Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4502714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4504714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4824714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4824714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	485599205
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4832714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT REFERRED COMPLEX

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	84505060
Hospital Revenue Code	510
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.10
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$22.98

NEW PATIENT REFERRED COMPLEX

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	84505060
Hospital Revenue Code	510
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

NEW PATIENT REFERRED-EXTENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	84505055
Hospital Revenue Code	510
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.18
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$27.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

NEW PATIENT REFERRED-EXTENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	84505055
Hospital Revenue Code	510
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

NEW PATIENT REFERRED - LIMITED

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	84505050
Hospital Revenue Code	510
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

NEW PATIENT REFERRED - LIMITED

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	84505050
Hospital Revenue Code	510
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

NEXGEN ALL-POLY PATELLA, 29MM

Facility

$2,297.75

Hospital Charge Code	270657043
Hospital Revenue Code	278
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$873.14
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66
Rate for Payer: UnitedHealthcare Community & State	$55.38
Rate for Payer: Wellpoint Medicaid Managed Care	$60.89

NEXGEN ALL-POLY PATELLA, 29MM

Facility

$2,297.75

Hospital Charge Code	270657043
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

NEXGEN ALL-POLY PATELLA,32MM

Facility

$2,297.75

Hospital Charge Code	270662346
Hospital Revenue Code	278
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$873.14
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66
Rate for Payer: UnitedHealthcare Community & State	$55.38
Rate for Payer: Wellpoint Medicaid Managed Care	$60.89

NEXGEN ALL-POLY PATELLA,32MM

Facility

$2,297.75

Hospital Charge Code	270662346
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

NEXGEN ALLY-POLY PATELLA

Facility

$2,300.00

Hospital Charge Code	270658854
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

NEXGEN ALLY-POLY PATELLA

Facility

$2,300.00

Hospital Charge Code	270658854
Hospital Revenue Code	278
Min. Negotiated Rate	$55.43
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$55.43
Rate for Payer: Wellpoint Medicaid Managed Care	$60.95

NEXGEN ALLY POLY PATELLA 29MM

Facility

$2,297.75

Hospital Charge Code	270657853
Hospital Revenue Code	278
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$873.14
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66
Rate for Payer: UnitedHealthcare Community & State	$55.38
Rate for Payer: Wellpoint Medicaid Managed Care	$60.89

NEXGEN ALLY POLY PATELLA 29MM

Facility

$2,297.75

Hospital Charge Code	270657853
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.50
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

NEXGEN AUG PATELLA MED THICK

Facility

$16,980.00

Service Code	HCPCS C1776
Hospital Charge Code	270683821
Hospital Revenue Code	278
Min. Negotiated Rate	$409.22
Max. Negotiated Rate	$8,490.00
Rate for Payer: Aetna Commercial	$6,452.40
Rate for Payer: Aetna Medicare Advantage	$5,094.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,329.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,329.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,329.90
Rate for Payer: Cigna Commercial	$8,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,735.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.00
Rate for Payer: UnitedHealthcare Community & State	$409.22
Rate for Payer: Wellpoint Medicaid Managed Care	$449.97

NEXGEN AUG PATELLA MED THICK

Facility

$16,980.00

Service Code	HCPCS C1776
Hospital Charge Code	270683821
Hospital Revenue Code	278
Min. Negotiated Rate	$2,547.00
Max. Negotiated Rate	$4,109.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,735.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.00

NEXGEN KNEE REPLACEMENT,

Facility

$2,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270657860
Hospital Revenue Code	278
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$63.62
Rate for Payer: Wellpoint Medicaid Managed Care	$69.96

NEXGEN KNEE REPLACEMENT,

Facility

$2,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270657860
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

NEXGEN KNEE REPLACEMENT EXTENS

Facility

$1,320.00

Hospital Charge Code	270657045
Hospital Revenue Code	278
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$319.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$198.00

Know your out-of-pocket cost for care.

All Charges