Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4504716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	87506070
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

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84208270
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	93950145
Hospital Revenue Code	510
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4822716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4832716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84208270
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	83652405
Hospital Revenue Code	514
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.25

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4535716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	9800365
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4546716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4515716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4502716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4515716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4510716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4509716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	9800365
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	74308300
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84511041
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	87502230
Hospital Revenue Code	510
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.25

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4824716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4527716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4818716
Hospital Revenue Code	913
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	485099212
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	485599212
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

Know your out-of-pocket cost for care.

All Charges