Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MEDICAL FOLLOW UP*****

Facility

$40.00

Service Code	HCPCS 90801
Hospital Charge Code	9300070
Hospital Revenue Code	910
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

MEDICAL FP VISIT W/MD OR NP***

Facility

$25.30

Service Code	HCPCS 99212WF
Hospital Charge Code	9600024
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

MEDICAL FP VISIT W/MD OR NP***

Facility

$25.30

Service Code	HCPCS 99212WF
Hospital Charge Code	9600024
Hospital Revenue Code	519
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$9.61
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

MEDICAL RECORDING CHART PAPER

Facility

$44.40

Hospital Charge Code	270665693
Hospital Revenue Code	270
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.20
Rate for Payer: Aetna Commercial	$16.87
Rate for Payer: Aetna Medicare Advantage	$13.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.32
Rate for Payer: Cigna Commercial	$22.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.32
Rate for Payer: Oxford Commercial	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.66
Rate for Payer: UnitedHealthcare Commercial	$8.88
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

MEDICAL RECORDING CHART PAPER

Facility

$44.40

Hospital Charge Code	270665693
Hospital Revenue Code	270
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$6.66
Rate for Payer: Qualcare PPO/HMO/WC	$6.66

MEDICAL REVIEW OFFICER

Facility

$225.20

Service Code	HCPCS 99211
Hospital Charge Code	MROCLIENT
Hospital Revenue Code	510
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

MEDICAL REVIEW OFFICER

Facility

$225.20

Service Code	HCPCS 99211
Hospital Charge Code	MROCLIENT
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

MEDICAL VISIT EST PT 40MIN****

Facility

$150.00

Service Code	HCPCS 99215
Hospital Charge Code	9400169
Hospital Revenue Code	519
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MEDICAL VISIT EST PT 40MIN****

Facility

$150.00

Service Code	HCPCS 99215
Hospital Charge Code	9400169
Hospital Revenue Code	519
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

MEDICAL VISIT NEW 30M****

Facility

$132.00

Hospital Charge Code	9400128
Hospital Revenue Code	519
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

MEDICAL VISIT NEW 30M****

Facility

$132.00

Hospital Charge Code	9400128
Hospital Revenue Code	519
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

MEDICAL VS EST 10 MIN*****

Facility

$55.00

Service Code	HCPCS 99212
Hospital Charge Code	9400144
Hospital Revenue Code	519
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

MEDICAL VS EST 10 MIN*****

Facility

$55.00

Service Code	HCPCS 99212
Hospital Charge Code	9400144
Hospital Revenue Code	519
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

MEDICAL VS EST 30MIN*****

Facility

$90.00

Service Code	HCPCS 99214
Hospital Charge Code	9400151
Hospital Revenue Code	519
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

MEDICAL VS EST 30MIN*****

Facility

$90.00

Service Code	HCPCS 99214
Hospital Charge Code	9400151
Hospital Revenue Code	519
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: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

MEDICAL VS NEW 45 MIN*****

Facility

$165.00

Service Code	HCPCS 99204
Hospital Charge Code	9400136
Hospital Revenue Code	519
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

MEDICAL VS NEW 45 MIN*****

Facility

$165.00

Service Code	HCPCS 99204
Hospital Charge Code	9400136
Hospital Revenue Code	519
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

MEDICINE GLASS W/LIP 1 OZ

Facility

$9.05

Hospital Charge Code	270659392
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna Commercial	$3.44
Rate for Payer: Aetna Medicare Advantage	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.31
Rate for Payer: Cigna Commercial	$4.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.36
Rate for Payer: UnitedHealthcare Commercial	$1.81
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

MEDICINE GLASS W/LIP 1 OZ

Facility

$9.05

Hospital Charge Code	270659392
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.36

MEDIHONEY 44ML

Facility

$212.00

Hospital Charge Code	606390572
Hospital Revenue Code	250
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

MEDIHONEY 44ML

Facility

$212.00

Hospital Charge Code	606390572
Hospital Revenue Code	250
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

MEDIHONEY GEL TUBE

Facility

$82.19

Hospital Charge Code	606380009
Hospital Revenue Code	250
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$12.33
Rate for Payer: Qualcare PPO/HMO/WC	$12.33

MEDIHONEY GEL TUBE

Facility

$82.19

Hospital Charge Code	606380009
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.09
Rate for Payer: Aetna Commercial	$31.23
Rate for Payer: Aetna Medicare Advantage	$24.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.96
Rate for Payer: Cigna Commercial	$41.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.66
Rate for Payer: Oxford Commercial	$16.44
Rate for Payer: Qualcare PPO/HMO/WC	$12.33
Rate for Payer: UnitedHealthcare Commercial	$16.44
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

MEDIHONEY GEL TUBE

Facility

$95.12

Hospital Charge Code	606351017
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$14.27

MEDIHONEY GEL TUBE

Facility

$66.06

Service Code	NDC 9958003461
Hospital Charge Code	606390420
Hospital Revenue Code	272
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$9.91

Know your out-of-pocket cost for care.

All Charges