Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OT FINGER SPLINT DYNAM RT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203015
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

OT-FINGER SPLINT STAT - BIL

Facility

$0.01

Service Code	HCPCS 29130GO
Hospital Charge Code	74203125
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 STAT - BIL

Facility

$0.01

Service Code	HCPCS 29130GO
Hospital Charge Code	74203125
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT-FINGER SPLINT STATI -LT

Facility

$0.01

Service Code	HCPCS 29130GO
Hospital Charge Code	74203127
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT-FINGER SPLINT STATI -LT

Facility

$0.01

Service Code	HCPCS 29130GO
Hospital Charge Code	74203127
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 STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

OT FINGER SPLINT STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
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

OT FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
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	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

OT FOR PARTIAL HOSP PER DAY

Facility

$900.50

Hospital Charge Code	50021
Hospital Revenue Code	430
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$342.19
Rate for Payer: Aetna Medicare Advantage	$270.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.63
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	$229.63
Rate for Payer: Cigna Commercial	$450.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.15
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.07
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$21.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.86

OT FOR PARTIAL HOSP PER DAY

Facility

$900.50

Hospital Charge Code	50021
Hospital Revenue Code	430
Min. Negotiated Rate	$135.07
Max. Negotiated Rate	$135.07
Rate for Payer: Qualcare PPO/HMO/WC	$135.07

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
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	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6.48

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
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	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$156.79
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
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	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

OTHER AFTERCARE AND CONVALESCENCE

Facility

$5,669.88

Service Code	APR-DRG 8622
Min. Negotiated Rate	$5,558.71
Max. Negotiated Rate	$5,669.88
Rate for Payer: UnitedHealthcare Community & State	$5,558.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,669.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5,558.71

OTHER AFTERCARE AND CONVALESCENCE

Facility

$7,278.54

Service Code	APR-DRG 8623
Min. Negotiated Rate	$7,135.82
Max. Negotiated Rate	$7,278.54
Rate for Payer: UnitedHealthcare Community & State	$7,135.82
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,278.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7,135.82

OTHER AFTERCARE AND CONVALESCENCE

Facility

$7,642.39

Service Code	APR-DRG 8624
Min. Negotiated Rate	$7,492.54
Max. Negotiated Rate	$7,642.39
Rate for Payer: UnitedHealthcare Community & State	$7,492.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,642.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7,492.54

OTHER AFTERCARE AND CONVALESCENCE

Facility

$4,062.48

Service Code	APR-DRG 8621
Min. Negotiated Rate	$3,982.82
Max. Negotiated Rate	$4,062.48
Rate for Payer: UnitedHealthcare Community & State	$3,982.82
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,062.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3,982.82

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$13,028.83

Service Code	APR-DRG 2533
Min. Negotiated Rate	$12,773.36
Max. Negotiated Rate	$13,028.83
Rate for Payer: UnitedHealthcare Community & State	$12,773.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,028.83
Rate for Payer: Wellpoint Medicaid Managed Care	$12,773.36

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$9,162.97

Service Code	APR-DRG 2532
Min. Negotiated Rate	$8,983.30
Max. Negotiated Rate	$9,162.97
Rate for Payer: UnitedHealthcare Community & State	$8,983.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,162.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8,983.30

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$22,417.72

Service Code	APR-DRG 2534
Min. Negotiated Rate	$21,978.16
Max. Negotiated Rate	$22,417.72
Rate for Payer: UnitedHealthcare Community & State	$21,978.16
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,417.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21,978.16

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$7,103.64

Service Code	APR-DRG 2531
Min. Negotiated Rate	$6,964.35
Max. Negotiated Rate	$7,103.64
Rate for Payer: UnitedHealthcare Community & State	$6,964.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,103.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6,964.35

Know your out-of-pocket cost for care.

All Charges