Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OTOPROBE LONG ANGLE F/IRIDEX

Facility

$1,500.00

Hospital Charge Code	270639255
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
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	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.55
Rate for Payer: Wellpoint Medicaid Managed Care	$5.01

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
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	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$82.84
Rate for Payer: Aetna Medicare Advantage	$65.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.59
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	$55.59
Rate for Payer: Cigna Commercial	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.25
Rate for Payer: Wellpoint Medicaid Managed Care	$5.78

OT PULSE LAVAGE/WOUND DEBR<20C

Facility

$205.65

Hospital Charge Code	9100200
Hospital Revenue Code	430
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
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	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

OT PULSE LAVAGE/WOUND DEBR<20C

Facility

$205.65

Hospital Charge Code	9100200
Hospital Revenue Code	430
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

OT PULSE LAVAGE/WOUND DEBR>20C

Facility

$205.65

Hospital Charge Code	9100201
Hospital Revenue Code	430
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
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	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

OT PULSE LAVAGE/WOUND DEBR>20C

Facility

$205.65

Hospital Charge Code	9100201
Hospital Revenue Code	430
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

OT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
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 RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

OT REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$63.55
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
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	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

OT ROM STRENGTHENIN 15MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	74203043
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

OT ROM STRENGTHENIN 15MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	74203043
Hospital Revenue Code	430
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$164.92
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

OT SENSORY INTEGRAT/WRITI

Facility

$112.00

Service Code	HCPCS 97533GO
Hospital Charge Code	74203061
Hospital Revenue Code	430
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

OT SENSORY INTEGRAT/WRITI

Facility

$112.00

Service Code	HCPCS 97533GO
Hospital Charge Code	74203061
Hospital Revenue Code	430
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
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	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

OT SHORT ARM SPLIN DYN RT

Facility

$358.00

Service Code	HCPCS 29126GO
Hospital Charge Code	74203011
Hospital Revenue Code	430
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$136.04
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
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	$91.29
Rate for Payer: Cigna Commercial	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

OT SHORT ARM SPLIN DYN RT

Facility

$358.00

Service Code	HCPCS 29126GO
Hospital Charge Code	74203011
Hospital Revenue Code	430
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

OT SHORT ARM SPLN STAT RT

Facility

$351.00

Service Code	HCPCS 29125GO
Hospital Charge Code	74203009
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 SHORT ARM SPLN STAT RT

Facility

$351.00

Service Code	HCPCS 29125GO
Hospital Charge Code	74203009
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

Know your out-of-pocket cost for care.

All Charges