Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$29.25
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.14
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$29.25
Rate for Payer: Wellpoint Medicaid Managed Care	$32.17

OFF VISIT EST PATIENT LIVEL 1

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OFF VISIT EST PATIENT LIVEL 1

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$121.47
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.89
Rate for Payer: Qualcare PPO/HMO/WC	$47.95
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: Wellpoint Medicaid Managed Care	$8.47

OFF VISIT NEW PATIENT LEVEL 1

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$121.47
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.89
Rate for Payer: Qualcare PPO/HMO/WC	$47.95
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: Wellpoint Medicaid Managed Care	$8.47

OFF VISIT NEW PATIENT LEVEL 1

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OFF VISIT NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
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 NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
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 NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
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 NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
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 NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OFF VISIT NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
Hospital Revenue Code	510
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.46
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.31

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84505020
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84505020
Hospital Revenue Code	510
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$524.46
Rate for Payer: Aetna Commercial	$398.59
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$524.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.68
Rate for Payer: Qualcare PPO/HMO/WC	$157.34
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$27.80

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$1,541.04
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,183.08
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,541.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,694.51

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$74.37
Max. Negotiated Rate	$74.37
Rate for Payer: Qualcare PPO/HMO/WC	$74.37

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$11.95
Max. Negotiated Rate	$247.90
Rate for Payer: Aetna Commercial	$188.40
Rate for Payer: Aetna Medicare Advantage	$148.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.43
Rate for Payer: Cigna Commercial	$247.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.74
Rate for Payer: Oxford Commercial	$99.16
Rate for Payer: Qualcare PPO/HMO/WC	$74.37
Rate for Payer: UnitedHealthcare Commercial	$99.16
Rate for Payer: UnitedHealthcare Community & State	$11.95
Rate for Payer: Wellpoint Medicaid Managed Care	$13.14

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$21.05

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$70.15
Rate for Payer: Aetna Commercial	$53.31
Rate for Payer: Aetna Medicare Advantage	$42.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.78
Rate for Payer: Cigna Commercial	$70.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.09
Rate for Payer: Oxford Commercial	$28.06
Rate for Payer: Qualcare PPO/HMO/WC	$21.05
Rate for Payer: UnitedHealthcare Commercial	$28.06
Rate for Payer: UnitedHealthcare Community & State	$3.38
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Commercial	$39.33
Rate for Payer: Aetna Medicare Advantage	$31.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$51.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.05
Rate for Payer: Oxford Commercial	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$20.70
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

OIL RED O STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005302
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

OIL RED O STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005302
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.30

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.67
Rate for Payer: Aetna Commercial	$5.83
Rate for Payer: Aetna Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.91
Rate for Payer: Cigna Commercial	$7.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Oxford Commercial	$3.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.30
Rate for Payer: UnitedHealthcare Commercial	$3.07
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

Know your out-of-pocket cost for care.

All Charges