Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FOLLOWER PHILLIPS 18FR

Facility

$252.20

Hospital Charge Code	270600285
Hospital Revenue Code	272
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Commercial	$95.84
Rate for Payer: Aetna Medicare Advantage	$75.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.31
Rate for Payer: Cigna Commercial	$126.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.66
Rate for Payer: Oxford Commercial	$50.44
Rate for Payer: Qualcare PPO/HMO/WC	$37.83
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: UnitedHealthcare Community & State	$6.08
Rate for Payer: Wellpoint Medicaid Managed Care	$6.68

FOLLOWER PHILLIPS 8FR

Facility

$249.80

Hospital Charge Code	270600280
Hospital Revenue Code	272
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.90
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: Aetna Medicare Advantage	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.70
Rate for Payer: Cigna Commercial	$124.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Oxford Commercial	$49.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.47
Rate for Payer: UnitedHealthcare Commercial	$49.96
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

FOLLOWER PHILLIPS 8FR

Facility

$249.80

Hospital Charge Code	270600280
Hospital Revenue Code	272
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$37.47
Rate for Payer: Qualcare PPO/HMO/WC	$37.47

FOLLOWUP ENHANCED COUNSELING**

Facility

$30.00

Service Code	HCPCS Y7634WF
Hospital Charge Code	9600017
Hospital Revenue Code	519
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

FOLLOWUP ENHANCED COUNSELING**

Facility

$30.00

Service Code	HCPCS Y7634WF
Hospital Charge Code	9600017
Hospital Revenue Code	519
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

FOLLOWUP HOSP CARE 15MINS

Facility

$350.00

Service Code	HCPCS 99231
Hospital Charge Code	83246210
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 15MINS

Facility

$350.00

Service Code	HCPCS 99231
Hospital Charge Code	83246210
Hospital Revenue Code	919
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

FOLLOWUP HOSP CARE 25MINS

Facility

$350.00

Service Code	HCPCS 99232
Hospital Charge Code	83246215
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 25MINS

Facility

$350.00

Service Code	HCPCS 99232
Hospital Charge Code	83246215
Hospital Revenue Code	919
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

FOLLOWUP HOSP CARE 35MINS

Facility

$350.00

Service Code	HCPCS 99233
Hospital Charge Code	83246220
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 35MINS

Facility

$350.00

Service Code	HCPCS 99233
Hospital Charge Code	83246220
Hospital Revenue Code	919
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

FOLLOW-UP - MILD

Professional

Both

$73.00

Service Code	HCPCS 99231
Hospital Charge Code	2500098
Hospital Revenue Code	981
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$121.35
Rate for Payer: Aetna Commercial	$63.83
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$121.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.35
Rate for Payer: Cigna Commercial	$52.81
Rate for Payer: Cigna Medicare Advantage	$52.81
Rate for Payer: Clover Medicare Advantage	$51.97
Rate for Payer: EmblemHealth Commercial	$50.46
Rate for Payer: Fidelis All Plans	$33.94
Rate for Payer: Humana Medicare Advantage	$69.40
Rate for Payer: UnitedHealthcare Commercial	$42.87
Rate for Payer: UnitedHealthcare Community & State	$42.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.87
Rate for Payer: Wellpoint Medicaid Managed Care	$50.46

FOLLOW-UP - MODERATE

Professional

Both

$122.25

Service Code	HCPCS 99232
Hospital Charge Code	2500080
Hospital Revenue Code	981
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$223.96
Rate for Payer: Aetna Commercial	$95.96
Rate for Payer: Aetna Medicare Advantage	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$223.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$223.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.96
Rate for Payer: Cigna Commercial	$140.73
Rate for Payer: Cigna Medicare Advantage	$140.73
Rate for Payer: Clover Medicare Advantage	$78.62
Rate for Payer: Elderplan Medicare Advantage	$76.25
Rate for Payer: EmblemHealth Commercial	$44.23
Rate for Payer: Fidelis All Plans	$51.04
Rate for Payer: Healthfirst NY All Plans	$26.27
Rate for Payer: Humana Medicare Advantage	$77.28
Rate for Payer: Local 1199 Commercial	$57.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Marpai Administrators LLC Commercial	$69.27
Rate for Payer: MetroPlus Health All Plans	$28.08
Rate for Payer: Molina Healthcare All Plans	$26.27
Rate for Payer: Oscar Health Commercial	$156.14
Rate for Payer: Tricare Tricare	$83.33
Rate for Payer: UnitedHealthcare Commercial	$51.39
Rate for Payer: UnitedHealthcare Community & State	$51.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.39
Rate for Payer: Wellpoint Medicaid Managed Care	$80.18

