Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100205
Hospital Revenue Code	918
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$77.82
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.44
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

OT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100205
Hospital Revenue Code	918
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
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	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

OT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GO
Hospital Charge Code	9100050
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

OT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GO
Hospital Charge Code	9100050
Hospital Revenue Code	430
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

OT ELEC STIM UNATTENDED

Facility

$153.00

Service Code	HCPCS G0283GO
Hospital Charge Code	74203085
Hospital Revenue Code	430
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

OT ELEC STIM UNATTENDED

Facility

$153.00

Service Code	HCPCS G0283GO
Hospital Charge Code	74203085
Hospital Revenue Code	430
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
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	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

OT EVAL HIGH COMPLEX 60 MIN

Facility

$2,400.00

Service Code	HCPCS 97167GO
Hospital Charge Code	74203124
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL HIGH COMPLEX 60 MIN

Facility

$2,400.00

Service Code	HCPCS 97167GO
Hospital Charge Code	74203124
Hospital Revenue Code	434
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

OT EVAL LOW COMPLEX 30 MIN

Facility

$2,400.00

Service Code	HCPCS 97165GO
Hospital Charge Code	74203122
Hospital Revenue Code	434
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

OT EVAL LOW COMPLEX 30 MIN

Facility

$2,400.00

Service Code	HCPCS 97165GO
Hospital Charge Code	74203122
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL MOD COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97166GO
Hospital Charge Code	74203126
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL MOD COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97166GO
Hospital Charge Code	74203126
Hospital Revenue Code	434
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

OT EVALUATION

Facility

$523.00

Service Code	HCPCS 97003GO
Hospital Charge Code	74203021
Hospital Revenue Code	434
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$198.74
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
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	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$12.60
Rate for Payer: Wellpoint Medicaid Managed Care	$13.86

OT EVALUATION

Facility

$332.85

Service Code	HCPCS 97003GO
Hospital Charge Code	9000431
Hospital Revenue Code	434
Min. Negotiated Rate	$49.93
Max. Negotiated Rate	$49.93
Rate for Payer: Qualcare PPO/HMO/WC	$49.93

OT EVALUATION

Facility

$523.00

Service Code	HCPCS 97003GO
Hospital Charge Code	74203021
Hospital Revenue Code	434
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

OT EVALUATION

Facility

$332.85

Service Code	HCPCS 97003GO
Hospital Charge Code	9000431
Hospital Revenue Code	434
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$126.48
Rate for Payer: Aetna Medicare Advantage	$99.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.88
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	$84.88
Rate for Payer: Cigna Commercial	$166.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.93
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.02
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

OT EVALUATION****

Facility

$125.00

Service Code	HCPCS 97003GO
Hospital Charge Code	9100046
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 EVALUATION****

Facility

$125.00

Service Code	HCPCS 97003GO
Hospital Charge Code	9100046
Hospital Revenue Code	434
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

OT:FAMILY EDUCATION/CONF 15 MI

Facility

$60.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008315
Hospital Revenue Code	430
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
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	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

OT:FAMILY EDUCATION/CONF 15 MI

Facility

$60.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008315
Hospital Revenue Code	430
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

OT - FINGER SPLINT DYNAM - LT

Facility

$0.01

Service Code	HCPCS 29131GO
Hospital Charge Code	74203123
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT - FINGER SPLINT DYNAM - LT

Facility

$0.01

Service Code	HCPCS 29131GO
Hospital Charge Code	74203123
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

OT FINGER SPLINT DYNAM RT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203015
Hospital Revenue Code	430
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$133.38
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
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	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$9.30

Know your out-of-pocket cost for care.

All Charges