Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEVIRAPINE 200MG TAB

Facility

$4.00

Hospital Charge Code	6063943147
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NEVIRAPINE 50MG/5ML

Facility

$5.29

Service Code	NDC 65862005724
Hospital Charge Code	606390249
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

NEVIRAPINE 50MG/5ML

Facility

$5.29

Service Code	NDC 65862005724
Hospital Charge Code	606390249
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.59
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

NEVIRAPINE TAB 200MG

Facility

$43.75

Hospital Charge Code	60629136
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.88
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.16
Rate for Payer: Cigna Commercial	$21.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.12
Rate for Payer: Oxford Commercial	$8.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.56
Rate for Payer: UnitedHealthcare Commercial	$8.75
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

NEVIRAPINE TAB 200MG

Facility

$43.75

Hospital Charge Code	60629136
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$6.56
Rate for Payer: Qualcare PPO/HMO/WC	$6.56

NEVOS SPONGE 50X20X7MM DBM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

NEVOS SPONGE 50X20X7MM DBM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692542
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

NEWBORN HEARING SCREENING

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	1800030
Hospital Revenue Code	471
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

NEWBORN HEARING SCREENING

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	1800030
Hospital Revenue Code	471
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

NEW I/P CONSULT LEVEL 4

Facility

$628.83

Service Code	HCPCS 99222
Hospital Charge Code	85000870
Hospital Revenue Code	510
Min. Negotiated Rate	$94.32
Max. Negotiated Rate	$94.32
Rate for Payer: Qualcare PPO/HMO/WC	$94.32

NEW I/P CONSULT LEVEL 4

Facility

$628.83

Service Code	HCPCS 99222
Hospital Charge Code	85000870
Hospital Revenue Code	510
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$314.42
Rate for Payer: Aetna Commercial	$238.96
Rate for Payer: Aetna Medicare Advantage	$188.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.35
Rate for Payer: Cigna Commercial	$314.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$94.32
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.66

NEW PATIENT LEV 2 >=15 MINS

Facility

$575.00

Service Code	HCPCS 99202
Hospital Charge Code	421599202
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4511711
Hospital Revenue Code	513
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4535711
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

NEW PATIENT LEV 2 >=15 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	87506045
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

NEW PATIENT LEV 2 >=15 MINS

Facility

$575.00

Service Code	HCPCS 99202
Hospital Charge Code	421099202
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	87502205
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4515711
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	93950135
Hospital Revenue Code	510
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.60
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

NEW PATIENT LEV 2 >=15 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84511031
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	485099202
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

NEW PATIENT LEV 2 >=15 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84511031
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4509711
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	93950135
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4509711
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

Know your out-of-pocket cost for care.

All Charges