Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT-AMBULATION CLASS DBL*****

Facility

$96.00

Hospital Charge Code	9000100
Hospital Revenue Code	429
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PTA PERIPH ARTERY EA ADDL S&I

Facility

$1,237.80

Service Code	HCPCS 75964
Hospital Charge Code	5100348
Hospital Revenue Code	320
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$470.36
Rate for Payer: Aetna Medicare Advantage	$371.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.64
Rate for Payer: Cigna Commercial	$618.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.67
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.83
Rate for Payer: Wellpoint Medicaid Managed Care	$32.80

PTA PERIPH ARTERY EA ADDL S&I

Facility

$1,237.80

Service Code	HCPCS 75964
Hospital Charge Code	5100348
Hospital Revenue Code	320
Min. Negotiated Rate	$185.67
Max. Negotiated Rate	$185.67
Rate for Payer: Qualcare PPO/HMO/WC	$185.67

PTA PERIPH ARTERY S&I

Facility

$1,742.10

Service Code	HCPCS 75962
Hospital Charge Code	5100320
Hospital Revenue Code	320
Min. Negotiated Rate	$261.31
Max. Negotiated Rate	$261.31
Rate for Payer: Qualcare PPO/HMO/WC	$261.31

PTA PERIPH ARTERY S&I

Facility

$1,742.10

Service Code	HCPCS 75962
Hospital Charge Code	5100320
Hospital Revenue Code	320
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$662.00
Rate for Payer: Aetna Medicare Advantage	$522.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$444.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$444.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$444.24
Rate for Payer: Cigna Commercial	$871.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.31
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$41.98
Rate for Payer: Wellpoint Medicaid Managed Care	$46.17

PTA PERIPHERAL ARTERY-LT

Facility

$21,962.30

Service Code	HCPCS 75962LT
Hospital Charge Code	7412018
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PTA PERIPHERAL ARTERY-LT

Facility

$21,962.30

Service Code	HCPCS 75962LT
Hospital Charge Code	2691970
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PTA PERIPHERAL ARTERY-LT

Facility

$21,962.30

Service Code	HCPCS 75962LT
Hospital Charge Code	2691970
Hospital Revenue Code	320
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) 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: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA PERIPHERAL ARTERY-LT

Facility

$21,962.30

Service Code	HCPCS 75962LT
Hospital Charge Code	7412018
Hospital Revenue Code	320
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) 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: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA PERIPHERAL ARTERY-RT

Facility

$21,962.30

Service Code	HCPCS 75962RT
Hospital Charge Code	7412019
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PTA PERIPHERAL ARTERY-RT

Facility

$21,962.30

Service Code	HCPCS 75962RT
Hospital Charge Code	7412019
Hospital Revenue Code	320
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) 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: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA PERIPHERAL ARTERY-RT

Facility

$21,962.30

Service Code	HCPCS 75962RT
Hospital Charge Code	2691975
Hospital Revenue Code	320
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) 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: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

PTA PERIPHERAL ARTERY-RT

Facility

$21,962.30

Service Code	HCPCS 75962RT
Hospital Charge Code	2691975
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

PT APPL CAST CLUBFOOT

Facility

$869.79

Service Code	HCPCS 29450GP
Hospital Charge Code	422529450
Hospital Revenue Code	420
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$330.52
Rate for Payer: Aetna Medicare Advantage	$260.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.80
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	$221.80
Rate for Payer: Cigna Commercial	$434.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.94
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.47
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$23.05

PT APPL CAST CLUBFOOT

Facility

$869.79

Service Code	HCPCS 29450GP
Hospital Charge Code	422529450
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

PT APPL CAST GAUNTLET

Facility

$475.00

Service Code	HCPCS 29085GP
Hospital Charge Code	422529085
Hospital Revenue Code	420
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

PT APPL CAST GAUNTLET

Facility

$475.00

Service Code	HCPCS 29085GP
Hospital Charge Code	422529085
Hospital Revenue Code	420
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
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	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

PT APPL CAST LEG LONG BRACE

Facility

$1,360.45

Service Code	HCPCS 29358GP
Hospital Charge Code	422529358
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPL CAST LEG LONG BRACE

Facility

$1,360.45

Service Code	HCPCS 29358GP
Hospital Charge Code	422529358
Hospital Revenue Code	420
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$516.97
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

PT APPL CAST LEG LONG WALK/AMB

Facility

$1,360.45

Service Code	HCPCS 29355GP
Hospital Charge Code	422529355
Hospital Revenue Code	420
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$516.97
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

PT APPL CAST LEG LONG WALK/AMB

Facility

$1,360.45

Service Code	HCPCS 29355GP
Hospital Charge Code	422529355
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPL CAST LEG SHORT WALKING

Facility

$1,066.99

Service Code	HCPCS 29425GP
Hospital Charge Code	422529425
Hospital Revenue Code	420
Min. Negotiated Rate	$160.05
Max. Negotiated Rate	$160.05
Rate for Payer: Qualcare PPO/HMO/WC	$160.05

PT APPL CAST LEG SHORT WALKING

Facility

$1,066.99

Service Code	HCPCS 29425GP
Hospital Charge Code	422529425
Hospital Revenue Code	420
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$405.46
Rate for Payer: Aetna Medicare Advantage	$320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.08
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	$272.08
Rate for Payer: Cigna Commercial	$533.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$25.71
Rate for Payer: Wellpoint Medicaid Managed Care	$28.28

PT APPL CAST LONG LEG

Facility

$1,360.45

Service Code	HCPCS 29345GP
Hospital Charge Code	422529345
Hospital Revenue Code	420
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$516.97
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

PT APPL CAST LONG LEG

Facility

$1,360.45

Service Code	HCPCS 29345GP
Hospital Charge Code	422529345
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

Know your out-of-pocket cost for care.

All Charges