Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
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 IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
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 III NP 30 MINS

Facility

$578.00

Service Code	HCPCS 99203
Hospital Charge Code	94810200
Hospital Revenue Code	513
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

E&M LEVEL III NP 30 MINS

Facility

$578.00

Service Code	HCPCS 99203
Hospital Charge Code	94810200
Hospital Revenue Code	513
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

E&M LEVEL II NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
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 NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
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 NP 20 MINS

Facility

$333.00

Service Code	HCPCS 99202
Hospital Charge Code	94810195
Hospital Revenue Code	510
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

E&M LEVEL II NP 20 MINS

Facility

$333.00

Service Code	HCPCS 99202
Hospital Charge Code	94810195
Hospital Revenue Code	510
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$126.54
Rate for Payer: Aetna Medicare Advantage	$99.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.92
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.90
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Community & State	$8.03
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

E&M LEVEL I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
Hospital Revenue Code	513
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.02
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

E&M LEVEL I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL I NP 10 MINS

Facility

$1,879.97

Service Code	HCPCS 99201
Hospital Charge Code	94810190
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

E&M LEVEL I NP 10 MINS

Facility

$1,879.97

Service Code	HCPCS 99201
Hospital Charge Code	94810190
Hospital Revenue Code	900
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$714.39
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84509035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84509035
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

E&M LEVEL IV 45 MINS

Facility

$800.80

Service Code	HCPCS 99204
Hospital Charge Code	87504095
Hospital Revenue Code	513
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

E&M LEVEL IV 45 MINS

Facility

$800.80

Service Code	HCPCS 99204
Hospital Charge Code	87504095
Hospital Revenue Code	513
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84509045
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 IV ESTAB. 25 MINS

Facility

$800.80

Service Code	HCPCS 99214
Hospital Charge Code	87504120
Hospital Revenue Code	513
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

E&M LEVEL IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84517045
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 IV ESTAB. 25 MINS

Facility

$800.80

Service Code	HCPCS 99214
Hospital Charge Code	87504120
Hospital Revenue Code	513
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

E&M LEVEL IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84518045
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