Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLUME AWAY

Facility

$199.84

Hospital Charge Code	270663223
Hospital Revenue Code	270
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190205
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190205
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

PL-VAS OV EP PROBLEM FOCUSED

Facility

$428.58

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$214.29
Rate for Payer: Aetna Commercial	$162.86
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.29
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

PL-VAS OV EP PROBLEM FOCUSED

Facility

$428.58

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$214.29
Rate for Payer: Aetna Commercial	$162.86
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.29
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

PL-VAS OV PROBLEM FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	83033020
Hospital Revenue Code	510
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

PL-VAS OV PROBLEM FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	83033020
Hospital Revenue Code	510
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PM1110 ACCENT SR PACEMKR U_US

Facility

$26,435.00

Hospital Charge Code	270656343
Hospital Revenue Code	278
Min. Negotiated Rate	$3,965.25
Max. Negotiated Rate	$6,397.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,815.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,965.25

PM1110 ACCENT SR PACEMKR U_US

Facility

$26,435.00

Hospital Charge Code	270656343
Hospital Revenue Code	278
Min. Negotiated Rate	$637.08
Max. Negotiated Rate	$13,217.50
Rate for Payer: Aetna Commercial	$10,045.30
Rate for Payer: Aetna Medicare Advantage	$7,930.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,740.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,740.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,740.93
Rate for Payer: Cigna Commercial	$13,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,815.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,965.25
Rate for Payer: UnitedHealthcare Community & State	$637.08
Rate for Payer: Wellpoint Medicaid Managed Care	$700.53

PMAKER REVO MRI SURESCN RVDR01

Facility

$29,730.00

Hospital Charge Code	270645703
Hospital Revenue Code	275
Min. Negotiated Rate	$4,459.50
Max. Negotiated Rate	$7,194.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,946.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,194.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,540.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,459.50

PMAKER REVO MRI SURESCN RVDR01

Facility

$29,730.00

Hospital Charge Code	270645703
Hospital Revenue Code	275
Min. Negotiated Rate	$716.49
Max. Negotiated Rate	$14,865.00
Rate for Payer: Aetna Commercial	$11,297.40
Rate for Payer: Aetna Medicare Advantage	$8,919.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,581.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,581.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,946.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,581.15
Rate for Payer: Cigna Commercial	$14,865.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,194.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,540.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,459.50
Rate for Payer: UnitedHealthcare Community & State	$716.49
Rate for Payer: Wellpoint Medicaid Managed Care	$787.85

P-MASTECTOMY W/LN REMOVAL BL

Facility

$42,601.70

Service Code	HCPCS 19302
Hospital Charge Code	16000439
Hospital Revenue Code	360
Min. Negotiated Rate	$1,026.70
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,780.51
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,026.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,128.95

P-MASTECTOMY W/LN REMOVAL BL

Facility

$42,601.70

Service Code	HCPCS 19302
Hospital Charge Code	16000439
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

PML RARA T (15:17)) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708015C
Hospital Revenue Code	301
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$748.33
Rate for Payer: Aetna Commercial	$563.88
Rate for Payer: Aetna Medicare Advantage	$671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$748.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$748.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$207.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$748.33
Rate for Payer: Cigna Commercial	$707.08
Rate for Payer: Cigna Medicare Advantage	$207.31
Rate for Payer: Clover Medicare Advantage	$196.94
Rate for Payer: EmblemHealth Commercial	$621.93
Rate for Payer: Humana Medicare Advantage	$213.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$207.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$165.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$207.31
Rate for Payer: Wellcare Medicare Advantage	$207.31
Rate for Payer: Wellpoint Medicaid Managed Care	$37.47

PML RARA T (15:17)) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708015C
Hospital Revenue Code	301
Min. Negotiated Rate	$212.12
Max. Negotiated Rate	$212.12
Rate for Payer: Qualcare PPO/HMO/WC	$212.12

PML RARA T (1517) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708019
Hospital Revenue Code	310
Min. Negotiated Rate	$212.12
Max. Negotiated Rate	$212.12
Rate for Payer: Qualcare PPO/HMO/WC	$212.12

PML RARA T (1517) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708019
Hospital Revenue Code	310
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$748.33
Rate for Payer: Aetna Commercial	$563.88
Rate for Payer: Aetna Medicare Advantage	$671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$748.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$748.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$207.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$748.33
Rate for Payer: Cigna Commercial	$707.08
Rate for Payer: Cigna Medicare Advantage	$207.31
Rate for Payer: Clover Medicare Advantage	$196.94
Rate for Payer: EmblemHealth Commercial	$621.93
Rate for Payer: Humana Medicare Advantage	$213.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$207.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.12
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$165.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$207.31
Rate for Payer: Wellcare Medicare Advantage	$207.31
Rate for Payer: Wellpoint Medicaid Managed Care	$37.47

PM Oxycodone Quant Urine

Facility

$499.75

Service Code	HCPCS 80365
Hospital Charge Code	39900531
Hospital Revenue Code	301
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.24

PM Oxycodone Quant Urine

Facility

$499.75

Service Code	HCPCS 80365
Hospital Charge Code	39900531
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

PM RPR RUPT ACHLS TNDN W GRFT

Facility

$65,621.54

Service Code	HCPCS 27652
Hospital Charge Code	16000379
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
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	$19,686.46
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,843.23
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,581.48
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	$1,738.97

PM RPR RUPT ACHLS TNDN W GRFT

Facility

$65,621.54

Service Code	HCPCS 27652
Hospital Charge Code	16000379
Hospital Revenue Code	360
Min. Negotiated Rate	$9,843.23
Max. Negotiated Rate	$9,843.23
Rate for Payer: Qualcare PPO/HMO/WC	$9,843.23

PM-UR OV EP EXPANDED PROB FOCU

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	75190220
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

PM-UR OV EP EXPANDED PROB FOCU

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	75190220
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

Know your out-of-pocket cost for care.

All Charges