Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FP SMKNG&TOBACCO CESS COUNSLG

Facility

$123.00

Service Code	HCPCS 99406
Hospital Charge Code	83652505
Hospital Revenue Code	942
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,202.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

FP SMKNG&TOBACCO CESS COUNSLG

Facility

$123.00

Service Code	HCPCS 99406
Hospital Charge Code	83652505
Hospital Revenue Code	942
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

FP SMK&TOBACCO CESS COUNSELING

Facility

$123.00

Service Code	HCPCS 99407
Hospital Charge Code	83652507
Hospital Revenue Code	942
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

FP SMK&TOBACCO CESS COUNSELING

Facility

$123.00

Service Code	HCPCS 99407
Hospital Charge Code	83652507
Hospital Revenue Code	942
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,202.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

FP SMOKE & TOBAC CESS COU 3-10

Facility

$123.00

Service Code	HCPCS 99406
Hospital Charge Code	87502380
Hospital Revenue Code	510
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

FP SMOKE & TOBAC CESS COU 3-10

Facility

$123.00

Service Code	HCPCS 99406
Hospital Charge Code	87502380
Hospital Revenue Code	510
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$160.67
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

FP SMOKE&TOB CESS COUNSL>10MIN

Facility

$123.00

Service Code	HCPCS 99407
Hospital Charge Code	87502385
Hospital Revenue Code	510
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$160.67
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

FP SMOKE&TOB CESS COUNSL>10MIN

Facility

$123.00

Service Code	HCPCS 99407
Hospital Charge Code	87502385
Hospital Revenue Code	510
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

FP SP ENGERIX HEP B PED 10MCG

Facility

$50.00

Service Code	HCPCS 90744
Hospital Charge Code	83652599
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$12.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

FP SP ENGERIX HEP B PED 10MCG

Facility

$50.00

Service Code	HCPCS 90744
Hospital Charge Code	83652599
Hospital Revenue Code	636
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$63.81
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

FP SP TD TOX>7 YRS& OLDER-N P

Facility

$130.18

Service Code	HCPCS 90714
Hospital Charge Code	83652601
Hospital Revenue Code	636
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.53

FP SP TD TOX>7 YRS& OLDER-N P

Facility

$130.18

Service Code	HCPCS 90714
Hospital Charge Code	83652601
Hospital Revenue Code	636
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$65.09
Rate for Payer: Aetna Commercial	$49.47
Rate for Payer: Aetna Medicare Advantage	$39.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.20
Rate for Payer: Cigna Commercial	$65.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.53
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.45

FP SUBUNGUAL HEMATOMA EVACUAT

Facility

$696.50

Service Code	HCPCS 11740
Hospital Charge Code	87502490
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

FP SUBUNGUAL HEMATOMA EVACUAT

Facility

$696.50

Service Code	HCPCS 11740
Hospital Charge Code	87502490
Hospital Revenue Code	761
Min. Negotiated Rate	$16.79
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.95
Rate for Payer: Oxford Commercial	$139.30
Rate for Payer: Qualcare PPO/HMO/WC	$104.47
Rate for Payer: UnitedHealthcare Commercial	$139.30
Rate for Payer: UnitedHealthcare Community & State	$16.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

FP SUBUNGUAL HEMATOMA EVACUAT

Facility

$177.00

Service Code	HCPCS 11740
Hospital Charge Code	83652055
Hospital Revenue Code	761
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.10
Rate for Payer: Oxford Commercial	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$26.55
Rate for Payer: UnitedHealthcare Commercial	$35.40
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

FP SUBUNGUAL HEMATOMA EVACUAT

Facility

$177.00

Service Code	HCPCS 11740
Hospital Charge Code	83652055
Hospital Revenue Code	761
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$26.55
Rate for Payer: Qualcare PPO/HMO/WC	$26.55

FP TYMPANOMETER

Facility

$203.70

Service Code	HCPCS 92567
Hospital Charge Code	87502710
Hospital Revenue Code	471
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.11
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.55
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

FP TYMPANOMETER

Facility

$203.70

Service Code	HCPCS 92567
Hospital Charge Code	87502710
Hospital Revenue Code	471
Min. Negotiated Rate	$30.55
Max. Negotiated Rate	$30.55
Rate for Payer: Qualcare PPO/HMO/WC	$30.55

FP VACC ADM

Facility

$156.00

Service Code	HCPCS 90471
Hospital Charge Code	83652518
Hospital Revenue Code	771
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$308.77
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

FP VACC ADM

Facility

$156.00

Service Code	HCPCS 90471
Hospital Charge Code	83652518
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

FRACTIONATED PORPHYRINS I

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FRACTIONATED PORPHYRINS I

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538A
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FRACTIONATED PORPHYRINS II

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538B
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FRACTIONATED PORPHYRINS II

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538B
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FRACTIONATED PORPHYRINS III

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538C
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

Know your out-of-pocket cost for care.

All Charges