Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED DIFF MD <5YO1ST 15MIN

Facility

$504.55

Service Code	HCPCS 99155
Hospital Charge Code	5792288
Hospital Revenue Code	370
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$252.28
Rate for Payer: Aetna Commercial	$191.73
Rate for Payer: Aetna Medicare Advantage	$151.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.66
Rate for Payer: Cigna Commercial	$252.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.37
Rate for Payer: Oxford Commercial	$100.91
Rate for Payer: Qualcare PPO/HMO/WC	$75.68
Rate for Payer: UnitedHealthcare Commercial	$100.91
Rate for Payer: UnitedHealthcare Community & State	$12.16
Rate for Payer: Wellpoint Medicaid Managed Care	$13.37

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	7412073
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2500268
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5100852
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	7412073
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5792289
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2500268
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5100852
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	321099156
Hospital Revenue Code	370
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$9.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	321099156
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5792289
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.22
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

Know your out-of-pocket cost for care.

All Charges