Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4527712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4518712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4824712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	421099203
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

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4509712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4818712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4535712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4818712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4502712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	87502210
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4546712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4504712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4515712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4515712
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	$83.51
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: Wellpoint Medicaid Managed Care	$11.93

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4502712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$628.83

Service Code	HCPCS 99203
Hospital Charge Code	85000830
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

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	485099203
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

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4509712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$628.83

Service Code	HCPCS 99203
Hospital Charge Code	85000830
Hospital Revenue Code	510
Min. Negotiated Rate	$94.32
Max. Negotiated Rate	$94.32
Rate for Payer: Qualcare PPO/HMO/WC	$94.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	9800300
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	421599203
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

NEW PATIENT LEV 3 >=30 MINS

Facility

$621.00

Service Code	HCPCS 99203
Hospital Charge Code	93950137
Hospital Revenue Code	510
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$235.98
Rate for Payer: Aetna Medicare Advantage	$186.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.35
Rate for Payer: Cigna Commercial	$310.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.30
Rate for Payer: Qualcare PPO/HMO/WC	$93.15
Rate for Payer: UnitedHealthcare Community & State	$14.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16.46

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4504712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84511033
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4546712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

Know your out-of-pocket cost for care.

All Charges