Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OP OFFICE VS - LEVEL 2 EST PT

Facility

$37.00

Service Code	HCPCS 99212
Hospital Charge Code	260112
Hospital Revenue Code	510
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

OP OFFICE VS - LEVEL 2 NEW PT

Facility

$474.10

Service Code	HCPCS 99202
Hospital Charge Code	260102
Hospital Revenue Code	510
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$237.05
Rate for Payer: Aetna Commercial	$180.16
Rate for Payer: Aetna Medicare Advantage	$142.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.90
Rate for Payer: Cigna Commercial	$237.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.23
Rate for Payer: Qualcare PPO/HMO/WC	$71.11
Rate for Payer: UnitedHealthcare Community & State	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

OP OFFICE VS - LEVEL 2 NEW PT

Facility

$474.10

Service Code	HCPCS 99202
Hospital Charge Code	260102
Hospital Revenue Code	510
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

OP OFFICE VS - LEVEL 3 EST PT

Facility

$47.00

Service Code	HCPCS 99213
Hospital Charge Code	260113
Hospital Revenue Code	510
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

OP OFFICE VS - LEVEL 3 EST PT

Facility

$47.00

Service Code	HCPCS 99213
Hospital Charge Code	260113
Hospital Revenue Code	510
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

OP OFFICE VS - LEVEL 3 NEW PT

Facility

$63.00

Service Code	HCPCS 99203
Hospital Charge Code	260103
Hospital Revenue Code	510
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

OP OFFICE VS - LEVEL 3 NEW PT

Facility

$63.00

Service Code	HCPCS 99203
Hospital Charge Code	260103
Hospital Revenue Code	510
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

OP OFFICE VS - LEVEL 4 EST PT

Facility

$62.00

Service Code	HCPCS 99214
Hospital Charge Code	260114
Hospital Revenue Code	510
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

OP OFFICE VS - LEVEL 4 EST PT

Facility

$62.00

Service Code	HCPCS 99214
Hospital Charge Code	260114
Hospital Revenue Code	510
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$23.56
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

OP OFFICE VS - LEVEL 4 NEW PT

Facility

$93.00

Service Code	HCPCS 99204
Hospital Charge Code	260104
Hospital Revenue Code	510
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

OP OFFICE VS - LEVEL 4 NEW PT

Facility

$93.00

Service Code	HCPCS 99204
Hospital Charge Code	260104
Hospital Revenue Code	510
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$46.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.95
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

OP OFFICE VS - LEVEL 5 EST PT

Facility

$91.00

Service Code	HCPCS 99215
Hospital Charge Code	260115
Hospital Revenue Code	510
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

OP OFFICE VS - LEVEL 5 EST PT

Facility

$91.00

Service Code	HCPCS 99215
Hospital Charge Code	260115
Hospital Revenue Code	510
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

OP OFFICE VS - LEVEL 5 NEW PT

Facility

$101.00

Service Code	HCPCS 99205
Hospital Charge Code	260105
Hospital Revenue Code	510
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

OP OFFICE VS - LEVEL 5 NEW PT

Facility

$101.00

Service Code	HCPCS 99205
Hospital Charge Code	260105
Hospital Revenue Code	510
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
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	$25,388.29
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$2,039.53
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	$2,242.63

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$12,694.14
Max. Negotiated Rate	$12,694.14
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$984.10
Rate for Payer: Aetna Commercial	$747.91
Rate for Payer: Aetna Medicare Advantage	$590.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.89
Rate for Payer: Cigna Commercial	$984.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23
Rate for Payer: UnitedHealthcare Community & State	$47.43
Rate for Payer: Wellpoint Medicaid Managed Care	$52.16

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$476.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23

OPRELVEKIN 5MG VIAL

Facility

$843.00

Hospital Charge Code	60635207
Hospital Revenue Code	636
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$204.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

OPRELVEKIN 5MG VIAL

Facility

$843.00

Hospital Charge Code	60635207
Hospital Revenue Code	636
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.50
Rate for Payer: Aetna Commercial	$320.34
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

OPSITE *********

Facility

$55.00

Hospital Charge Code	8001190
Hospital Revenue Code	279
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

OPSITE *********

Facility

$55.00

Hospital Charge Code	8001190
Hospital Revenue Code	279
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: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

O&P SMEAR PRIM SOURCE W INTERP

Facility

$65.00

Service Code	HCPCS 87209
Hospital Charge Code	3035156B
Hospital Revenue Code	309
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.90
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

O&P SMEAR PRIM SOURCE W INTERP

Facility

$65.00

Service Code	HCPCS 87209
Hospital Charge Code	3035156B
Hospital Revenue Code	309
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

Know your out-of-pocket cost for care.

All Charges