Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHOTHERAPY/ACTINOTHERAPY

Facility

$209.59

Service Code	HCPCS 96900
Hospital Charge Code	83090020
Hospital Revenue Code	940
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.88
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.44
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$5.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.55

PHOTHERAPY/ACTINOTHERAPY

Facility

$209.59

Service Code	HCPCS 96900
Hospital Charge Code	83092030
Hospital Revenue Code	940
Min. Negotiated Rate	$31.44
Max. Negotiated Rate	$31.44
Rate for Payer: Qualcare PPO/HMO/WC	$31.44

PHOTOBBLADE 3

Facility

$1,600.00

Hospital Charge Code	270703813
Hospital Revenue Code	272
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

PHOTOBBLADE 3

Facility

$1,600.00

Hospital Charge Code	270703813
Hospital Revenue Code	272
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Oxford Commercial	$320.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$320.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

PHOTOBLADE 3 SMOKE EVACU

Facility

$2,100.00

Hospital Charge Code	270703814
Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

PHOTOBLADE 3 SMOKE EVACU

Facility

$2,100.00

Hospital Charge Code	270703814
Hospital Revenue Code	272
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.00
Rate for Payer: Oxford Commercial	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$420.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

PHOTOGRAPHS - (ENDOSCOPY)***

Facility

$121.00

Hospital Charge Code	2300671
Hospital Revenue Code	279
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$60.50
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$24.20
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$24.20
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

PHOTOGRAPHS - (ENDOSCOPY)***

Facility

$121.00

Hospital Charge Code	2300671
Hospital Revenue Code	279
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

PHP Activity Therapy/session

Facility

$165.80

Service Code	HCPCS G0176
Hospital Charge Code	84509055
Hospital Revenue Code	904
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$24.87

PHP Activity Therapy/session

Facility

$165.80

Service Code	HCPCS G0176
Hospital Charge Code	84509055
Hospital Revenue Code	904
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$82.90
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Aetna Medicare Advantage	$49.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$82.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.74
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

PHP ACTIVITY THERAPY SESS IOP

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4546757
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY THERAPY SESS IOP

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4546757
Hospital Revenue Code	904
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PHP ACTIVITY TX/SESSION ADULT

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509527
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY TX/SESSION ADULT

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509527
Hospital Revenue Code	904
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509528
Hospital Revenue Code	904
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4510528
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509528
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4510528
Hospital Revenue Code	904
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PH,PC02,P02,ETC (BLD G)***

Facility

$90.00

Hospital Charge Code	3012044
Hospital Revenue Code	309
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

PH,PC02,P02,ETC (BLD G)***

Facility

$90.00

Hospital Charge Code	3012044
Hospital Revenue Code	309
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

PHP Education/Training

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	84509051
Hospital Revenue Code	942
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

PHP Education/Training

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	84509051
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING ADULT

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509529
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING ADULT

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509529
Hospital Revenue Code	942
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

PHP EDUCATION/TRAINING CHILD

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4510530
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

Know your out-of-pocket cost for care.

All Charges