Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RW NAIL EXCISION-MATRIX PERMNT

Facility

$1,208.00

Service Code	HCPCS 11750
Hospital Charge Code	84206060
Hospital Revenue Code	761
Min. Negotiated Rate	$181.20
Max. Negotiated Rate	$181.20
Rate for Payer: Qualcare PPO/HMO/WC	$181.20

RW NEW PT - VISIT - COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84206330
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

RW NEW PT - VISIT - COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84206330
Hospital Revenue Code	510
Min. Negotiated Rate	$24.17
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.90
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$24.17
Rate for Payer: Wellpoint Medicaid Managed Care	$26.58

RW NEW PT - VISIT - COMPREHENS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84206325
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

RW NEW PT - VISIT - COMPREHENS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84206325
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

RW NEW PT - VISIT - DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84206320
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

RW NEW PT - VISIT - DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84206320
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW NEW PT - VISIT - EXPANDED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	84206315
Hospital Revenue Code	510
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.60
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

RW NEW PT - VISIT - EXPANDED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	84206315
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

RW NEW PT - VISIT - FOCUSED

Facility

$234.00

Service Code	HCPCS 99201
Hospital Charge Code	84206310
Hospital Revenue Code	510
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

RW NEW PT - VISIT - FOCUSED

Facility

$234.00

Service Code	HCPCS 99201
Hospital Charge Code	84206310
Hospital Revenue Code	510
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

RW OFF VISIT EST PT MINIMAL

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	87502225
Hospital Revenue Code	510
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$43.32
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

RW OFF VISIT EST PT MINIMAL

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	87502225
Hospital Revenue Code	510
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

RW OFF VISIT FOCUSED NP

Facility

$234.00

Service Code	HCPCS 99201
Hospital Charge Code	87502200
Hospital Revenue Code	510
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

RW OFF VISIT FOCUSED NP

Facility

$234.00

Service Code	HCPCS 99201
Hospital Charge Code	87502200
Hospital Revenue Code	510
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

RW PAIRING BENIGN 2-4 LESIONS

Facility

$650.00

Service Code	HCPCS 11056
Hospital Charge Code	87502145
Hospital Revenue Code	761
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

RW PAIRING BENIGN 2-4 LESIONS

Facility

$650.00

Service Code	HCPCS 11056
Hospital Charge Code	87502145
Hospital Revenue Code	761
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

RW PAIRING BENIGN >4 LESIONS

Facility

$1,400.00

Service Code	HCPCS 11057
Hospital Charge Code	87502150
Hospital Revenue Code	761
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$420.00
Rate for Payer: Oxford Commercial	$280.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Commercial	$280.00
Rate for Payer: UnitedHealthcare Community & State	$33.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$37.10

RW PAIRING BENIGN >4 LESIONS

Facility

$1,400.00

Service Code	HCPCS 11057
Hospital Charge Code	87502150
Hospital Revenue Code	761
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

RW PAIRING BENIGN LES SINGLE

Facility

$512.00

Service Code	HCPCS 11055
Hospital Charge Code	87502140
Hospital Revenue Code	761
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$76.80
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

RW PAIRING BENIGN LES SINGLE

Facility

$512.00

Service Code	HCPCS 11055
Hospital Charge Code	87502140
Hospital Revenue Code	761
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.60
Rate for Payer: Oxford Commercial	$102.40
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Commercial	$102.40
Rate for Payer: UnitedHealthcare Community & State	$12.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$13.57

RW PAP SMEAR

Facility

$143.00

Hospital Charge Code	83652627
Hospital Revenue Code	770
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

RW PAP SMEAR

Facility

$143.00

Service Code	HCPCS Q0091
Hospital Charge Code	87502295
Hospital Revenue Code	770
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$28.60
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

RW PAP SMEAR

Facility

$143.00

Hospital Charge Code	83652627
Hospital Revenue Code	770
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$71.50
Rate for Payer: Aetna Commercial	$54.34
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.47
Rate for Payer: Cigna Commercial	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$28.60
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

RW PAP SMEAR

Facility

$143.00

Service Code	HCPCS Q0091
Hospital Charge Code	87502295
Hospital Revenue Code	770
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

Know your out-of-pocket cost for care.

All Charges