Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Other SLP Goal Status CM

Facility

$0.01

Service Code	HCPCS G9175GNCM
Hospital Charge Code	74204091CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Goal Status CM

Facility

$0.01

Service Code	HCPCS G9175GNCM
Hospital Charge Code	74204091CM
Hospital Revenue Code	440
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) 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

OTHER SLP GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9175GNCN
Hospital Charge Code	74204091CN
Hospital Revenue Code	440
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) 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

OTHER SLP GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9175GNCN
Hospital Charge Code	74204091CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$14,854.48

Service Code	APR-DRG 2231
Min. Negotiated Rate	$14,563.22
Max. Negotiated Rate	$14,854.48
Rate for Payer: UnitedHealthcare Community & State	$14,563.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,854.48
Rate for Payer: Wellpoint Medicaid Managed Care	$14,563.22

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$25,097.54

Service Code	APR-DRG 2233
Min. Negotiated Rate	$24,605.43
Max. Negotiated Rate	$25,097.54
Rate for Payer: UnitedHealthcare Community & State	$24,605.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,097.54
Rate for Payer: Wellpoint Medicaid Managed Care	$24,605.43

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$18,447.17

Service Code	APR-DRG 2232
Min. Negotiated Rate	$18,085.46
Max. Negotiated Rate	$18,447.17
Rate for Payer: UnitedHealthcare Community & State	$18,085.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,447.17
Rate for Payer: Wellpoint Medicaid Managed Care	$18,085.46

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$45,612.97

Service Code	APR-DRG 2234
Min. Negotiated Rate	$44,718.60
Max. Negotiated Rate	$45,612.97
Rate for Payer: UnitedHealthcare Community & State	$44,718.60
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,612.97
Rate for Payer: Wellpoint Medicaid Managed Care	$44,718.60

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$15,966.54

Service Code	APR-DRG 2222
Min. Negotiated Rate	$15,653.47
Max. Negotiated Rate	$15,966.54
Rate for Payer: UnitedHealthcare Community & State	$15,653.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,966.54
Rate for Payer: Wellpoint Medicaid Managed Care	$15,653.47

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$9,201.22

Service Code	APR-DRG 2221
Min. Negotiated Rate	$9,020.80
Max. Negotiated Rate	$9,201.22
Rate for Payer: UnitedHealthcare Community & State	$9,020.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,201.22
Rate for Payer: Wellpoint Medicaid Managed Care	$9,020.80

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$46,196.47

Service Code	APR-DRG 2224
Min. Negotiated Rate	$45,290.66
Max. Negotiated Rate	$46,196.47
Rate for Payer: UnitedHealthcare Community & State	$45,290.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,196.47
Rate for Payer: Wellpoint Medicaid Managed Care	$45,290.66

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$23,520.85

Service Code	APR-DRG 2223
Min. Negotiated Rate	$23,059.66
Max. Negotiated Rate	$23,520.85
Rate for Payer: UnitedHealthcare Community & State	$23,059.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,520.85
Rate for Payer: Wellpoint Medicaid Managed Care	$23,059.66

OTHER THAN SPUN HEMATOCRIT

Facility

$22.45

Service Code	HCPCS 85014
Hospital Charge Code	3007390B
Hospital Revenue Code	305
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

OTHER THAN SPUN HEMATOCRIT

Facility

$22.45

Service Code	HCPCS 85014
Hospital Charge Code	3007390B
Hospital Revenue Code	305
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.55
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: Cigna Medicare Advantage	$2.37
Rate for Payer: Clover Medicare Advantage	$2.25
Rate for Payer: EmblemHealth Commercial	$7.11
Rate for Payer: Humana Medicare Advantage	$2.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.37
Rate for Payer: Wellcare Medicare Advantage	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

OTHER VASCULAR PROCEDURES WITH CC

Facility

$86,028.10

Service Code	MSDRG 253
Min. Negotiated Rate	$26,194.45
Max. Negotiated Rate	$86,028.10
Rate for Payer: Aetna Commercial	$59,368.45
Rate for Payer: Aetna Medicare Advantage	$86,028.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59,315.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59,315.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,573.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59,315.55
Rate for Payer: Cigna Commercial	$48,574.06
Rate for Payer: Cigna Medicare Advantage	$27,573.11
Rate for Payer: Clover Medicare Advantage	$26,194.45
Rate for Payer: EmblemHealth Commercial	$82,719.33
Rate for Payer: Humana Medicare Advantage	$28,400.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,573.11
Rate for Payer: Oxford Commercial	$34,910.82
Rate for Payer: UnitedHealthcare Commercial	$61,217.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,573.11
Rate for Payer: Wellcare Medicare Advantage	$27,573.11

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$114,881.71

Service Code	MSDRG 252
Min. Negotiated Rate	$34,980.01
Max. Negotiated Rate	$114,881.71
Rate for Payer: Aetna Commercial	$79,194.15
Rate for Payer: Aetna Medicare Advantage	$114,881.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77,924.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77,924.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36,821.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77,924.35
Rate for Payer: Cigna Commercial	$65,280.05
Rate for Payer: Cigna Medicare Advantage	$36,821.06
Rate for Payer: Clover Medicare Advantage	$34,980.01
Rate for Payer: EmblemHealth Commercial	$110,463.18
Rate for Payer: Humana Medicare Advantage	$37,925.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36,821.06
Rate for Payer: Oxford Commercial	$46,917.64
Rate for Payer: UnitedHealthcare Commercial	$82,271.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$36,821.06
Rate for Payer: Wellcare Medicare Advantage	$36,821.06

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$59,721.57

Service Code	MSDRG 254
Min. Negotiated Rate	$18,184.45
Max. Negotiated Rate	$59,721.57
Rate for Payer: Aetna Commercial	$41,292.85
Rate for Payer: Aetna Medicare Advantage	$59,721.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,474.14
Rate for Payer: Cigna Commercial	$33,342.73
Rate for Payer: Cigna Medicare Advantage	$19,141.53
Rate for Payer: Clover Medicare Advantage	$18,184.45
Rate for Payer: EmblemHealth Commercial	$57,424.59
Rate for Payer: Humana Medicare Advantage	$19,715.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,141.53
Rate for Payer: Oxford Commercial	$23,963.87
Rate for Payer: UnitedHealthcare Commercial	$42,021.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,141.53
Rate for Payer: Wellcare Medicare Advantage	$19,141.53

OT HOME MGT SELFCAR 15MIN

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	74203063
Hospital Revenue Code	430
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

OT HOME MGT SELFCAR 15MIN

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	74203063
Hospital Revenue Code	430
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$145.92
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
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	$97.92
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.25
Rate for Payer: Wellpoint Medicaid Managed Care	$10.18

OT HYDROTHERAPY SGL SESSION

Facility

$62.10

Service Code	HCPCS 97022GO
Hospital Charge Code	9100052
Hospital Revenue Code	430
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

OT HYDROTHERAPY SGL SESSION

Facility

$62.10

Service Code	HCPCS 97022GO
Hospital Charge Code	9100052
Hospital Revenue Code	430
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
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	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

OTIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027215
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

OTIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027215
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

OT IONTOPHORESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GO
Hospital Charge Code	9100056
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 IONTOPHORESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GO
Hospital Charge Code	9100056
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

Know your out-of-pocket cost for care.

All Charges