Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FHC INFLU, SPLIT V PRES FREE

Facility

$80.00

Service Code	HCPCS 90655
Hospital Charge Code	9400092
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

FHC INFLU, SPLIT V PRES FREE

Facility

$80.00

Service Code	HCPCS 90655
Hospital Charge Code	9400092
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

FHC IN-OFFICE SCREENING AUDIO

Facility

$267.25

Service Code	HCPCS 92551
Hospital Charge Code	9400098
Hospital Revenue Code	510
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$133.62
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: Aetna Medicare Advantage	$80.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.15
Rate for Payer: Cigna Commercial	$133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.17
Rate for Payer: Qualcare PPO/HMO/WC	$40.09
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

FHC IN-OFFICE SCREENING AUDIO

Facility

$267.25

Service Code	HCPCS 92551
Hospital Charge Code	9400098
Hospital Revenue Code	510
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$40.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

FHC IN-OFFICE SCREENING VISIT

Facility

$160.00

Service Code	HCPCS 99173
Hospital Charge Code	9400100
Hospital Revenue Code	510
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC IN-OFFICE SCREENING VISIT

Facility

$160.00

Service Code	HCPCS 99173
Hospital Charge Code	9400100
Hospital Revenue Code	510
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

FHC MENTAL HEALTH REFERRAL

Facility

$369.65

Service Code	HCPCS 90899EP
Hospital Charge Code	9400096
Hospital Revenue Code	900
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$140.47
Rate for Payer: Aetna Medicare Advantage	$110.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.26
Rate for Payer: Cigna Commercial	$184.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.89
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.45
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$8.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

FHC MENTAL HEALTH REFERRAL

Facility

$369.65

Service Code	HCPCS 90899EP
Hospital Charge Code	9400096
Hospital Revenue Code	900
Min. Negotiated Rate	$55.45
Max. Negotiated Rate	$55.45
Rate for Payer: Qualcare PPO/HMO/WC	$55.45

FHC MULTIDISCIPLINARY TEAM VS

Facility

$320.85

Hospital Charge Code	9400038
Hospital Revenue Code	510
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

FHC MULTIDISCIPLINARY TEAM VS

Facility

$320.85

Hospital Charge Code	9400038
Hospital Revenue Code	510
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.25
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.50

FHC MUMPS

Facility

$738.45

Service Code	HCPCS 90704
Hospital Charge Code	9400093
Hospital Revenue Code	636
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$369.23
Rate for Payer: Aetna Commercial	$280.61
Rate for Payer: Aetna Medicare Advantage	$221.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.30
Rate for Payer: Cigna Commercial	$369.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.77
Rate for Payer: UnitedHealthcare Community & State	$17.80
Rate for Payer: Wellpoint Medicaid Managed Care	$19.57

FHC MUMPS

Facility

$738.45

Service Code	HCPCS 90704
Hospital Charge Code	9400093
Hospital Revenue Code	636
Min. Negotiated Rate	$110.77
Max. Negotiated Rate	$178.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.77

FHC NEW PT PREV MED VS 0-1 YR

Professional

Both

$440.00

Service Code	HCPCS 99381
Hospital Charge Code	9400040
Hospital Revenue Code	960
Min. Negotiated Rate	$42.16
Max. Negotiated Rate	$75.99
Rate for Payer: Aetna Commercial	$56.98
Rate for Payer: Aetna Medicare Advantage	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.99
Rate for Payer: UnitedHealthcare Commercial	$56.22
Rate for Payer: UnitedHealthcare Community & State	$56.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.22
Rate for Payer: Wellpoint Medicaid Managed Care	$42.16

FHC NEW PT PREV MED VS 12-17YR

Professional

Both

$281.65

Service Code	HCPCS 99384
Hospital Charge Code	9400042
Hospital Revenue Code	960
Min. Negotiated Rate	$56.72
Max. Negotiated Rate	$56.72
Rate for Payer: Aetna Medicare Advantage	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$56.72

FHC NEW PT PREV MED VS 1-4 YR

Professional

Both

$440.00

Service Code	HCPCS 99382
Hospital Charge Code	9400044
Hospital Revenue Code	960
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Medicare Advantage	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.00

FHC NEW PT PREV MED VS 18-39YR

Professional

Both

$281.65

Service Code	HCPCS 99385
Hospital Charge Code	9400046
Hospital Revenue Code	960
Min. Negotiated Rate	$71.49
Max. Negotiated Rate	$212.51
Rate for Payer: Aetna Commercial	$149.26
Rate for Payer: Aetna Medicare Advantage	$82.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$74.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.87
Rate for Payer: Cigna Commercial	$212.51
Rate for Payer: Cigna Medicare Advantage	$212.51
Rate for Payer: Marpai Administrators LLC Commercial	$182.38
Rate for Payer: Oscar Health Commercial	$85.01
Rate for Payer: UnitedHealthcare Commercial	$71.49
Rate for Payer: UnitedHealthcare Community & State	$71.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.49
Rate for Payer: Wellpoint Medicaid Managed Care	$90.42

FHC NEW PT PREV MED VS 40-64YR

Facility

$281.65

Service Code	HCPCS 99386
Hospital Charge Code	9400048
Hospital Revenue Code	510
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

FHC NEW PT PREV MED VS 40-64YR

Facility

$281.65

Service Code	HCPCS 99386
Hospital Charge Code	9400048
Hospital Revenue Code	510
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

FHC NEW PT PREV MED VS 5-11YR

Professional

Both

$281.65

Service Code	HCPCS 99383
Hospital Charge Code	9400050
Hospital Revenue Code	960
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Medicare Advantage	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.00
Rate for Payer: UnitedHealthcare Commercial	$63.75
Rate for Payer: UnitedHealthcare Community & State	$63.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$63.75

FHC NEW PT PREV MED VS 65+ YR

Professional

Both

$440.00

Service Code	HCPCS 99387
Hospital Charge Code	9400054
Hospital Revenue Code	960
Min. Negotiated Rate	$150.12
Max. Negotiated Rate	$150.12
Rate for Payer: Aetna Medicare Advantage	$150.12
Rate for Payer: UnitedHealthcare Commercial	$150.12
Rate for Payer: UnitedHealthcare Community & State	$150.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.12

FHC NEW PT VS LEVEL 1

Facility

$261.25

Service Code	HCPCS 99201
Hospital Charge Code	9400068
Hospital Revenue Code	510
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$130.62
Rate for Payer: Aetna Commercial	$99.28
Rate for Payer: Aetna Medicare Advantage	$78.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.62
Rate for Payer: Cigna Commercial	$130.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.38
Rate for Payer: Qualcare PPO/HMO/WC	$39.19
Rate for Payer: UnitedHealthcare Community & State	$6.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

FHC NEW PT VS LEVEL 1

Facility

$261.25

Service Code	HCPCS 99201
Hospital Charge Code	9400068
Hospital Revenue Code	510
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$39.19
Rate for Payer: Qualcare PPO/HMO/WC	$39.19

FHC NEW PT VS LEVEL 2

Facility

$385.00

Service Code	HCPCS 99202
Hospital Charge Code	9400056
Hospital Revenue Code	510
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Community & State	$9.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.20

FHC NEW PT VS LEVEL 2

Facility

$385.00

Service Code	HCPCS 99202
Hospital Charge Code	9400056
Hospital Revenue Code	510
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$57.75
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

FHC NEW PT VS LEVEL 3

Facility

$480.00

Service Code	HCPCS 99203
Hospital Charge Code	9400070
Hospital Revenue Code	510
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

Know your out-of-pocket cost for care.

All Charges