Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PTA VENOUS

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5100334
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA VENOUS S&I

Facility

$1,151.85

Service Code	HCPCS 75978
Hospital Charge Code	5100329
Hospital Revenue Code	320
Min. Negotiated Rate	$27.76
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$437.70
Rate for Payer: Aetna Medicare Advantage	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.72
Rate for Payer: Cigna Commercial	$575.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.78
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$27.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.52

PTA VENOUS S&I

Facility

$1,151.85

Service Code	HCPCS 75978
Hospital Charge Code	5100329
Hospital Revenue Code	320
Min. Negotiated Rate	$172.78
Max. Negotiated Rate	$172.78
Rate for Payer: Qualcare PPO/HMO/WC	$172.78

PTA VISCERL ARTERY EA ADDL S&I

Facility

$1,997.45

Service Code	HCPCS 75968
Hospital Charge Code	5100349
Hospital Revenue Code	320
Min. Negotiated Rate	$299.62
Max. Negotiated Rate	$299.62
Rate for Payer: Qualcare PPO/HMO/WC	$299.62

PTA VISCERL ARTERY EA ADDL S&I

Facility

$1,997.45

Service Code	HCPCS 75968
Hospital Charge Code	5100349
Hospital Revenue Code	320
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$759.03
Rate for Payer: Aetna Medicare Advantage	$599.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$509.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$509.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$509.35
Rate for Payer: Cigna Commercial	$998.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$599.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$299.62
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$48.14
Rate for Payer: Wellpoint Medicaid Managed Care	$52.93

PTB CAST

Facility

$1,066.99

Service Code	HCPCS 29435
Hospital Charge Code	5780145
Hospital Revenue Code	450
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$1,199.43
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.05
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$28.28

PTB CAST

Facility

$1,066.99

Service Code	HCPCS 29435
Hospital Charge Code	5780145
Hospital Revenue Code	450
Min. Negotiated Rate	$160.05
Max. Negotiated Rate	$160.05
Rate for Payer: Qualcare PPO/HMO/WC	$160.05

PT BIO FEEDBACK

Facility

$236.20

Service Code	HCPCS 90901GP
Hospital Charge Code	9000340
Hospital Revenue Code	917
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$89.76
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.86
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.26

PT BIO FEEDBACK

Facility

$236.20

Service Code	HCPCS 90901GP
Hospital Charge Code	9000340
Hospital Revenue Code	917
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

PT BIO FEEDBACK****

Facility

$115.00

Service Code	HCPCS 90910
Hospital Charge Code	90000340
Hospital Revenue Code	420
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
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	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

PT BIO FEEDBACK****

Facility

$115.00

Service Code	HCPCS 90910
Hospital Charge Code	90000340
Hospital Revenue Code	420
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

PT BIOFEEDBACK

Facility

$236.20

Service Code	HCPCS 90901GP
Hospital Charge Code	422590901
Hospital Revenue Code	420
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$89.76
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
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	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.26

PT BIOFEEDBACK

Facility

$236.20

Service Code	HCPCS 90901GP
Hospital Charge Code	422590901
Hospital Revenue Code	420
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

PT BIOFEEDBACK W/EMG 1ST 15

Facility

$236.20

Service Code	HCPCS 90912GP
Hospital Charge Code	422590912
Hospital Revenue Code	420
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$89.76
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
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	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.26

PT BIOFEEDBACK W/EMG 1ST 15

Facility

$236.20

Service Code	HCPCS 90912GP
Hospital Charge Code	422590912
Hospital Revenue Code	420
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

PT BIOFEEDBACK W/EMG ADDL 15 M

Facility

$236.20

Service Code	HCPCS 90913GP
Hospital Charge Code	422590913
Hospital Revenue Code	420
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

PT BIOFEEDBACK W/EMG ADDL 15 M

Facility

$236.20

Service Code	HCPCS 90913GP
Hospital Charge Code	422590913
Hospital Revenue Code	420
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$89.76
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
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	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.26

PT-BURNS DECUBITIS ULCER CA***

Facility

$178.20

Service Code	HCPCS 16020
Hospital Charge Code	9000357
Hospital Revenue Code	420
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$26.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.73

PT-BURNS DECUBITIS ULCER CA***

Facility

$178.20

Service Code	HCPCS 16020
Hospital Charge Code	9000357
Hospital Revenue Code	420
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$166.85
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.46
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.73
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

PTCA DRU EL STEN AD/VE-LC

Facility

$28,383.00

Hospital Charge Code	7411289
Hospital Revenue Code	481
Min. Negotiated Rate	$684.03
Max. Negotiated Rate	$14,191.50
Rate for Payer: Aetna Commercial	$10,785.54
Rate for Payer: Aetna Medicare Advantage	$8,514.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,237.66
Rate for Payer: Cigna Commercial	$14,191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,514.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45
Rate for Payer: UnitedHealthcare Community & State	$684.03
Rate for Payer: Wellpoint Medicaid Managed Care	$752.15

PTCA DRU EL STEN AD/VE-LC

Facility

$28,383.00

Hospital Charge Code	7411289
Hospital Revenue Code	481
Min. Negotiated Rate	$4,257.45
Max. Negotiated Rate	$4,257.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45

PTCA DRU EL STEN AD/VE-LD

Facility

$28,383.00

Hospital Charge Code	7411291
Hospital Revenue Code	481
Min. Negotiated Rate	$4,257.45
Max. Negotiated Rate	$4,257.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45

PTCA DRU EL STEN AD/VE-LD

Facility

$28,383.00

Hospital Charge Code	7411291
Hospital Revenue Code	481
Min. Negotiated Rate	$684.03
Max. Negotiated Rate	$14,191.50
Rate for Payer: Aetna Commercial	$10,785.54
Rate for Payer: Aetna Medicare Advantage	$8,514.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,237.66
Rate for Payer: Cigna Commercial	$14,191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,514.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45
Rate for Payer: UnitedHealthcare Community & State	$684.03
Rate for Payer: Wellpoint Medicaid Managed Care	$752.15

PTCA DRU EL STEN AD/VE-RC

Facility

$28,383.00

Hospital Charge Code	7411293
Hospital Revenue Code	481
Min. Negotiated Rate	$4,257.45
Max. Negotiated Rate	$4,257.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45

PTCA DRU EL STEN AD/VE-RC

Facility

$28,383.00

Hospital Charge Code	7411293
Hospital Revenue Code	481
Min. Negotiated Rate	$684.03
Max. Negotiated Rate	$14,191.50
Rate for Payer: Aetna Commercial	$10,785.54
Rate for Payer: Aetna Medicare Advantage	$8,514.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,237.66
Rate for Payer: Cigna Commercial	$14,191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,514.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,257.45
Rate for Payer: UnitedHealthcare Community & State	$684.03
Rate for Payer: Wellpoint Medicaid Managed Care	$752.15

Know your out-of-pocket cost for care.

All Charges