Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL I ESTAB. 5 MINS

Facility

$367.85

Service Code	HCPCS 99211
Hospital Charge Code	87504105
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84517039
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84518039
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

E&M LEVEL I ESTAB. 5 MINS

Facility

$367.85

Service Code	HCPCS 99211
Hospital Charge Code	87504105
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84518039
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84511039
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I ESTAB. 5 MINS

Facility

$550.00

Service Code	HCPCS 99211
Hospital Charge Code	84509039
Hospital Revenue Code	513
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84511039
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

E&M LEVEL I -ESTAB PAT 5MINS

Facility

$283.40

Hospital Charge Code	84504110
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

E&M LEVEL I -ESTAB PAT 5MINS

Facility

$283.40

Hospital Charge Code	84504110
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I EST PAT 5 MINS

Facility

$1,296.00

Service Code	HCPCS 99211
Hospital Charge Code	98410215
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

E&M LEVEL I EST PAT 5 MINS

Facility

$1,296.00

Service Code	HCPCS 99211
Hospital Charge Code	98410215
Hospital Revenue Code	914
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.80
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$31.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

E&M LEVEL I EST PAT 5MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	87506065
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

E&M LEVEL I EST PAT 5MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	87506065
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL II 20 MINS

Facility

$484.05

Service Code	HCPCS 99202
Hospital Charge Code	87504085
Hospital Revenue Code	513
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.22
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84509031
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

E&M LEVEL II 20 MINS

Facility

$364.85

Service Code	HCPCS 99202
Hospital Charge Code	84518031
Hospital Revenue Code	513
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$54.73

E&M LEVEL II 20 MINS

Facility

$484.05

Service Code	HCPCS 99202
Hospital Charge Code	87504085
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84517031
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

E&M LEVEL II 20 MINS

Facility

$364.85

Service Code	HCPCS 99202
Hospital Charge Code	84518031
Hospital Revenue Code	513
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$182.43
Rate for Payer: Aetna Commercial	$138.64
Rate for Payer: Aetna Medicare Advantage	$109.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.04
Rate for Payer: Cigna Commercial	$182.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.45
Rate for Payer: Qualcare PPO/HMO/WC	$54.73
Rate for Payer: UnitedHealthcare Community & State	$8.79
Rate for Payer: Wellpoint Medicaid Managed Care	$9.67

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84509031
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84517031
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II ESTAB. 10 MINS

Facility

$367.85

Hospital Charge Code	84310170
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

E&M LEVEL II ESTAB. 10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84517041
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

E&M LEVEL II ESTAB. 10 MINS

Facility

$484.05

Service Code	HCPCS 99212
Hospital Charge Code	87504110
Hospital Revenue Code	513
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.22
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

Know your out-of-pocket cost for care.

All Charges