Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4527718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4510718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$628.83

Service Code	HCPCS 99214
Hospital Charge Code	85000860
Hospital Revenue Code	510
Min. Negotiated Rate	$94.32
Max. Negotiated Rate	$94.32
Rate for Payer: Qualcare PPO/HMO/WC	$94.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$628.83

Service Code	HCPCS 99214
Hospital Charge Code	85000860
Hospital Revenue Code	510
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$314.42
Rate for Payer: Aetna Commercial	$238.96
Rate for Payer: Aetna Medicare Advantage	$188.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.35
Rate for Payer: Cigna Commercial	$314.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$94.32
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.66

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	87506085
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4832718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	87506085
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

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	74308310
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485599214
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

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485599214
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4822718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4546718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4502718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4502718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4535718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4832718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4527718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4546718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4518718
Hospital Revenue Code	913
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) NJ Health	$155.81
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: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485099214
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

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	9800385
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

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$678.40

Service Code	HCPCS 99214
Hospital Charge Code	84511045
Hospital Revenue Code	513
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$101.76
Rate for Payer: Qualcare PPO/HMO/WC	$101.76

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	87502240
Hospital Revenue Code	510
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$42.42
Rate for Payer: Qualcare PPO/HMO/WC	$42.42

Know your out-of-pocket cost for care.

All Charges