Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.60
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421599211
Hospital Revenue Code	510
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421599211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485099211
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485099211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	485599241
Hospital Revenue Code	510
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421099241
Hospital Revenue Code	510
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	485599241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421099241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421599242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421599242
Hospital Revenue Code	510
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421099242
Hospital Revenue Code	510
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	485599242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421099242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	485599242
Hospital Revenue Code	510
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

LEVEL 2 PLATE CERVICAL 50MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692100
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

LEVEL 2 PLATE CERVICAL 50MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692100
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421099243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

Know your out-of-pocket cost for care.

All Charges