Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT DEVELOPMENTAL TESTING: EXTE

Facility

$256.65

Service Code	HCPCS 96111
Hospital Charge Code	9100100
Hospital Revenue Code	918
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$97.53
Rate for Payer: Aetna Medicare Advantage	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.45
Rate for Payer: Cigna Commercial	$128.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.50
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$6.19
Rate for Payer: Wellpoint Medicaid Managed Care	$6.80

PT DEVELOPMENTAL TESTING: EXTE

Facility

$256.65

Service Code	HCPCS 96111
Hospital Charge Code	9100100
Hospital Revenue Code	918
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$38.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.50

PT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100095
Hospital Revenue Code	918
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$77.82
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.44
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

PT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100095
Hospital Revenue Code	918
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

PT DIATHERMY THRPY

Facility

$120.75

Service Code	HCPCS 97024GP
Hospital Charge Code	422597024
Hospital Revenue Code	420
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$45.88
Rate for Payer: Aetna Medicare Advantage	$36.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.79
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	$30.79
Rate for Payer: Cigna Commercial	$60.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.23
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.11
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.20

PT DIATHERMY THRPY

Facility

$120.75

Service Code	HCPCS 97024GP
Hospital Charge Code	422597024
Hospital Revenue Code	420
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$18.11
Rate for Payer: Qualcare PPO/HMO/WC	$18.11

PT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GP
Hospital Charge Code	9000266
Hospital Revenue Code	420
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

PT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GP
Hospital Charge Code	9000266
Hospital Revenue Code	420
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
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	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

PT ELECTRIC STIM UNATTENDED

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	9100177
Hospital Revenue Code	420
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

PT ELECTRIC STIM UNATTENDED

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	9100177
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PT EM 11-15-11

Facility

$35,160.00

Hospital Charge Code	270657058
Hospital Revenue Code	278
Min. Negotiated Rate	$5,274.00
Max. Negotiated Rate	$8,508.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,508.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,735.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,274.00

PT EM 11-15-11

Facility

$35,160.00

Hospital Charge Code	270657058
Hospital Revenue Code	278
Min. Negotiated Rate	$847.36
Max. Negotiated Rate	$17,580.00
Rate for Payer: Aetna Commercial	$13,360.80
Rate for Payer: Aetna Medicare Advantage	$10,548.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,965.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,965.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,965.80
Rate for Payer: Cigna Commercial	$17,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,508.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,735.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,274.00
Rate for Payer: UnitedHealthcare Community & State	$847.36
Rate for Payer: Wellpoint Medicaid Managed Care	$931.74

PT ER 11-13-11

Facility

$27,147.50

Hospital Charge Code	270656692
Hospital Revenue Code	278
Min. Negotiated Rate	$654.25
Max. Negotiated Rate	$13,573.75
Rate for Payer: Aetna Commercial	$10,316.05
Rate for Payer: Aetna Medicare Advantage	$8,144.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,922.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,922.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,922.61
Rate for Payer: Cigna Commercial	$13,573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,569.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,972.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,072.12
Rate for Payer: UnitedHealthcare Community & State	$654.25
Rate for Payer: Wellpoint Medicaid Managed Care	$719.41

PT ER 11-13-11

Facility

$27,147.50

Hospital Charge Code	270656692
Hospital Revenue Code	278
Min. Negotiated Rate	$4,072.12
Max. Negotiated Rate	$6,569.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,429.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,569.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,972.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,072.12

PT E-STIM ATTENDED EA 15 MIN

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	422597032
Hospital Revenue Code	420
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
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	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

PT E-STIM ATTENDED EA 15 MIN

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	422597032
Hospital Revenue Code	420
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

PT E-STIM UNATTENDED

Facility

$206.00

Service Code	HCPCS 97014GP
Hospital Charge Code	422597014
Hospital Revenue Code	420
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

PT E-STIM UNATTENDED

Facility

$206.00

Service Code	HCPCS 97014GP
Hospital Charge Code	422597014
Hospital Revenue Code	420
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$78.28
Rate for Payer: Aetna Medicare Advantage	$61.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
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	$52.53
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.46

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	422597163
Hospital Revenue Code	424
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	9109162
Hospital Revenue Code	424
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	9109162
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	422597163
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL HIGH COMPLEX 45 MIN

Facility

$394.00

Service Code	HCPCS 97163
Hospital Charge Code	409297163
Hospital Revenue Code	424
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

PT EVAL HIGH COMPLEX 45 MIN

Facility

$394.00

Service Code	HCPCS 97163
Hospital Charge Code	409297163
Hospital Revenue Code	424
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$149.72
Rate for Payer: Aetna Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.47
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	$100.47
Rate for Payer: Cigna Commercial	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.44

PT EVAL LOW COMPLEX 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97161GP
Hospital Charge Code	9109160
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

Know your out-of-pocket cost for care.

All Charges