Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT OCCUPAT THERAPY DBL SESS***

Facility

$379.00

Hospital Charge Code	900399
Hospital Revenue Code	439
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$144.02
Rate for Payer: Aetna Medicare Advantage	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.64
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	$96.64
Rate for Payer: Cigna Commercial	$189.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.04

PT OCCUPAT THERAPY DBL SESS***

Facility

$379.00

Hospital Charge Code	900399
Hospital Revenue Code	439
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$56.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.85

PT OCCUPAT THER DBL SESSION***

Facility

$379.00

Service Code	HCPCS H5300
Hospital Charge Code	9000399
Hospital Revenue Code	439
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$144.02
Rate for Payer: Aetna Medicare Advantage	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.64
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	$96.64
Rate for Payer: Cigna Commercial	$189.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.04

PT OCCUPAT THER DBL SESSION***

Facility

$379.00

Service Code	HCPCS H5300
Hospital Charge Code	9000399
Hospital Revenue Code	439
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$56.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.85

PT ORTHO MGT/FIT/TRN EA 15 MIN

Facility

$134.50

Service Code	HCPCS 97760GP
Hospital Charge Code	422597760
Hospital Revenue Code	420
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$20.18

PT ORTHO MGT/FIT/TRN EA 15 MIN

Facility

$134.50

Service Code	HCPCS 97760GP
Hospital Charge Code	422597760
Hospital Revenue Code	420
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$51.11
Rate for Payer: Aetna Medicare Advantage	$40.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.30
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	$34.30
Rate for Payer: Cigna Commercial	$67.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.18
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.56

PT ORTHOTIC FITTNG/TRAING EA**

Facility

$55.00

Service Code	HCPCS 97504GP
Hospital Charge Code	9001022
Hospital Revenue Code	420
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

PT ORTHOTIC FITTNG/TRAING EA**

Facility

$55.00

Service Code	HCPCS 97504GP
Hospital Charge Code	9001022
Hospital Revenue Code	420
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
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	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

PT-ORTHOTICS FITTIN 15MIN

Facility

$158.00

Hospital Charge Code	9109115
Hospital Revenue Code	420
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

PT-ORTHOTICS FITTIN 15MIN

Facility

$158.00

Hospital Charge Code	9109115
Hospital Revenue Code	420
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$60.04
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
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	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

PT ORTH/PROST MGMT EA 15 MIN

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	422597763
Hospital Revenue Code	420
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$113.62
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
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	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

PT ORTH/PROST MGMT EA 15 MIN

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	422597763
Hospital Revenue Code	420
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

PT PARAFFIN BATH THRPY

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	422597018
Hospital Revenue Code	420
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

PT PARAFFIN BATH THRPY

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	422597018
Hospital Revenue Code	420
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

PT PERFORMANCE TEST EA 15 MIN

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	422597750
Hospital Revenue Code	420
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.74
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
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	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.84
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

PT PERFORMANCE TEST EA 15 MIN

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	422597750
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PT PHYSICAL MEDICINE PROCEDURE

Facility

$161.00

Service Code	HCPCS 97139GP
Hospital Charge Code	422597139
Hospital Revenue Code	420
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

PT PHYSICAL MEDICINE PROCEDURE

Facility

$161.00

Service Code	HCPCS 97139GP
Hospital Charge Code	422597139
Hospital Revenue Code	420
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$61.18
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
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	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

PT-PHYS PERF TST 15MIN

Facility

$195.00

Hospital Charge Code	9109120
Hospital Revenue Code	420
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
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	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

PT-PHYS PERF TST 15MIN

Facility

$195.00

Hospital Charge Code	9109120
Hospital Revenue Code	420
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PT PROSTHETIC TRAIN EA 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	422597761
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PT PROSTHETIC TRAIN EA 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	422597761
Hospital Revenue Code	420
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
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	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.15
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.15
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

PT PROSTHETIC TRAINING*****

Facility

$45.00

Service Code	HCPCS 97520GP
Hospital Charge Code	9100085
Hospital Revenue Code	420
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
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	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

PT PROSTHETIC TRAINING*****

Facility

$45.00

Service Code	HCPCS 97520GP
Hospital Charge Code	9100085
Hospital Revenue Code	420
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

PT PROSTH TRAIN UE/LE/15 MIN 1

Facility

$134.50

Service Code	HCPCS 97760GP
Hospital Charge Code	9100160
Hospital Revenue Code	420
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$51.11
Rate for Payer: Aetna Medicare Advantage	$40.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.30
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	$34.30
Rate for Payer: Cigna Commercial	$67.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.18
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.56

Know your out-of-pocket cost for care.

All Charges