Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT-MAT CLASS*****

Facility

$61.00

Hospital Charge Code	9000126
Hospital Revenue Code	429
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

PT MIXED STATUS

Facility

$400.00

Hospital Charge Code	3002285
Hospital Revenue Code	305
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

PT MIXED STATUS

Facility

$400.00

Hospital Charge Code	3002285
Hospital Revenue Code	305
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

PT MIXED STUDY

Facility

$317.94

Service Code	HCPCS 85610
Hospital Charge Code	3002285A
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$158.97
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$158.97
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

PT MIXED STUDY

Facility

$317.94

Service Code	HCPCS 85610
Hospital Charge Code	3002285A
Hospital Revenue Code	305
Min. Negotiated Rate	$47.69
Max. Negotiated Rate	$47.69
Rate for Payer: Qualcare PPO/HMO/WC	$47.69

PT MIXED STUDY

Facility

$200.00

Service Code	HCPCS 85611
Hospital Charge Code	3002285B
Hospital Revenue Code	305
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

PT MIXED STUDY

Facility

$200.00

Service Code	HCPCS 85611
Hospital Charge Code	3002285B
Hospital Revenue Code	305
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.72
Rate for Payer: Aetna Medicare Advantage	$12.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.22
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: Cigna Medicare Advantage	$3.94
Rate for Payer: Clover Medicare Advantage	$3.74
Rate for Payer: EmblemHealth Commercial	$11.82
Rate for Payer: Humana Medicare Advantage	$4.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.94
Rate for Payer: Wellcare Medicare Advantage	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

PT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GP
Hospital Charge Code	9100165
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 MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GP
Hospital Charge Code	9100165
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PT NEG PRESSURE WOUND <=50 CM

Facility

$2,127.92

Service Code	HCPCS 97607GP
Hospital Charge Code	422597607
Hospital Revenue Code	420
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

PT NEG PRESSURE WOUND <=50 CM

Facility

$2,127.92

Service Code	HCPCS 97607GP
Hospital Charge Code	422597607
Hospital Revenue Code	420
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$1,063.96
Rate for Payer: Aetna Commercial	$808.61
Rate for Payer: Aetna Medicare Advantage	$638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.62
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	$542.62
Rate for Payer: Cigna Commercial	$1,063.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$51.28
Rate for Payer: Wellpoint Medicaid Managed Care	$56.39

PT NEG PRESSURE WOUND >50 CM

Facility

$2,127.92

Service Code	HCPCS 97608GP
Hospital Charge Code	422597608
Hospital Revenue Code	420
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$1,063.96
Rate for Payer: Aetna Commercial	$808.61
Rate for Payer: Aetna Medicare Advantage	$638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.62
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	$542.62
Rate for Payer: Cigna Commercial	$1,063.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$51.28
Rate for Payer: Wellpoint Medicaid Managed Care	$56.39

PT NEG PRESSURE WOUND >50 CM

Facility

$2,127.92

Service Code	HCPCS 97608GP
Hospital Charge Code	422597608
Hospital Revenue Code	420
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

PT NEG PRESS WND THER DME <=50

Facility

$1,105.55

Service Code	HCPCS 97605GP
Hospital Charge Code	422597605
Hospital Revenue Code	420
Min. Negotiated Rate	$165.83
Max. Negotiated Rate	$165.83
Rate for Payer: Qualcare PPO/HMO/WC	$165.83

PT NEG PRESS WND THER DME <=50

Facility

$1,105.55

Service Code	HCPCS 97605GP
Hospital Charge Code	422597605
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 NEG PRESS WND THER DME >50

Facility

$2,127.92

Service Code	HCPCS 97606GP
Hospital Charge Code	422597606
Hospital Revenue Code	420
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

PT NEG PRESS WND THER DME >50

Facility

$2,127.92

Service Code	HCPCS 97606GP
Hospital Charge Code	422597606
Hospital Revenue Code	420
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$1,063.96
Rate for Payer: Aetna Commercial	$808.61
Rate for Payer: Aetna Medicare Advantage	$638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.62
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	$542.62
Rate for Payer: Cigna Commercial	$1,063.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.38
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$51.28
Rate for Payer: Wellpoint Medicaid Managed Care	$56.39

PT NEUROMUSC RE-EDUC EA 15M***

Facility

$50.00

Service Code	HCPCS 97112
Hospital Charge Code	9100115
Hospital Revenue Code	420
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PT NEUROMUSC RE-EDUC EA 15M***

Facility

$50.00

Service Code	HCPCS 97112
Hospital Charge Code	9100115
Hospital Revenue Code	420
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
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	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

PT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GP
Hospital Charge Code	9100080
Hospital Revenue Code	420
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
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	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

PT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GP
Hospital Charge Code	9100080
Hospital Revenue Code	420
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PT NEUROMUSCULAR RE-EDUCATION

Facility

$186.00

Service Code	HCPCS 97112
Hospital Charge Code	409297112
Hospital Revenue Code	420
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

PT NEUROMUSCULAR RE-EDUCATION

Facility

$186.00

Service Code	HCPCS 97112
Hospital Charge Code	409297112
Hospital Revenue Code	420
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
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	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

PT NEUROMUSCUL RE-ED EA 15 MIN

Facility

$314.00

Service Code	HCPCS 97112GP
Hospital Charge Code	422597112
Hospital Revenue Code	420
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

PT NEUROMUSCUL RE-ED EA 15 MIN

Facility

$314.00

Service Code	HCPCS 97112GP
Hospital Charge Code	422597112
Hospital Revenue Code	420
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

Know your out-of-pocket cost for care.

All Charges