Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OT TNS

Facility

$77.65

Service Code	HCPCS 64550GO
Hospital Charge Code	9100048
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT ULTRASOUND ATTEN 15MIN

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	74203041
Hospital Revenue Code	430
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

OT ULTRASOUND ATTEN 15MIN

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	74203041
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OT ULTRASOUND EA 15 MIN

Facility

$65.65

Service Code	HCPCS 97035GO
Hospital Charge Code	9100058
Hospital Revenue Code	430
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
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	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

OT ULTRASOUND EA 15 MIN

Facility

$65.65

Service Code	HCPCS 97035GO
Hospital Charge Code	9100058
Hospital Revenue Code	430
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

OT VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OT VASOPNEUMATIC DEVICES

Facility

$91.25

Hospital Charge Code	9100040
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT VASOPNEUMATIC DEVICES

Facility

$91.25

Hospital Charge Code	9100040
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 VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
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	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
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	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
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	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$90.15
Max. Negotiated Rate	$90.15
Rate for Payer: Qualcare PPO/HMO/WC	$90.15

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$228.38
Rate for Payer: Aetna Medicare Advantage	$180.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.25
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	$153.25
Rate for Payer: Cigna Commercial	$300.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$14.48
Rate for Payer: Wellpoint Medicaid Managed Care	$15.93

OT WOUND CARE/APPLIC OF DRSG

Facility

$153.65

Hospital Charge Code	9100093
Hospital Revenue Code	430
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
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	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

OT WOUND CARE/APPLIC OF DRSG

Facility

$153.65

Hospital Charge Code	9100093
Hospital Revenue Code	430
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$17.32
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.65
Rate for Payer: Oxford Commercial	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

OUTPATIENT ADULT AND CHILD

Facility

$665.20

Service Code	HCPCS 99213
Hospital Charge Code	485099216
Hospital Revenue Code	919
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.60
Rate for Payer: Aetna Commercial	$252.78
Rate for Payer: Aetna Medicare Advantage	$199.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.63
Rate for Payer: Cigna Commercial	$332.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.56
Rate for Payer: Qualcare PPO/HMO/WC	$99.78
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.63

OUTPATIENT ADULT AND CHILD

Facility

$665.20

Service Code	HCPCS 99213
Hospital Charge Code	485099216
Hospital Revenue Code	919
Min. Negotiated Rate	$99.78
Max. Negotiated Rate	$99.78
Rate for Payer: Qualcare PPO/HMO/WC	$99.78

OVAAN CYSTECTOMY UL/BL

Facility

$44,316.79

Service Code	HCPCS 59825
Hospital Charge Code	1600000426
Hospital Revenue Code	360
Min. Negotiated Rate	$6,647.52
Max. Negotiated Rate	$6,647.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,647.52

OVAAN CYSTECTOMY UL/BL

Facility

$44,316.79

Service Code	HCPCS 59825
Hospital Charge Code	1600000426
Hospital Revenue Code	360
Min. Negotiated Rate	$1,068.03
Max. Negotiated Rate	$22,158.40
Rate for Payer: Aetna Commercial	$16,840.38
Rate for Payer: Aetna Medicare Advantage	$13,295.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,300.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,300.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,300.78
Rate for Payer: Cigna Commercial	$22,158.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,295.04
Rate for Payer: Qualcare PPO/HMO/WC	$6,647.52
Rate for Payer: UnitedHealthcare Community & State	$1,068.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1,174.39

Know your out-of-pocket cost for care.

All Charges