Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	485099204
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	4517713
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	4832713
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	4832713
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	4510713
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	4511713
Hospital Revenue Code	513
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

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84208255
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	4510713
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	84208255
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

$741.52

Service Code	HCPCS 99204
Hospital Charge Code	93950139
Hospital Revenue Code	510
Min. Negotiated Rate	$111.23
Max. Negotiated Rate	$111.23
Rate for Payer: Qualcare PPO/HMO/WC	$111.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	421099204
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	4822713
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

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	485599204
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	4509713
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	485099204
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

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	87506055
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

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4824713
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	$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	4511713
Hospital Revenue Code	513
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) 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	4527713
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

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	421099204
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	4818713
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	$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	421599204
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

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84511035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

Know your out-of-pocket cost for care.

All Charges