Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OT-SHORT ARM SPNT DYNC-LT

Facility

$0.01

Service Code	HCPCS 29126GO
Hospital Charge Code	74203129
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT-SHORT ARM SPNT DYNC-LT

Facility

$0.01

Service Code	HCPCS 29126GO
Hospital Charge Code	74203129
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 SHORT ARM SPNT STAT-LT

Facility

$0.01

Service Code	HCPCS 29125GO
Hospital Charge Code	74203131
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 SHORT ARM SPNT STAT-LT

Facility

$0.01

Service Code	HCPCS 29125GO
Hospital Charge Code	74203131
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT STRAPPING CHEST-TORAX

Facility

$458.00

Service Code	HCPCS 29200
Hospital Charge Code	74203001
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

OT STRAPPING CHEST-TORAX

Facility

$458.00

Service Code	HCPCS 29200
Hospital Charge Code	74203001
Hospital Revenue Code	430
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$135.13
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

OT STRAPPING CHEST-TORAX

Facility

$458.00

Service Code	HCPCS 29200GO
Hospital Charge Code	74203017
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

OT STRAPPING CHEST-TORAX

Facility

$458.00

Service Code	HCPCS 29200GO
Hospital Charge Code	74203017
Hospital Revenue Code	430
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
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	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

OT STRAPPING ELBOW OR WRIST

Facility

$458.00

Service Code	HCPCS 29260
Hospital Charge Code	74203005
Hospital Revenue Code	430
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
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	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$49.06
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

OT STRAPPING ELBOW OR WRIST

Facility

$458.00

Service Code	HCPCS 29260
Hospital Charge Code	74203005
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

OT STRAPPING HAND FINGER

Facility

$468.75

Service Code	HCPCS 29280
Hospital Charge Code	74203007
Hospital Revenue Code	430
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
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	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$49.06
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.62
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

OT STRAPPING HAND FINGER

Facility

$468.75

Service Code	HCPCS 29280
Hospital Charge Code	74203007
Hospital Revenue Code	430
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

OT STRAPPING SHOULDER

Facility

$458.00

Service Code	HCPCS 29240
Hospital Charge Code	74203003
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

OT STRAPPING SHOULDER

Facility

$458.00

Service Code	HCPCS 29240
Hospital Charge Code	74203003
Hospital Revenue Code	430
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$110.64
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

OT TENS

Facility

$134.00

Service Code	HCPCS 64550GO
Hospital Charge Code	74203019
Hospital Revenue Code	430
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$50.92
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
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	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.23
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

OT TENS

Facility

$134.00

Service Code	HCPCS 64550GO
Hospital Charge Code	74203019
Hospital Revenue Code	430
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

OT THERAPEUTIC GROUP

Facility

$103.25

Service Code	HCPCS 97150GO
Hospital Charge Code	9100034
Hospital Revenue Code	430
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
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	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

OT THERAPEUTIC GROUP

Facility

$103.25

Service Code	HCPCS 97150GO
Hospital Charge Code	9100034
Hospital Revenue Code	430
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

OT THERA PROCEDURES GROUP

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	74203055
Hospital Revenue Code	430
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

OT THERA PROCEDURES GROUP

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	74203055
Hospital Revenue Code	430
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
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	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

OT THERAPY EXERCISE EA 15 MIN

Facility

$223.95

Service Code	HCPCS 97110GO
Hospital Charge Code	9000332
Hospital Revenue Code	430
Min. Negotiated Rate	$33.59
Max. Negotiated Rate	$33.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.59

OT THERAPY EXERCISE EA 15 MIN

Facility

$223.95

Service Code	HCPCS 97110GO
Hospital Charge Code	9000332
Hospital Revenue Code	430
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$85.10
Rate for Payer: Aetna Medicare Advantage	$67.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.11
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	$57.11
Rate for Payer: Cigna Commercial	$111.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

OT:THER EXERCISE/TRAIN 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008215
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:THER EXERCISE/TRAIN 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008215
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

OT TNS

Facility

$77.65

Service Code	HCPCS 64550GO
Hospital Charge Code	9100048
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

Know your out-of-pocket cost for care.

All Charges