Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OFFICE OP VISIT EST - V

Facility

$833.26

Service Code	HCPCS 99215
Hospital Charge Code	85000865
Hospital Revenue Code	510
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$416.63
Rate for Payer: Aetna Commercial	$316.64
Rate for Payer: Aetna Medicare Advantage	$249.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.48
Rate for Payer: Cigna Commercial	$416.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.98
Rate for Payer: Qualcare PPO/HMO/WC	$124.99
Rate for Payer: UnitedHealthcare Community & State	$20.08
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

OFFICE OP VISIT EST - V

Facility

$833.26

Service Code	HCPCS 99215
Hospital Charge Code	85000865
Hospital Revenue Code	510
Min. Negotiated Rate	$124.99
Max. Negotiated Rate	$124.99
Rate for Payer: Qualcare PPO/HMO/WC	$124.99

OFFICE OP VISIT NEW - I

Facility

$368.18

Service Code	HCPCS 99201
Hospital Charge Code	85000820
Hospital Revenue Code	510
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$184.09
Rate for Payer: Aetna Commercial	$139.91
Rate for Payer: Aetna Medicare Advantage	$110.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.89
Rate for Payer: Cigna Commercial	$184.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.45
Rate for Payer: Qualcare PPO/HMO/WC	$55.23
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.76

OFFICE OP VISIT NEW - I

Facility

$368.18

Service Code	HCPCS 99201
Hospital Charge Code	85000820
Hospital Revenue Code	510
Min. Negotiated Rate	$55.23
Max. Negotiated Rate	$55.23
Rate for Payer: Qualcare PPO/HMO/WC	$55.23

OFFICE OP VISIT NEW - II

Facility

$477.85

Service Code	HCPCS 99202
Hospital Charge Code	85000825
Hospital Revenue Code	510
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$71.68
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

OFFICE OP VISIT NEW - II

Facility

$477.85

Service Code	HCPCS 99202
Hospital Charge Code	85000825
Hospital Revenue Code	510
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$238.93
Rate for Payer: Aetna Commercial	$181.58
Rate for Payer: Aetna Medicare Advantage	$143.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.85
Rate for Payer: Cigna Commercial	$238.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.35
Rate for Payer: Qualcare PPO/HMO/WC	$71.68
Rate for Payer: UnitedHealthcare Community & State	$11.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12.66

OF FOOT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 28465
Hospital Charge Code	16000574
Hospital Revenue Code	360
Min. Negotiated Rate	$1,180.71
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,697.63
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,180.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,298.29

OF FOOT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 28465
Hospital Charge Code	16000574
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OFFSET CONNECTOR 3MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687950
Hospital Revenue Code	278
Min. Negotiated Rate	$295.59
Max. Negotiated Rate	$6,132.50
Rate for Payer: Aetna Commercial	$4,660.70
Rate for Payer: Aetna Medicare Advantage	$3,679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,127.57
Rate for Payer: Cigna Commercial	$6,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,698.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75
Rate for Payer: UnitedHealthcare Community & State	$295.59
Rate for Payer: Wellpoint Medicaid Managed Care	$325.02

OFFSET CONNECTOR 3MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687950
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$2,968.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,698.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET CONNECTOR 5MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687676
Hospital Revenue Code	278
Min. Negotiated Rate	$295.59
Max. Negotiated Rate	$6,132.50
Rate for Payer: Aetna Commercial	$4,660.70
Rate for Payer: Aetna Medicare Advantage	$3,679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,127.57
Rate for Payer: Cigna Commercial	$6,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,698.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75
Rate for Payer: UnitedHealthcare Community & State	$295.59
Rate for Payer: Wellpoint Medicaid Managed Care	$325.02

OFFSET CONNECTOR 5MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$2,968.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,698.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET LAT TOPLOAD 30MM

Facility

$4,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270695326
Hospital Revenue Code	278
Min. Negotiated Rate	$109.05
Max. Negotiated Rate	$2,262.50
Rate for Payer: Aetna Commercial	$1,719.50
Rate for Payer: Aetna Medicare Advantage	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,153.88
Rate for Payer: Cigna Commercial	$2,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,095.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$995.50
Rate for Payer: Qualcare PPO/HMO/WC	$678.75
Rate for Payer: UnitedHealthcare Community & State	$109.05
Rate for Payer: Wellpoint Medicaid Managed Care	$119.91

OFFSET LAT TOPLOAD 30MM

Facility

$4,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270695326
Hospital Revenue Code	278
Min. Negotiated Rate	$678.75
Max. Negotiated Rate	$1,095.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,095.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$995.50
Rate for Payer: Qualcare PPO/HMO/WC	$678.75

OFFSET TIBIAL TRAY 67MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270680591
Hospital Revenue Code	278
Min. Negotiated Rate	$310.17
Max. Negotiated Rate	$6,435.00
Rate for Payer: Aetna Commercial	$4,890.60
Rate for Payer: Aetna Medicare Advantage	$3,861.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,281.85
Rate for Payer: Cigna Commercial	$6,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,831.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50
Rate for Payer: UnitedHealthcare Community & State	$310.17
Rate for Payer: Wellpoint Medicaid Managed Care	$341.06

OFFSET TIBIAL TRAY 67MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270680591
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$3,114.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,831.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFFSET TIBIAL TRAY 71MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270682263
Hospital Revenue Code	278
Min. Negotiated Rate	$310.17
Max. Negotiated Rate	$6,435.00
Rate for Payer: Aetna Commercial	$4,890.60
Rate for Payer: Aetna Medicare Advantage	$3,861.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,281.85
Rate for Payer: Cigna Commercial	$6,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,831.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50
Rate for Payer: UnitedHealthcare Community & State	$310.17
Rate for Payer: Wellpoint Medicaid Managed Care	$341.06

OFFSET TIBIAL TRAY 71MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270682263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$3,114.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,831.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$17.36

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.64
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$19.97
Rate for Payer: Wellpoint Medicaid Managed Care	$21.96

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT EST PATIENT LEVEL 5

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84505045
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

Know your out-of-pocket cost for care.

All Charges