Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL IV SP GROSS&MICROSCOPIC

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005294
Hospital Revenue Code	310
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$346.05
Rate for Payer: Aetna Commercial	$263.00
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$346.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$16.68
Rate for Payer: Wellpoint Medicaid Managed Care	$18.34

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064045
Hospital Revenue Code	310
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005293
Hospital Revenue Code	312
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005293
Hospital Revenue Code	312
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$346.05
Rate for Payer: Aetna Commercial	$263.00
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$346.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$16.68
Rate for Payer: Wellpoint Medicaid Managed Care	$18.34

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064045
Hospital Revenue Code	310
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$57.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$18.34

LEVEL IV SURG PATHOLOGY***

Facility

$22.00

Service Code	HCPCS 8830559
Hospital Charge Code	3005294A
Hospital Revenue Code	312
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

LEVEL IV SURG PATHOLOGY***

Facility

$22.00

Service Code	HCPCS 8830559
Hospital Charge Code	3005294A
Hospital Revenue Code	312
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

LEVEL OF CARE-BRIEF

Facility

$224.00

Service Code	HCPCS 99211
Hospital Charge Code	94186090
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

LEVEL OF CARE-BRIEF

Facility

$224.00

Service Code	HCPCS 99211
Hospital Charge Code	94186090
Hospital Revenue Code	510
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

LEVEL OF CARE-COMPREHNSVE

Facility

$464.00

Service Code	HCPCS 99215
Hospital Charge Code	94186110
Hospital Revenue Code	510
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

LEVEL OF CARE-COMPREHNSVE

Facility

$464.00

Service Code	HCPCS 99215
Hospital Charge Code	94186110
Hospital Revenue Code	510
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$232.00
Rate for Payer: Aetna Commercial	$176.32
Rate for Payer: Aetna Medicare Advantage	$139.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.32
Rate for Payer: Cigna Commercial	$232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$69.60
Rate for Payer: UnitedHealthcare Community & State	$11.18
Rate for Payer: Wellpoint Medicaid Managed Care	$12.30

LEVEL OF CARE-EXTENDED

Facility

$371.00

Service Code	HCPCS 99214
Hospital Charge Code	94186105
Hospital Revenue Code	510
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$55.65
Rate for Payer: Qualcare PPO/HMO/WC	$55.65

LEVEL OF CARE-EXTENDED

Facility

$371.00

Service Code	HCPCS 99214
Hospital Charge Code	94186105
Hospital Revenue Code	510
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$185.50
Rate for Payer: Aetna Commercial	$140.98
Rate for Payer: Aetna Medicare Advantage	$111.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.61
Rate for Payer: Cigna Commercial	$185.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.65
Rate for Payer: UnitedHealthcare Community & State	$8.94
Rate for Payer: Wellpoint Medicaid Managed Care	$9.83

LEVEL OF CARE-INTERMEDATE

Facility

$303.00

Service Code	HCPCS 99213
Hospital Charge Code	94186100
Hospital Revenue Code	510
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$115.14
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Community & State	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

LEVEL OF CARE-INTERMEDATE

Facility

$303.00

Service Code	HCPCS 99213
Hospital Charge Code	94186100
Hospital Revenue Code	510
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LEVEL OF CARE-LIMITED

Facility

$267.00

Service Code	HCPCS 99212
Hospital Charge Code	94186095
Hospital Revenue Code	510
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

LEVEL OF CARE-LIMITED

Facility

$267.00

Service Code	HCPCS 99212
Hospital Charge Code	94186095
Hospital Revenue Code	510
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.10
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Community & State	$6.43
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005311
Hospital Revenue Code	312
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005311
Hospital Revenue Code	312
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005310
Hospital Revenue Code	310
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005310
Hospital Revenue Code	310
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

LEVEL VI SP GROSS&MICROSCOPIC*

Facility

$39.00

Service Code	HCPCS 8830959
Hospital Charge Code	3005310A
Hospital Revenue Code	312
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

LEVEL VI SP GROSS&MICROSCOPIC*

Facility

$39.00

Service Code	HCPCS 8830959
Hospital Charge Code	3005310A
Hospital Revenue Code	312
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

LEVEL V SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005301
Hospital Revenue Code	312
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LEVEL V SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005301
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges