Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84518047
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84518047
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Hospital Charge Code	84310185
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84517047
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$333.51
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.30
Rate for Payer: Qualcare PPO/HMO/WC	$131.65
Rate for Payer: UnitedHealthcare Community & State	$21.15
Rate for Payer: Wellpoint Medicaid Managed Care	$23.26

E&M LEVEL V NP 60 MINS

Facility

$183.00

Service Code	HCPCS 99205
Hospital Charge Code	94810210
Hospital Revenue Code	915
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

E&M LEVEL V NP 60 MINS

Facility

$183.00

Service Code	HCPCS 99205
Hospital Charge Code	94810210
Hospital Revenue Code	915
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$163.83
Rate for Payer: Aetna Commercial	$69.54
Rate for Payer: Aetna Medicare Advantage	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.66
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

E&M LVL III EST PT 15 MINS

Facility

$1,017.00

Service Code	HCPCS 99213
Hospital Charge Code	94810225
Hospital Revenue Code	513
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$386.46
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$508.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.10
Rate for Payer: Qualcare PPO/HMO/WC	$152.55
Rate for Payer: UnitedHealthcare Community & State	$24.51
Rate for Payer: Wellpoint Medicaid Managed Care	$26.95

E&M LVL III EST PT 15 MINS

Facility

$1,017.00

Service Code	HCPCS 99213
Hospital Charge Code	94810225
Hospital Revenue Code	513
Min. Negotiated Rate	$152.55
Max. Negotiated Rate	$152.55
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

E&M LVL IV EST PAT 25 MINS

Facility

$1,879.97

Service Code	HCPCS 99214
Hospital Charge Code	94810230
Hospital Revenue Code	513
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$939.99
Rate for Payer: Aetna Commercial	$714.39
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

E&M LVL IV EST PAT 25 MINS

Facility

$1,879.97

Service Code	HCPCS 99214
Hospital Charge Code	94810230
Hospital Revenue Code	513
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

E&M LVL V EST PAT 40 MINS

Facility

$408.00

Service Code	HCPCS 99215
Hospital Charge Code	94810235
Hospital Revenue Code	915
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.20

E&M LVL V EST PAT 40 MINS

Facility

$408.00

Service Code	HCPCS 99215
Hospital Charge Code	94810235
Hospital Revenue Code	915
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$155.04
Rate for Payer: Aetna Medicare Advantage	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.04
Rate for Payer: Cigna Commercial	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.40
Rate for Payer: Qualcare PPO/HMO/WC	$61.20
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

EMPTY EVAC CONTAINER250ML

Facility

$302.00

Hospital Charge Code	60635678
Hospital Revenue Code	250
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

EMPTY EVAC CONTAINER250ML

Facility

$302.00

Hospital Charge Code	60635678
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$151.00
Rate for Payer: Aetna Commercial	$114.76
Rate for Payer: Aetna Medicare Advantage	$90.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.01
Rate for Payer: Cigna Commercial	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.60
Rate for Payer: Oxford Commercial	$60.40
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$60.40
Rate for Payer: UnitedHealthcare Community & State	$7.28
Rate for Payer: Wellpoint Medicaid Managed Care	$8.00

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$814.52
Rate for Payer: Aetna Commercial	$619.04
Rate for Payer: Aetna Medicare Advantage	$488.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.41
Rate for Payer: Cigna Commercial	$814.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.71
Rate for Payer: Oxford Commercial	$325.81
Rate for Payer: Qualcare PPO/HMO/WC	$244.36
Rate for Payer: UnitedHealthcare Commercial	$325.81
Rate for Payer: UnitedHealthcare Community & State	$39.26
Rate for Payer: Wellpoint Medicaid Managed Care	$43.17

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$244.36
Max. Negotiated Rate	$244.36
Rate for Payer: Qualcare PPO/HMO/WC	$244.36

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$67.27
Rate for Payer: Aetna Commercial	$51.13
Rate for Payer: Aetna Medicare Advantage	$40.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.31
Rate for Payer: Cigna Commercial	$67.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.36
Rate for Payer: Oxford Commercial	$26.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.18
Rate for Payer: UnitedHealthcare Commercial	$26.91
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.57

Know your out-of-pocket cost for care.

All Charges