Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653165
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-LIMITED

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	83653160
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV-NEW-LIMITED

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	83653160
Hospital Revenue Code	514
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 NEW PATIENT HIGH COMPLEXITY

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84506110
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OV NEW PATIENT HIGH COMPLEXITY

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84506110
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

OV NEW PATIENT LOW COMPLEXITY

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84506100
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV NEW PATIENT LOW COMPLEXITY

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84506100
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 NEW PATIENT MODERATE COMPLX

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84506105
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

OV NEW PATIENT MODERATE COMPLX

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84506105
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OV NEW PT EXPANDED PROBL FOCUS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84506095
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV NEW PT EXPANDED PROBL FOCUS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84506095
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 NEW PT STRAIGHT FORWARD

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84506090
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

OV NEW PT STRAIGHT FORWARD

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84506090
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OVVAN CYSTECTOMY UL/BL

Facility

$6,544.55

Service Code	HCPCS 58925
Hospital Charge Code	1600000356
Hospital Revenue Code	360
Min. Negotiated Rate	$981.68
Max. Negotiated Rate	$981.68
Rate for Payer: Qualcare PPO/HMO/WC	$981.68

OVVAN CYSTECTOMY UL/BL

Facility

$6,544.55

Service Code	HCPCS 58925
Hospital Charge Code	1600000356
Hospital Revenue Code	360
Min. Negotiated Rate	$157.72
Max. Negotiated Rate	$21,452.59
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,452.59
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,963.37
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$981.68
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$157.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$173.43

OXACILLIN 1 GM VIAL

Facility

$66.40

Hospital Charge Code	60630055
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$9.96

OXACILLIN 1 GM VIAL

Facility

$66.40

Hospital Charge Code	60630055
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.20
Rate for Payer: Aetna Commercial	$25.23
Rate for Payer: Aetna Medicare Advantage	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.93
Rate for Payer: Cigna Commercial	$33.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.92
Rate for Payer: Oxford Commercial	$13.28
Rate for Payer: Qualcare PPO/HMO/WC	$9.96
Rate for Payer: UnitedHealthcare Commercial	$13.28
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

OXACILLIN 2GM VIAL

Facility

$128.61

Hospital Charge Code	60630056
Hospital Revenue Code	250
Min. Negotiated Rate	$19.29
Max. Negotiated Rate	$19.29
Rate for Payer: Qualcare PPO/HMO/WC	$19.29

OXACILLIN 2GM VIAL

Facility

$128.61

Hospital Charge Code	60630056
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$64.31
Rate for Payer: Aetna Commercial	$48.87
Rate for Payer: Aetna Medicare Advantage	$38.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.80
Rate for Payer: Cigna Commercial	$64.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.58
Rate for Payer: Oxford Commercial	$25.72
Rate for Payer: Qualcare PPO/HMO/WC	$19.29
Rate for Payer: UnitedHealthcare Commercial	$25.72
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

OXACILLIN VL 1GM

Facility

$171.00

Hospital Charge Code	6006548
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$64.98
Rate for Payer: Aetna Medicare Advantage	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.60
Rate for Payer: Cigna Commercial	$85.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.30
Rate for Payer: Oxford Commercial	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.65
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: UnitedHealthcare Community & State	$4.12
Rate for Payer: Wellpoint Medicaid Managed Care	$4.53

OXACILLIN VL 1GM

Facility

$171.00

Hospital Charge Code	6006548
Hospital Revenue Code	250
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$25.65

OXACILLIN VL 2GM

Facility

$324.00

Hospital Charge Code	6006555
Hospital Revenue Code	250
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

OXACILLIN VL 2GM

Facility

$324.00

Hospital Charge Code	6006555
Hospital Revenue Code	250
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$64.80
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

OXALATE

Facility

$517.00

Service Code	HCPCS 83945
Hospital Charge Code	38472427
Hospital Revenue Code	301
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$258.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$46.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.16
Rate for Payer: Cigna Commercial	$258.50
Rate for Payer: Cigna Medicare Advantage	$14.45
Rate for Payer: Clover Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$43.35
Rate for Payer: Humana Medicare Advantage	$14.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.45
Rate for Payer: Wellcare Medicare Advantage	$14.45
Rate for Payer: Wellpoint Medicaid Managed Care	$13.70

OXALATE

Facility

$517.00

Service Code	HCPCS 83945
Hospital Charge Code	38472427
Hospital Revenue Code	301
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

Know your out-of-pocket cost for care.

All Charges