Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OSTEOTOME MIDLINE 3.0

Facility

$1,606.45

Hospital Charge Code	270670674
Hospital Revenue Code	272
Min. Negotiated Rate	$240.97
Max. Negotiated Rate	$240.97
Rate for Payer: Qualcare PPO/HMO/WC	$240.97

OSTEOTOME MIDLINE 3.0

Facility

$1,606.45

Hospital Charge Code	270670674
Hospital Revenue Code	272
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$803.23
Rate for Payer: Aetna Commercial	$610.45
Rate for Payer: Aetna Medicare Advantage	$481.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.64
Rate for Payer: Cigna Commercial	$803.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.94
Rate for Payer: Oxford Commercial	$321.29
Rate for Payer: Qualcare PPO/HMO/WC	$240.97
Rate for Payer: UnitedHealthcare Commercial	$321.29
Rate for Payer: UnitedHealthcare Community & State	$38.72
Rate for Payer: Wellpoint Medicaid Managed Care	$42.57

OSTEOTOME THIN BLADE 20MM

Facility

$1,062.00

Service Code	HCPCS A4649
Hospital Charge Code	270697342
Hospital Revenue Code	272
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Qualcare PPO/HMO/WC	$159.30

OSTEOTOME THIN BLADE 20MM

Facility

$1,062.00

Service Code	HCPCS A4649
Hospital Charge Code	270697342
Hospital Revenue Code	272
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$531.00
Rate for Payer: Aetna Commercial	$403.56
Rate for Payer: Aetna Medicare Advantage	$318.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.81
Rate for Payer: Cigna Commercial	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.60
Rate for Payer: Oxford Commercial	$212.40
Rate for Payer: Qualcare PPO/HMO/WC	$159.30
Rate for Payer: UnitedHealthcare Commercial	$212.40
Rate for Payer: UnitedHealthcare Community & State	$25.59
Rate for Payer: Wellpoint Medicaid Managed Care	$28.14

OSTEOTOMY,CALCANEUS RT

Facility

$57,834.50

Service Code	HCPCS 28300
Hospital Charge Code	16000331
Hospital Revenue Code	360
Min. Negotiated Rate	$8,675.17
Max. Negotiated Rate	$8,675.17
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17

OSTEOTOMY,CALCANEUS RT

Facility

$57,834.50

Service Code	HCPCS 28300
Hospital Charge Code	16000331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,016.00
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,350.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,393.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,532.61

OSTEOTOMY MIDT BONE-RT

Facility

$57,834.50

Service Code	HCPCS 28304
Hospital Charge Code	16000723
Hospital Revenue Code	360
Min. Negotiated Rate	$1,016.00
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,350.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,393.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,532.61

OSTEOTOMY MIDT BONE-RT

Facility

$57,834.50

Service Code	HCPCS 28304
Hospital Charge Code	16000723
Hospital Revenue Code	360
Min. Negotiated Rate	$8,675.17
Max. Negotiated Rate	$8,675.17
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17

OSTEOTOMY MIDT BONES; W AUTOG

Facility

$28,042.44

Service Code	HCPCS 28305
Hospital Charge Code	16000906
Hospital Revenue Code	360
Min. Negotiated Rate	$4,206.37
Max. Negotiated Rate	$4,206.37
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37

OSTEOTOMY MIDT BONES; W AUTOG

Facility

$28,042.44

Service Code	HCPCS 28305
Hospital Charge Code	16000906
Hospital Revenue Code	360
Min. Negotiated Rate	$675.82
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,412.73
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$675.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$743.12

OSTETMY CRRCT DFRMITY,PHALANX

Facility

$26,471.80

Service Code	HCPCS 26567
Hospital Charge Code	16000856
Hospital Revenue Code	360
Min. Negotiated Rate	$637.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,941.54
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$637.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$701.50

OSTETMY CRRCT DFRMITY,PHALANX

Facility

$26,471.80

Service Code	HCPCS 26567
Hospital Charge Code	16000856
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

OSTOMY SURFIT POUCH 1-3/4 FLNG

Facility

$5.13

Hospital Charge Code	270650213
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

OSTOMY SURFIT POUCH 1-3/4 FLNG

Facility

$5.13

Hospital Charge Code	270650213
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$1.95
Rate for Payer: Aetna Medicare Advantage	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.31
Rate for Payer: Cigna Commercial	$2.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.54
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

OSTOMY WOUND DRAIN UP TO 3

Facility

$36.88

Hospital Charge Code	270650208
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.44
Rate for Payer: Aetna Commercial	$14.01
Rate for Payer: Aetna Medicare Advantage	$11.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.06
Rate for Payer: Oxford Commercial	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$7.38
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

OSTOMY WOUND DRAIN UP TO 3

Facility

$36.88

Hospital Charge Code	270650208
Hospital Revenue Code	270
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

OT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GO
Hospital Charge Code	9100038
Hospital Revenue Code	430
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

OT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GO
Hospital Charge Code	9100038
Hospital Revenue Code	430
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

OT BALANCE/NME/COOR 15MIN

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203045
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OT BALANCE/NME/COOR 15MIN

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203045
Hospital Revenue Code	430
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

OT CHILD STUDY****

Facility

$125.00

Service Code	HCPCS 97003
Hospital Charge Code	9000464
Hospital Revenue Code	434
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

OT CHILD STUDY****

Facility

$125.00

Service Code	HCPCS 97003
Hospital Charge Code	9000464
Hospital Revenue Code	434
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

OT CKOUT ORTHO/PROS 15MIN

Facility

$259.00

Service Code	HCPCS 97763GO
Hospital Charge Code	74203079
Hospital Revenue Code	430
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$98.42
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.24
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

OT CKOUT ORTHO/PROS 15MIN

Facility

$259.00

Service Code	HCPCS 97763GO
Hospital Charge Code	74203079
Hospital Revenue Code	430
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

OT COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS G0515GO
Hospital Charge Code	9100240
Hospital Revenue Code	430
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

Know your out-of-pocket cost for care.

All Charges