.52
Rate for Payer: Humana Medicare Advantage	$21,284.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,664.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,974.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,158.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,380.80
Rate for Payer: UnitedHealthcare Community & State	$1,989.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,664.84
Rate for Payer: Wellcare Medicare Advantage	$20,664.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2,187.27

BRACHYTX, NON-STR,YTTRIUM-90

Facility

$82,538.65

Service Code	HCPCS C2616
Hospital Charge Code	5701123
Hospital Revenue Code	278
Min. Negotiated Rate	$12,380.80
Max. Negotiated Rate	$19,974.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,507.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,974.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18,158.50
Rate for Payer: Qualcare PPO/HMO/WC	$12,380.80

BRACKET BEGG CRV BASE 256-650

Facility

$22.45

Hospital Charge Code	270611071
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

BRACKET BEGG CRV BASE 256-650

Facility

$22.45

Hospital Charge Code	270611071
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

BRACKET BEGG CUSPID *****

Facility

$57.00

Hospital Charge Code	1604867
Hospital Revenue Code	272
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

BRACKET BEGG CUSPID *****

Facility

$57.00

Hospital Charge Code	1604867
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

BRACKET BEGG CUSPID 256-357

Facility

$19.25

Hospital Charge Code	270611036
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BRACKET BEGG CUSPID 256-357

Facility

$19.25

Hospital Charge Code	270611036
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

BRACKET BEGG CUSPID 256-363

Facility

$16.85

Hospital Charge Code	270601064
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

BRACKET BEGG CUSPID 256-363

Facility

$16.85

Hospital Charge Code	270601064
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

BRACKET BEGG FLAT BASE 256-550

Facility

$19.25

Hospital Charge Code	270611070
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BRACKET BEGG FLAT BASE 256-550

Facility

$19.25

Hospital Charge Code	270611070
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

BRACKET BEGG SLAT 256550*****

Facility

$57.00

Hospital Charge Code	1605112
Hospital Revenue Code	272
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

BRACKET BEGG SLAT 256550*****

Facility

$57.00

Hospital Charge Code	1605112
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

BRACKET BEGG UPPER LAT 256-360

Facility

$22.45

Hospital Charge Code	270611069
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

BRACKET BEGG UPPER LAT 256-360

Facility

$22.45

Hospital Charge Code	270611069
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

BRACKET HOLDER 4P HALF MOON

Facility

$81.40

Hospital Charge Code	270678364
Hospital Revenue Code	272
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$40.70
Rate for Payer: Aetna Commercial	$30.93
Rate for Payer: Aetna Medicare Advantage	$24.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.76
Rate for Payer: Cigna Commercial	$40.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.42
Rate for Payer: Oxford Commercial	$16.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.21
Rate for Payer: UnitedHealthcare Commercial	$16.28
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.16

BRACKET HOLDER 4P HALF MOON

Facility

$81.40

Hospital Charge Code	270678364
Hospital Revenue Code	272
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$12.21
Rate for Payer: Qualcare PPO/HMO/WC	$12.21

BRACKET UNIVRL KEYHOLE 9.25 14

Facility

$270.00

Hospital Charge Code	270665198
Hospital Revenue Code	270
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

Know your out-of-pocket cost for care.

All Charges