Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FHC NEW PT VS LEVEL 3

Facility

$480.00

Service Code	HCPCS 99203
Hospital Charge Code	9400070
Hospital Revenue Code	510
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

FHC NEW PT VS LEVEL 4

Facility

$598.75

Service Code	HCPCS 99204
Hospital Charge Code	9400072
Hospital Revenue Code	510
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$299.38
Rate for Payer: Aetna Commercial	$227.53
Rate for Payer: Aetna Medicare Advantage	$179.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.68
Rate for Payer: Cigna Commercial	$299.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.62
Rate for Payer: Qualcare PPO/HMO/WC	$89.81
Rate for Payer: UnitedHealthcare Community & State	$14.43
Rate for Payer: Wellpoint Medicaid Managed Care	$15.87

FHC NEW PT VS LEVEL 4

Facility

$598.75

Service Code	HCPCS 99204
Hospital Charge Code	9400072
Hospital Revenue Code	510
Min. Negotiated Rate	$89.81
Max. Negotiated Rate	$89.81
Rate for Payer: Qualcare PPO/HMO/WC	$89.81

FHC NEW PT VS LEVEL 5

Facility

$1,100.00

Service Code	HCPCS 99205
Hospital Charge Code	9400058
Hospital Revenue Code	510
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

FHC NEW PT VS LEVEL 5

Facility

$1,100.00

Service Code	HCPCS 99205
Hospital Charge Code	9400058
Hospital Revenue Code	510
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

FHC NORMAL NEWBORN

Facility

$425.00

Service Code	HCPCS 99460EP
Hospital Charge Code	9400103
Hospital Revenue Code	450
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

FHC NORMAL NEWBORN

Facility

$425.00

Service Code	HCPCS 99460EP
Hospital Charge Code	9400103
Hospital Revenue Code	450
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

FHC NURSE VISIT*****

Facility

$71.50

Hospital Charge Code	9400011
Hospital Revenue Code	519
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

FHC NURSE VISIT*****

Facility

$71.50

Hospital Charge Code	9400011
Hospital Revenue Code	519
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$27.17
Rate for Payer: Aetna Medicare Advantage	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.23
Rate for Payer: Cigna Commercial	$35.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.72
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

FHC OTHER REFERRAL

Facility

$581.25

Service Code	HCPCS 99241EP
Hospital Charge Code	9400101
Hospital Revenue Code	510
Min. Negotiated Rate	$87.19
Max. Negotiated Rate	$87.19
Rate for Payer: Qualcare PPO/HMO/WC	$87.19

FHC OTHER REFERRAL

Facility

$581.25

Service Code	HCPCS 99241EP
Hospital Charge Code	9400101
Hospital Revenue Code	510
Min. Negotiated Rate	$14.01
Max. Negotiated Rate	$290.62
Rate for Payer: Aetna Commercial	$220.88
Rate for Payer: Aetna Medicare Advantage	$174.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.22
Rate for Payer: Cigna Commercial	$290.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.38
Rate for Payer: Qualcare PPO/HMO/WC	$87.19
Rate for Payer: UnitedHealthcare Community & State	$14.01
Rate for Payer: Wellpoint Medicaid Managed Care	$15.40

FHC POSTPARTUM HEALTHSTART VS

Facility

$505.00

Service Code	HCPCS 99241
Hospital Charge Code	9400060
Hospital Revenue Code	510
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

FHC POSTPARTUM HEALTHSTART VS

Facility

$505.00

Service Code	HCPCS 99241
Hospital Charge Code	9400060
Hospital Revenue Code	510
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

FHC REFER LAB-LEAD

Facility

$38.45

Service Code	HCPCS 83655EP
Hospital Charge Code	9400090
Hospital Revenue Code	301
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.61
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.80
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

FHC REFER LAB-LEAD

Facility

$38.45

Service Code	HCPCS 83655EP
Hospital Charge Code	9400090
Hospital Revenue Code	301
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

FHC REFER LAB-OTHER

Facility

$246.45

Service Code	HCPCS 84999EP
Hospital Charge Code	9400091
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

FHC REFER LAB-OTHER

Facility

$246.45

Service Code	HCPCS 84999EP
Hospital Charge Code	9400091
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

FHC SUBSEQUENT HEALTHSTART VS

Facility

$248.75

Service Code	HCPCS 99241
Hospital Charge Code	9400078
Hospital Revenue Code	510
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$124.38
Rate for Payer: Aetna Commercial	$94.53
Rate for Payer: Aetna Medicare Advantage	$74.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.43
Rate for Payer: Cigna Commercial	$124.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$37.31
Rate for Payer: UnitedHealthcare Community & State	$5.99
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

FHC SUBSEQUENT HEALTHSTART VS

Facility

$248.75

Service Code	HCPCS 99241
Hospital Charge Code	9400078
Hospital Revenue Code	510
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$37.31
Rate for Payer: Qualcare PPO/HMO/WC	$37.31

FHC SUBSEQUENT HEALTHSTRT VSII

Facility

$270.00

Service Code	HCPCS 99241
Hospital Charge Code	9400086
Hospital Revenue Code	510
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: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

FHC SUBSEQUENT HEALTHSTRT VSII

Facility

$270.00

Service Code	HCPCS 99241
Hospital Charge Code	9400086
Hospital Revenue Code	510
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

FHC VENI-CAPILLARY(LEAD SCRN)

Facility

$160.00

Service Code	HCPCS 3641659
Hospital Charge Code	9400088
Hospital Revenue Code	300
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$124.00
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: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

FHC VENI-CAPILLARY(LEAD SCRN)

Facility

$160.00

Service Code	HCPCS 3641659
Hospital Charge Code	9400088
Hospital Revenue Code	300
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC VENI-CAPILLARY (OTHER)

Facility

$160.00

Service Code	HCPCS 36416
Hospital Charge Code	9400089
Hospital Revenue Code	300
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC VENI-CAPILLARY (OTHER)

Facility

$160.00

Service Code	HCPCS 36416
Hospital Charge Code	9400089
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$124.00
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) NJ Health	$3.48
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: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

Know your out-of-pocket cost for care.

All Charges