Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	485599243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421099243
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

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421599243
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

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421599243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	485599243
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

LEVEL 4 GRS & MICRO EXAM

Facility

$1,358.00

Service Code	HCPCS 88305
Hospital Charge Code	38474049
Hospital Revenue Code	310
Min. Negotiated Rate	$35.99
Max. Negotiated Rate	$407.40
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.70
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$57.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$35.99

LEVEL 4 GRS & MICRO EXAM

Facility

$1,358.00

Service Code	HCPCS 88305
Hospital Charge Code	38474049
Hospital Revenue Code	310
Min. Negotiated Rate	$203.70
Max. Negotiated Rate	$203.70
Rate for Payer: Qualcare PPO/HMO/WC	$203.70

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	395099244
Hospital Revenue Code	510
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.18
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$27.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	395099244
Hospital Revenue Code	510
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421599244
Hospital Revenue Code	510
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.46
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.31

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421099244
Hospital Revenue Code	510
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.46
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.31

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421099244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	485599244
Hospital Revenue Code	510
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.46
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$25.74
Rate for Payer: Wellpoint Medicaid Managed Care	$28.31

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	485599244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421599244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$235.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$29.12

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$352.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$57.88

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$327.60
Rate for Payer: Qualcare PPO/HMO/WC	$327.60

Know your out-of-pocket cost for care.

All Charges