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	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

$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

$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	4818716
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	4510716
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

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	83652405
Hospital Revenue Code	514
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

$477.85

Service Code	HCPCS 99212
Hospital Charge Code	85000850
Hospital Revenue Code	510
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$238.93
Rate for Payer: Aetna Commercial	$181.58
Rate for Payer: Aetna Medicare Advantage	$143.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.85
Rate for Payer: Cigna Commercial	$238.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.35
Rate for Payer: Qualcare PPO/HMO/WC	$71.68
Rate for Payer: UnitedHealthcare Community & State	$11.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12.66

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4511716
Hospital Revenue Code	513
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) 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: Wellpoint Medicaid Managed Care	$9.28

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4511716
Hospital Revenue Code	513
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	4518716
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	4518716
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 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4832717
Hospital Revenue Code	913
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4527717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	485599213
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	45117170
Hospital Revenue Code	513
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	421099213
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4509717
Hospital Revenue Code	913
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4511717
Hospital Revenue Code	513
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4832717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4510717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$477.85

Service Code	HCPCS 99213
Hospital Charge Code	85000855
Hospital Revenue Code	510
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$71.68
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4822717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	93950147
Hospital Revenue Code	510
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$17.36

Know your out-of-pocket cost for care.

All Charges