Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSY TX PT/FAM 60 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90838
Hospital Charge Code	73237017
Hospital Revenue Code	914
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna Commercial	$259.24
Rate for Payer: Aetna Medicare Advantage	$204.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.96
Rate for Payer: Cigna Commercial	$341.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.66
Rate for Payer: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: UnitedHealthcare Community & State	$16.44
Rate for Payer: Wellpoint Medicaid Managed Care	$18.08

PSY TX PT/FAM 60 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90838
Hospital Charge Code	73237017
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PTA AORTIC

Facility

$5,659.55

Service Code	HCPCS 35472
Hospital Charge Code	5100332
Hospital Revenue Code	761
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$2,150.63
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,697.87
Rate for Payer: Oxford Commercial	$1,131.91
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$1,131.91
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.98

PTA AORTIC

Facility

$5,659.55

Service Code	HCPCS 35472
Hospital Charge Code	5100332
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA BRACHIOCEPHALIC

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5100510
Hospital Revenue Code	761
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$2,150.63
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,697.87
Rate for Payer: Oxford Commercial	$1,131.91
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$1,131.91
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.98

PTA BRACHIOCEPHALIC

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5100510
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PT ADD WALKER TO CAST

Facility

$468.75

Service Code	HCPCS 29440GP
Hospital Charge Code	422529440
Hospital Revenue Code	420
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$178.12
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
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	$119.53
Rate for Payer: Cigna Commercial	$234.38
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: Wellpoint Medicaid Managed Care	$12.42

PT ADD WALKER TO CAST

Facility

$468.75

Service Code	HCPCS 29440GP
Hospital Charge Code	422529440
Hospital Revenue Code	420
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

PT ADL SESSION EA 15 MIN

Facility

$169.00

Service Code	HCPCS 97535
Hospital Charge Code	409297535
Hospital Revenue Code	420
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

PT ADL SESSION EA 15 MIN

Facility

$169.00

Service Code	HCPCS 97535
Hospital Charge Code	409297535
Hospital Revenue Code	420
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$64.22
Rate for Payer: Aetna Medicare Advantage	$50.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.09
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	$43.09
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

PT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GP
Hospital Charge Code	9000084
Hospital Revenue Code	420
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

PT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GP
Hospital Charge Code	9000084
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 75968LT
Hospital Charge Code	2691990
Hospital Revenue Code	320
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$2,326.36
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$147.54
Rate for Payer: Wellpoint Medicaid Managed Care	$162.23

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 7596850
Hospital Charge Code	7412022
Hospital Revenue Code	320
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$2,326.36
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$147.54
Rate for Payer: Wellpoint Medicaid Managed Care	$162.23

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 7596850
Hospital Charge Code	7412022
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 75968LT
Hospital Charge Code	2691990
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA FEMORAL POPLITEAL

Facility

$5,659.55

Service Code	HCPCS 35474
Hospital Charge Code	5100333
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA FEMORAL POPLITEAL

Facility

$5,659.55

Service Code	HCPCS 35474
Hospital Charge Code	5100333
Hospital Revenue Code	761
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$2,150.63
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,697.87
Rate for Payer: Oxford Commercial	$1,131.91
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$1,131.91
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.98

PTAH STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005312
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PTAH STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005312
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
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) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
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	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	5100330
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	74110039
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	5100330
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	74110039
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PT-AMBULATION CLASS DBL*****

Facility

$96.00

Hospital Charge Code	9000100
Hospital Revenue Code	429
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$36.48
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
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	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

Know your out-of-pocket cost for care.

All Charges