Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT APPL CAST SHLDER TO HIPS

Facility

$1,360.45

Service Code	HCPCS 29035GP
Hospital Charge Code	422529035
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 SHLDER TO HIPS

Facility

$1,360.45

Service Code	HCPCS 29035GP
Hospital Charge Code	422529035
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 SHORT LEG

Facility

$1,360.45

Service Code	HCPCS 29405GP
Hospital Charge Code	422529405
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 SHORT LEG

Facility

$1,360.45

Service Code	HCPCS 29405GP
Hospital Charge Code	422529405
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 RISSER JACKET BODY

Facility

$1,360.45

Service Code	HCPCS 29010GP
Hospital Charge Code	422529010
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 RISSER JACKET BODY

Facility

$1,360.45

Service Code	HCPCS 29010GP
Hospital Charge Code	422529010
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 SPLINT ARM SHORT DYNAM

Facility

$358.00

Service Code	HCPCS 29126GP
Hospital Charge Code	422529126
Hospital Revenue Code	420
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

PT APPL SPLINT ARM SHORT DYNAM

Facility

$358.00

Service Code	HCPCS 29126GP
Hospital Charge Code	422529126
Hospital Revenue Code	420
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$136.04
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
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	$91.29
Rate for Payer: Cigna Commercial	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

PT APPL SPLINT ARM SHORT STATC

Facility

$358.00

Service Code	HCPCS 29125GP
Hospital Charge Code	422529125
Hospital Revenue Code	420
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

PT APPL SPLINT ARM SHORT STATC

Facility

$358.00

Service Code	HCPCS 29125GP
Hospital Charge Code	422529125
Hospital Revenue Code	420
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$136.04
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
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	$91.29
Rate for Payer: Cigna Commercial	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

PT APPL SPLINT FINGER DYNAM

Facility

$322.82

Service Code	HCPCS 29131GP
Hospital Charge Code	422529131
Hospital Revenue Code	420
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

PT APPL SPLINT FINGER DYNAM

Facility

$322.82

Service Code	HCPCS 29131GP
Hospital Charge Code	422529131
Hospital Revenue Code	420
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$122.67
Rate for Payer: Aetna Medicare Advantage	$96.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.32
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	$82.32
Rate for Payer: Cigna Commercial	$161.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

PT APPL SPLINT FINGER STATIC

Facility

$322.82

Service Code	HCPCS 29130GP
Hospital Charge Code	422529130
Hospital Revenue Code	420
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$122.67
Rate for Payer: Aetna Medicare Advantage	$96.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.32
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	$82.32
Rate for Payer: Cigna Commercial	$161.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

PT APPL SPLINT FINGER STATIC

Facility

$322.82

Service Code	HCPCS 29130GP
Hospital Charge Code	422529130
Hospital Revenue Code	420
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

PT APPL SPLINT LONG LEG

Facility

$869.79

Service Code	HCPCS 29505GP
Hospital Charge Code	422529505
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 SPLINT LONG LEG

Facility

$869.79

Service Code	HCPCS 29505GP
Hospital Charge Code	422529505
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 SPLINT SHORT LEG

Facility

$869.79

Service Code	HCPCS 29515GP
Hospital Charge Code	422529515
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 SPLINT SHORT LEG

Facility

$869.79

Service Code	HCPCS 29515GP
Hospital Charge Code	422529515
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 APPLY CAST CYLINDER LEG

Facility

$1,360.45

Service Code	HCPCS 29365GP
Hospital Charge Code	422529365
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST CYLINDER LEG

Facility

$1,360.45

Service Code	HCPCS 29365GP
Hospital Charge Code	422529365
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 APPLY CAST FINGER

Facility

$475.00

Service Code	HCPCS 29086GP
Hospital Charge Code	422529086
Hospital Revenue Code	420
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

PT APPLY CAST FINGER

Facility

$475.00

Service Code	HCPCS 29086GP
Hospital Charge Code	422529086
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 APPLY CAST LONG ARM

Facility

$1,360.45

Service Code	HCPCS 29065GP
Hospital Charge Code	422529065
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST LONG ARM

Facility

$1,360.45

Service Code	HCPCS 29065GP
Hospital Charge Code	422529065
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 APPLY CAST RIGID LEG

Facility

$1,360.45

Service Code	HCPCS 29445GP
Hospital Charge Code	422529445
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