Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OT IONTO UNATTENDED 15MIN

Facility

$132.00

Service Code	HCPCS 97033GO
Hospital Charge Code	74203037
Hospital Revenue Code	430
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
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	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.60
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

OT IONTO UNATTENDED 15MIN

Facility

$132.00

Service Code	HCPCS 97033GO
Hospital Charge Code	74203037
Hospital Revenue Code	430
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

OTIRX 10ML

Facility

$122.14

Service Code	NDC 42192010804
Hospital Charge Code	60635362
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.07
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$36.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.15
Rate for Payer: Cigna Commercial	$61.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.64
Rate for Payer: Oxford Commercial	$24.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.32
Rate for Payer: UnitedHealthcare Commercial	$24.43
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

OTIRX 10ML

Facility

$122.14

Service Code	NDC 42192010804
Hospital Charge Code	60635362
Hospital Revenue Code	250
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$18.32
Rate for Payer: Qualcare PPO/HMO/WC	$18.32

OTITIS MEDIA AND URI WITH MCC

Facility

$40,344.72

Service Code	MSDRG 152
Min. Negotiated Rate	$12,284.45
Max. Negotiated Rate	$40,344.72
Rate for Payer: Aetna Commercial	$27,978.75
Rate for Payer: Aetna Medicare Advantage	$40,344.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,931.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,680.59
Rate for Payer: Cigna Commercial	$22,123.69
Rate for Payer: Cigna Medicare Advantage	$12,931.00
Rate for Payer: Clover Medicare Advantage	$12,284.45
Rate for Payer: EmblemHealth Commercial	$38,793.00
Rate for Payer: Humana Medicare Advantage	$13,318.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,931.00
Rate for Payer: Oxford Commercial	$15,900.59
Rate for Payer: UnitedHealthcare Commercial	$27,882.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,931.00
Rate for Payer: Wellcare Medicare Advantage	$12,931.00

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$25,993.87

Service Code	MSDRG 153
Min. Negotiated Rate	$7,914.80
Max. Negotiated Rate	$25,993.87
Rate for Payer: Aetna Commercial	$18,118.07
Rate for Payer: Aetna Medicare Advantage	$25,993.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,331.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,980.53
Rate for Payer: Cigna Commercial	$13,814.67
Rate for Payer: Cigna Medicare Advantage	$8,331.37
Rate for Payer: Clover Medicare Advantage	$7,914.80
Rate for Payer: EmblemHealth Commercial	$24,994.11
Rate for Payer: Humana Medicare Advantage	$8,581.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,331.37
Rate for Payer: Oxford Commercial	$9,928.79
Rate for Payer: UnitedHealthcare Commercial	$17,410.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,331.37
Rate for Payer: Wellcare Medicare Advantage	$8,331.37

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
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	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

OT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
Hospital Revenue Code	430
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

OT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
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 MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

OT MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$124.64
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

OT MASSAGE THERAPY

Facility

$116.85

Service Code	HCPCS 97124GO
Hospital Charge Code	9100185
Hospital Revenue Code	430
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

OT MASSAGE THERAPY

Facility

$116.85

Service Code	HCPCS 97124GO
Hospital Charge Code	9100185
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 MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
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	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

OTOBIOTIC/15ML

Facility

$75.00

Hospital Charge Code	60633596
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

OTOBIOTIC/15ML

Facility

$75.00

Hospital Charge Code	60633596
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$94.24
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.56
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.56
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

OTOPROBE LONG ANGLE F/IRIDEX

Facility

$1,500.00

Hospital Charge Code	270639255
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

Know your out-of-pocket cost for care.

All Charges