Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT APPLY STRAPPING UNNA BOOT

Facility

$476.00

Service Code	HCPCS 29580GP
Hospital Charge Code	422529580
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

PT APPLY STRAPPING UNNA BOOT

Facility

$476.00

Service Code	HCPCS 29580GP
Hospital Charge Code	422529580
Hospital Revenue Code	420
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$180.88
Rate for Payer: Aetna Medicare Advantage	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.38
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	$121.38
Rate for Payer: Cigna Commercial	$238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$12.61

PT AQUATIC THERAPY

Facility

$93.45

Service Code	HCPCS 97113GP
Hospital Charge Code	9100065
Hospital Revenue Code	420
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

PT AQUATIC THERAPY

Facility

$93.45

Service Code	HCPCS 97113GP
Hospital Charge Code	9100065
Hospital Revenue Code	420
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
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	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

PT AQUATIC THRPY EA 15 MIN

Facility

$93.45

Service Code	HCPCS 97113GP
Hospital Charge Code	422597113
Hospital Revenue Code	420
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

PT AQUATIC THRPY EA 15 MIN

Facility

$93.45

Service Code	HCPCS 97113GP
Hospital Charge Code	422597113
Hospital Revenue Code	420
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
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	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

PTA RENAL/VISCERAL ARTERY

Facility

$3,034.25

Service Code	HCPCS 35471
Hospital Charge Code	5100325
Hospital Revenue Code	761
Min. Negotiated Rate	$73.13
Max. Negotiated Rate	$1,517.12
Rate for Payer: Aetna Commercial	$1,153.02
Rate for Payer: Aetna Medicare Advantage	$910.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$773.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$773.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$773.73
Rate for Payer: Cigna Commercial	$1,517.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.27
Rate for Payer: Oxford Commercial	$606.85
Rate for Payer: Qualcare PPO/HMO/WC	$455.14
Rate for Payer: UnitedHealthcare Commercial	$606.85
Rate for Payer: UnitedHealthcare Community & State	$73.13
Rate for Payer: Wellpoint Medicaid Managed Care	$80.41

PTA RENAL/VISCERAL ARTERY

Facility

$3,034.25

Service Code	HCPCS 35471
Hospital Charge Code	5100325
Hospital Revenue Code	761
Min. Negotiated Rate	$455.14
Max. Negotiated Rate	$455.14
Rate for Payer: Qualcare PPO/HMO/WC	$455.14

PTA RENAL/VISCERAL ARTERY S&I

Facility

$1,236.50

Service Code	HCPCS 75966
Hospital Charge Code	5100328
Hospital Revenue Code	320
Min. Negotiated Rate	$185.47
Max. Negotiated Rate	$185.47
Rate for Payer: Qualcare PPO/HMO/WC	$185.47

PTA RENAL/VISCERAL ARTERY S&I

Facility

$1,236.50

Service Code	HCPCS 75966
Hospital Charge Code	5100328
Hospital Revenue Code	320
Min. Negotiated Rate	$29.80
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$469.87
Rate for Payer: Aetna Medicare Advantage	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.31
Rate for Payer: Cigna Commercial	$618.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.95
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.47
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.80
Rate for Payer: Wellpoint Medicaid Managed Care	$32.77

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	2690775
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	7411843
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

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	2690775
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

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	7411843
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,122.00

Service Code	HCPCS 75966LT
Hospital Charge Code	7412020
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,122.00

Service Code	HCPCS 75966LT
Hospital Charge Code	7412020
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

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,552.00

Service Code	HCPCS 75966LT
Hospital Charge Code	2691980
Hospital Revenue Code	320
Min. Negotiated Rate	$157.90
Max. Negotiated Rate	$3,276.00
Rate for Payer: Aetna Commercial	$2,489.76
Rate for Payer: Aetna Medicare Advantage	$1,965.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,670.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,670.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,670.76
Rate for Payer: Cigna Commercial	$3,276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,965.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$982.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$157.90
Rate for Payer: Wellpoint Medicaid Managed Care	$173.63

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,552.00

Service Code	HCPCS 75966LT
Hospital Charge Code	2691980
Hospital Revenue Code	320
Min. Negotiated Rate	$982.80
Max. Negotiated Rate	$982.80
Rate for Payer: Qualcare PPO/HMO/WC	$982.80

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	2691985
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	7412021
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

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	2691985
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

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	7412021
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PT ASSIST TECH ASSES EA 15 MIN

Facility

$164.00

Service Code	HCPCS 97755GP
Hospital Charge Code	422597755
Hospital Revenue Code	420
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

PT ASSIST TECH ASSES EA 15 MIN

Facility

$164.00

Service Code	HCPCS 97755GP
Hospital Charge Code	422597755
Hospital Revenue Code	420
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
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	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

PTA VENOUS

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5100334
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

Know your out-of-pocket cost for care.

All Charges