FOLLOW-UP - SEVERE

Professional

Both

$218.25

Service Code	HCPCS 99233
Hospital Charge Code	2500072
Hospital Revenue Code	981
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$321.55
Rate for Payer: Aetna Commercial	$123.22
Rate for Payer: Aetna Medicare Advantage	$83.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$321.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.55
Rate for Payer: Cigna Commercial	$206.40
Rate for Payer: Cigna Medicare Advantage	$206.40
Rate for Payer: Clover Medicare Advantage	$117.85
Rate for Payer: Elderplan Medicare Advantage	$113.35
Rate for Payer: EmblemHealth Commercial	$28.71
Rate for Payer: Fidelis All Plans	$73.84
Rate for Payer: Healthfirst NY All Plans	$37.65
Rate for Payer: Humana Medicare Advantage	$90.36
Rate for Payer: Local 1199 Commercial	$83.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.28
Rate for Payer: Marpai Administrators LLC Commercial	$83.83
Rate for Payer: MetroPlus Health All Plans	$37.65
Rate for Payer: Molina Healthcare All Plans	$37.65
Rate for Payer: Oscar Health Commercial	$224.40
Rate for Payer: UnitedHealthcare Commercial	$116.17
Rate for Payer: UnitedHealthcare Community & State	$116.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$116.17
Rate for Payer: Wellpoint Medicaid Managed Care	$122.26

FOLVITE/5MG/1ML

Facility

$90.00

Hospital Charge Code	60633012
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

FOLVITE/5MG/1ML

Facility

$90.00

Hospital Charge Code	60633012
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

FOMEPIZOLE 1 GM/ML INJ

Facility

$9,144.50

Service Code	HCPCS J1451
Hospital Charge Code	60629078
Hospital Revenue Code	636
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$2,212.97
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna Medicare Advantage	$21.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.61
Rate for Payer: Cigna Medicare Advantage	$6.54
Rate for Payer: Clover Medicare Advantage	$6.21
Rate for Payer: EmblemHealth Commercial	$19.62
Rate for Payer: Humana Medicare Advantage	$6.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.67
Rate for Payer: UnitedHealthcare Community & State	$220.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.54
Rate for Payer: Wellcare Medicare Advantage	$6.54
Rate for Payer: Wellpoint Medicaid Managed Care	$242.33

FOMEPIZOLE 1 GM/ML INJ

Facility

$9,144.50

Service Code	HCPCS J1451
Hospital Charge Code	60629078
Hospital Revenue Code	636
Min. Negotiated Rate	$1,371.67
Max. Negotiated Rate	$2,212.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.67

FONDAPARINUX SODIUM 7.5 MG SYR

Facility

$9,378.45

Hospital Charge Code	60630049
Hospital Revenue Code	250
Min. Negotiated Rate	$226.02
Max. Negotiated Rate	$4,689.23
Rate for Payer: Aetna Commercial	$3,563.81
Rate for Payer: Aetna Medicare Advantage	$2,813.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,391.50
Rate for Payer: Cigna Commercial	$4,689.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.53
Rate for Payer: Oxford Commercial	$1,875.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.77
Rate for Payer: UnitedHealthcare Commercial	$1,875.69
Rate for Payer: UnitedHealthcare Community & State	$226.02
Rate for Payer: Wellpoint Medicaid Managed Care	$248.53

FONDAPARINUX SODIUM 7.5 MG SYR

Facility

$9,378.45

Hospital Charge Code	60630049
Hospital Revenue Code	250
Min. Negotiated Rate	$1,406.77
Max. Negotiated Rate	$1,406.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.77

FOOT AND TOE PROCEDURES

Facility

$19,353.60

Service Code	APR-DRG 3143
Min. Negotiated Rate	$18,974.12
Max. Negotiated Rate	$19,353.60
Rate for Payer: UnitedHealthcare Community & State	$18,974.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,353.60
Rate for Payer: Wellpoint Medicaid Managed Care	$18,974.12

FOOT AND TOE PROCEDURES

Facility

$14,664.28

Service Code	APR-DRG 3142
Min. Negotiated Rate	$14,376.75
Max. Negotiated Rate	$14,664.28
Rate for Payer: UnitedHealthcare Community & State	$14,376.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,664.28
Rate for Payer: Wellpoint Medicaid Managed Care	$14,376.75

FOOT AND TOE PROCEDURES

Facility

$13,688.89

Service Code	APR-DRG 3141
Min. Negotiated Rate	$13,420.48
Max. Negotiated Rate	$13,688.89
Rate for Payer: UnitedHealthcare Community & State	$13,420.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,688.89
Rate for Payer: Wellpoint Medicaid Managed Care	$13,420.48

FOOT AND TOE PROCEDURES

Facility

$34,907.80

Service Code	APR-DRG 3144
Min. Negotiated Rate	$34,223.33
Max. Negotiated Rate	$34,907.80
Rate for Payer: UnitedHealthcare Community & State	$34,223.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,907.80
Rate for Payer: Wellpoint Medicaid Managed Care	$34,223.33

FOOT AP LAT LT

Facility

$6,601.19

Service Code	HCPCS 73620LT
Hospital Charge Code	2002459
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges