Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANNUAL VISIT WHC*****

Facility

$49.50

Service Code	HCPCS 99395WF
Hospital Charge Code	9600012
Hospital Revenue Code	519
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna Commercial	$18.81
Rate for Payer: Aetna Medicare Advantage	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.62
Rate for Payer: Cigna Commercial	$24.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$7.42
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

ANNUAL WELLNESS VISIT - FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502680
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

ANNUAL WELLNESS VISIT - FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502680
Hospital Revenue Code	770
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.90
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$13.09
Rate for Payer: Wellpoint Medicaid Managed Care	$14.39

ANNUAL WELLNESS VISIT-FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	83652533
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

ANNUAL WELLNESS VISIT-FIRST

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	83652533
Hospital Revenue Code	770
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.90
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$13.09
Rate for Payer: Wellpoint Medicaid Managed Care	$14.39

ANNUAL WELLNESS VISIT - SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502685
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNUAL WELLNESS VISIT - SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502685
Hospital Revenue Code	770
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

ANNUAL WELLNESS VISIT-SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	83652535
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNUAL WELLNESS VISIT-SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	83652535
Hospital Revenue Code	770
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

ANNUAL WELLNESS VST FIRST GE

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502825
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

ANNUAL WELLNESS VST FIRST GE

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502825
Hospital Revenue Code	770
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.90
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$13.09
Rate for Payer: Wellpoint Medicaid Managed Care	$14.39

ANNUAL WELLNESS VST SUBSQ GE

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502830
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNUAL WELLNESS VST SUBSQ GE

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502830
Hospital Revenue Code	770
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

ANNULOTOMY KNIFE

Facility

$7,420.00

Hospital Charge Code	270696761
Hospital Revenue Code	272
Min. Negotiated Rate	$178.82
Max. Negotiated Rate	$3,710.00
Rate for Payer: Aetna Commercial	$2,819.60
Rate for Payer: Aetna Medicare Advantage	$2,226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,892.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,892.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,892.10
Rate for Payer: Cigna Commercial	$3,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.00
Rate for Payer: Oxford Commercial	$1,484.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.00
Rate for Payer: UnitedHealthcare Commercial	$1,484.00
Rate for Payer: UnitedHealthcare Community & State	$178.82
Rate for Payer: Wellpoint Medicaid Managed Care	$196.63

ANNULOTOMY KNIFE

Facility

$7,420.00

Hospital Charge Code	270696761
Hospital Revenue Code	272
Min. Negotiated Rate	$1,113.00
Max. Negotiated Rate	$1,113.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.00

ANOGENITAL EXAM CHILD

Facility

$59.00

Service Code	HCPCS 99170
Hospital Charge Code	5780315
Hospital Revenue Code	450
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$866.98
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

ANOGENITAL EXAM CHILD

Facility

$59.00

Service Code	HCPCS 99170
Hospital Charge Code	5780315
Hospital Revenue Code	450
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

ANOSCOPE HALF FOBER OPTIC

Facility

$3,008.75

Hospital Charge Code	270658897
Hospital Revenue Code	272
Min. Negotiated Rate	$451.31
Max. Negotiated Rate	$451.31
Rate for Payer: Qualcare PPO/HMO/WC	$451.31

ANOSCOPE HALF FOBER OPTIC

Facility

$3,008.75

Hospital Charge Code	270658897
Hospital Revenue Code	272
Min. Negotiated Rate	$72.51
Max. Negotiated Rate	$1,504.38
Rate for Payer: Aetna Commercial	$1,143.33
Rate for Payer: Aetna Medicare Advantage	$902.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$767.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$767.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$767.23
Rate for Payer: Cigna Commercial	$1,504.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.62
Rate for Payer: Oxford Commercial	$601.75
Rate for Payer: Qualcare PPO/HMO/WC	$451.31
Rate for Payer: UnitedHealthcare Commercial	$601.75
Rate for Payer: UnitedHealthcare Community & State	$72.51
Rate for Payer: Wellpoint Medicaid Managed Care	$79.73

ANOSCOPY & BIOPSY

Facility

$9,798.35

Service Code	HCPCS 46606
Hospital Charge Code	87502930
Hospital Revenue Code	761
Min. Negotiated Rate	$1,469.75
Max. Negotiated Rate	$1,469.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.75

ANOSCOPY & BIOPSY

Facility

$9,798.35

Service Code	HCPCS 46606
Hospital Charge Code	87502930
Hospital Revenue Code	761
Min. Negotiated Rate	$43.37
Max. Negotiated Rate	$5,131.69
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,939.51
Rate for Payer: Oxford Commercial	$1,959.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.75
Rate for Payer: UnitedHealthcare Commercial	$1,959.67
Rate for Payer: UnitedHealthcare Community & State	$236.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$259.66

ANOSCOPY DIAGNOSTIC

Facility

$696.50

Service Code	HCPCS 46600
Hospital Charge Code	87502816
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	$30.98
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: Wellpoint Medicaid Managed Care	$18.46

ANOSCOPY DIAGNOSTIC

Facility

$696.50

Service Code	HCPCS 46600
Hospital Charge Code	87502816
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

ANOSCOPY DX

Facility

$1,167.00

Service Code	HCPCS 46600
Hospital Charge Code	1600000703
Hospital Revenue Code	360
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$175.05
Rate for Payer: Qualcare PPO/HMO/WC	$175.05

ANOSCOPY DX

Facility

$1,167.00

Service Code	HCPCS 46600
Hospital Charge Code	1600000703
Hospital Revenue Code	360
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$350.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$28.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$30.93

Know your out-of-pocket cost for care.

All Charges