Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$36.83
Max. Negotiated Rate	$36.83
Rate for Payer: Qualcare PPO/HMO/WC	$36.83

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.75
Rate for Payer: Aetna Commercial	$93.29
Rate for Payer: Aetna Medicare Advantage	$73.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.60
Rate for Payer: Cigna Commercial	$122.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$36.83
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
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

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

WC LEVEL 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
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

WC LEVEL 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$132.43
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$52.27
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.24

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
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

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$132.43
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$52.27
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.24

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$696.85
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.23
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Community & State	$18.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$20.60

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.00
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$42.59
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$68.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$107.92
Rate for Payer: Aetna Medicare Advantage	$85.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.42
Rate for Payer: Cigna Commercial	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.53

WC MISSED A/B 1ST TRIMESTER

Professional

Both

$826.00

Service Code	HCPCS 59820
Hospital Charge Code	83652251
Hospital Revenue Code	960
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.00

WC NERVE BLOCK OTHER PERIPHERA

Facility

$2,035.90

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$305.38
Max. Negotiated Rate	$305.38
Rate for Payer: Qualcare PPO/HMO/WC	$305.38

WC NERVE BLOCK OTHER PERIPHERA

Facility

$2,035.90

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$49.07
Max. Negotiated Rate	$3,027.13
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$610.77
Rate for Payer: Qualcare PPO/HMO/WC	$305.38
Rate for Payer: UnitedHealthcare Community & State	$49.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$53.95

Know your out-of-pocket cost for care.

All Charges