Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OV-ESTABLISHED-EXTENDED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	83653195
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV-ESTABLISHED-EXTENDED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	83653195
Hospital Revenue Code	514
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

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	83653190
Hospital Revenue Code	514
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	74308305
Hospital Revenue Code	514
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	74308305
Hospital Revenue Code	514
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

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	83653190
Hospital Revenue Code	514
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

OV ESTAB PT EXPAND PROB FOCUS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84506120
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV ESTAB PT EXPAND PROB FOCUS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84506120
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

OV ESTAB PT HIGH COMPLEXITY

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84506135
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OV ESTAB PT HIGH COMPLEXITY

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84506135
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

OV ESTAB PT LOW COMPLEXITY

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84506125
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV ESTAB PT LOW COMPLEXITY

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84506125
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

OV ESTAB PT MODERATE COMPLEX

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84506130
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV ESTAB PT MODERATE COMPLEX

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84506130
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

OV ESTAB PT STRAIGHT FORWARD

Facility

$3,107.20

Service Code	HCPCS 99211
Hospital Charge Code	84506115
Hospital Revenue Code	510
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

OV ESTAB PT STRAIGHT FORWARD

Facility

$3,107.20

Service Code	HCPCS 99211
Hospital Charge Code	84506115
Hospital Revenue Code	510
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$1,553.60
Rate for Payer: Aetna Commercial	$1,180.74
Rate for Payer: Aetna Medicare Advantage	$932.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$792.34
Rate for Payer: Cigna Commercial	$1,553.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$932.16
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Community & State	$74.88
Rate for Payer: Wellpoint Medicaid Managed Care	$82.34

OVITEX CORE 6X10CM

Facility

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705069
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$822.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

OVITEX CORE 6X10CM

Facility

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705069
Hospital Revenue Code	278
Min. Negotiated Rate	$81.94
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,292.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Community & State	$81.94
Rate for Payer: Wellpoint Medicaid Managed Care	$90.10

OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	83653155
Hospital Revenue Code	514
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	83653155
Hospital Revenue Code	514
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

OV-NEW-COMPREHENSIVE

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	83653175
Hospital Revenue Code	514
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

OV-NEW-COMPREHENSIVE

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	83653175
Hospital Revenue Code	514
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653170
Hospital Revenue Code	514
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

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653165
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653170
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

Know your out-of-pocket cost for care.

All Charges