Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4509714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4509714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4517714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	421599205
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	421599205
Hospital Revenue Code	510
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4527714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	87506060
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4818714
Hospital Revenue Code	914
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4510714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4822714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	74308290
Hospital Revenue Code	514
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,140.79

Service Code	HCPCS 99205
Hospital Charge Code	85000840
Hospital Revenue Code	510
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$570.39
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna Medicare Advantage	$342.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.90
Rate for Payer: Cigna Commercial	$570.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.24
Rate for Payer: Qualcare PPO/HMO/WC	$171.12
Rate for Payer: UnitedHealthcare Community & State	$27.49
Rate for Payer: Wellpoint Medicaid Managed Care	$30.23

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4511714
Hospital Revenue Code	914
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	87502220
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4502714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84208260
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84208260
Hospital Revenue Code	510
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$524.46
Rate for Payer: Aetna Commercial	$398.59
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$524.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.68
Rate for Payer: Qualcare PPO/HMO/WC	$157.34
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$27.80

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4535714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4818714
Hospital Revenue Code	914
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4515714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4517714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,140.79

Service Code	HCPCS 99205
Hospital Charge Code	85000840
Hospital Revenue Code	510
Min. Negotiated Rate	$171.12
Max. Negotiated Rate	$171.12
Rate for Payer: Qualcare PPO/HMO/WC	$171.12

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4510714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4527714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4515714
Hospital Revenue Code	913
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

Know your out-of-pocket cost for care.

All Charges