Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 4 >=45 MINS

Facility

$833.26

Service Code	HCPCS 99204
Hospital Charge Code	85000835
Hospital Revenue Code	510
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$416.63
Rate for Payer: Aetna Commercial	$316.64
Rate for Payer: Aetna Medicare Advantage	$249.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.48
Rate for Payer: Cigna Commercial	$416.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.98
Rate for Payer: Qualcare PPO/HMO/WC	$124.99
Rate for Payer: UnitedHealthcare Community & State	$20.08
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	9800310
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4502713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4822713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4818713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4509713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4546713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4518713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$833.26

Service Code	HCPCS 99204
Hospital Charge Code	85000835
Hospital Revenue Code	510
Min. Negotiated Rate	$124.99
Max. Negotiated Rate	$124.99
Rate for Payer: Qualcare PPO/HMO/WC	$124.99

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4518713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	87502215
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4535713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4515713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4504713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4504713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4535713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84511035
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	87502215
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

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	485599204
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	87506055
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	9800310
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

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4517713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4824713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

NEW PATIENT LEV 4 >=45 MINS

Facility

$741.52

Service Code	HCPCS 99204
Hospital Charge Code	93950139
Hospital Revenue Code	510
Min. Negotiated Rate	$17.87
Max. Negotiated Rate	$370.76
Rate for Payer: Aetna Commercial	$281.78
Rate for Payer: Aetna Medicare Advantage	$222.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.09
Rate for Payer: Cigna Commercial	$370.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.46
Rate for Payer: Qualcare PPO/HMO/WC	$111.23
Rate for Payer: UnitedHealthcare Community & State	$17.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.65

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4527713
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	$124.22
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: Wellpoint Medicaid Managed Care	$14.57

Know your out-of-pocket cost for care.

All Charges