Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT JOINT MOBILIZATION EA 15 MI

Facility

$193.00

Service Code	HCPCS 97140
Hospital Charge Code	409297140
Hospital Revenue Code	420
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
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	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

PT JOINT MOBILIZATION EA 15 MI

Facility

$193.00

Service Code	HCPCS 97140
Hospital Charge Code	409297140
Hospital Revenue Code	420
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

PT JS 11-29-11

Facility

$30,720.00

Hospital Charge Code	270657059
Hospital Revenue Code	278
Min. Negotiated Rate	$4,608.00
Max. Negotiated Rate	$7,434.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,434.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,758.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,608.00

PT JS 11-29-11

Facility

$30,720.00

Hospital Charge Code	270657059
Hospital Revenue Code	278
Min. Negotiated Rate	$740.35
Max. Negotiated Rate	$15,360.00
Rate for Payer: Aetna Commercial	$11,673.60
Rate for Payer: Aetna Medicare Advantage	$9,216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,833.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,833.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,833.60
Rate for Payer: Cigna Commercial	$15,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,434.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,758.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,608.00
Rate for Payer: UnitedHealthcare Community & State	$740.35
Rate for Payer: Wellpoint Medicaid Managed Care	$814.08

PT-KINETRON/ORTHROTRON****

Facility

$93.60

Service Code	HCPCS 97110
Hospital Charge Code	9000134
Hospital Revenue Code	420
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$14.04
Rate for Payer: Qualcare PPO/HMO/WC	$14.04

PT-KINETRON/ORTHROTRON****

Facility

$93.60

Service Code	HCPCS 97110
Hospital Charge Code	9000134
Hospital Revenue Code	420
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$35.57
Rate for Payer: Aetna Medicare Advantage	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.87
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	$23.87
Rate for Payer: Cigna Commercial	$46.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.08
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.04
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

PT LASER TREATMENT

Facility

$133.00

Service Code	HCPCS 97039GP
Hospital Charge Code	422597039
Hospital Revenue Code	420
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$19.95
Rate for Payer: Qualcare PPO/HMO/WC	$19.95

PT LASER TREATMENT

Facility

$133.00

Service Code	HCPCS 97039GP
Hospital Charge Code	422597039
Hospital Revenue Code	420
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$50.54
Rate for Payer: Aetna Medicare Advantage	$39.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.91
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	$33.91
Rate for Payer: Cigna Commercial	$66.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

PTLLR TNDN BERING PTB CST

Facility

$618.00

Service Code	HCPCS 29435
Hospital Charge Code	94186065
Hospital Revenue Code	361
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$185.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

PTLLR TNDN BERING PTB CST

Facility

$618.00

Service Code	HCPCS 29435
Hospital Charge Code	94186065
Hospital Revenue Code	361
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

PT LOW FREQ NON CONT/THERM PER

Facility

$1,105.55

Service Code	HCPCS 97610GP
Hospital Charge Code	422597610
Hospital Revenue Code	420
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$420.11
Rate for Payer: Aetna Medicare Advantage	$331.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.92
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	$281.92
Rate for Payer: Cigna Commercial	$552.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.67
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.83
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$26.64
Rate for Payer: Wellpoint Medicaid Managed Care	$29.30

PT LOW FREQ NON CONT/THERM PER

Facility

$1,105.55

Service Code	HCPCS 97610GP
Hospital Charge Code	422597610
Hospital Revenue Code	420
Min. Negotiated Rate	$165.83
Max. Negotiated Rate	$165.83
Rate for Payer: Qualcare PPO/HMO/WC	$165.83

PT LR 11-29-11

Facility

$31,360.00

Hospital Charge Code	270657063
Hospital Revenue Code	278
Min. Negotiated Rate	$755.78
Max. Negotiated Rate	$15,680.00
Rate for Payer: Aetna Commercial	$11,916.80
Rate for Payer: Aetna Medicare Advantage	$9,408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,996.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,996.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,272.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,996.80
Rate for Payer: Cigna Commercial	$15,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,589.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,899.20
Rate for Payer: Qualcare PPO/HMO/WC	$4,704.00
Rate for Payer: UnitedHealthcare Community & State	$755.78
Rate for Payer: Wellpoint Medicaid Managed Care	$831.04

PT LR 11-29-11

Facility

$31,360.00

Hospital Charge Code	270657063
Hospital Revenue Code	278
Min. Negotiated Rate	$4,704.00
Max. Negotiated Rate	$7,589.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,272.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,589.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,899.20
Rate for Payer: Qualcare PPO/HMO/WC	$4,704.00

PT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	9100155
Hospital Revenue Code	420
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.83
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
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	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

PT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	9100155
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT MANUAL THRPY EA 15 MIN

Facility

$286.00

Service Code	HCPCS 97140GP
Hospital Charge Code	422597140
Hospital Revenue Code	420
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

PT MANUAL THRPY EA 15 MIN

Facility

$286.00

Service Code	HCPCS 97140GP
Hospital Charge Code	422597140
Hospital Revenue Code	420
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$108.68
Rate for Payer: Aetna Medicare Advantage	$85.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.93
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	$72.93
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

PT MASSAGE EA 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GP
Hospital Charge Code	422597124
Hospital Revenue Code	420
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

PT MASSAGE EA 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GP
Hospital Charge Code	422597124
Hospital Revenue Code	420
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$124.64
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

PT MASSAGE THERAPY EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97124GP
Hospital Charge Code	9100075
Hospital Revenue Code	420
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

PT MASSAGE THERAPY EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97124GP
Hospital Charge Code	9100075
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 MASSAGE THERAPY EA 15MIN***

Facility

$40.00

Service Code	HCPCS 97124
Hospital Charge Code	9100120
Hospital Revenue Code	420
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
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	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

PT MASSAGE THERAPY EA 15MIN***

Facility

$40.00

Service Code	HCPCS 97124
Hospital Charge Code	9100120
Hospital Revenue Code	420
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

PT-MAT CLASS*****

Facility

$61.00

Hospital Charge Code	9000126
Hospital Revenue Code	429
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
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	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

Know your out-of-pocket cost for care.

All Charges