Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
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 OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
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 OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
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 OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
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 SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	321099151
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	321099151
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	7412069
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2500264
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	366899151
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5100848
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5792285
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5100848
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	366899151
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2692146
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5792285
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	7412069
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2692146
Hospital Revenue Code	370
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2500264
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5792286
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	321099152
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2692141
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5100849
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2500265
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2500265
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	366899152
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

Know your out-of-pocket cost for care.

All Charges