Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$20.18

PT- PT/CHILDSTUDY******

Facility

$175.00

Service Code	HCPCS Q0086
Hospital Charge Code	900407
Hospital Revenue Code	429
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
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	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PT- PT/CHILDSTUDY******

Facility

$175.00

Service Code	HCPCS Q0086
Hospital Charge Code	900407
Hospital Revenue Code	429
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PT / PTT MIX****

Facility

$125.00

Service Code	HCPCS 85610
Hospital Charge Code	3032521
Hospital Revenue Code	301
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

PT / PTT MIX****

Facility

$125.00

Service Code	HCPCS 85610
Hospital Charge Code	3032521
Hospital Revenue Code	301
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
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	$62.50
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	$37.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
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	$3.31

PT PULSE LAVAGE/WOUND DEBR<20c

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9100090
Hospital Revenue Code	420
Min. Negotiated Rate	$20.32
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	$252.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

PT PULSE LAVAGE/WOUND DEBR<20c

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9100090
Hospital Revenue Code	420
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

PT PULSE LAVAGE/WOUND DEBR>20C

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9100091
Hospital Revenue Code	420
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

PT PULSE LAVAGE/WOUND DEBR>20C

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9100091
Hospital Revenue Code	420
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$320.34
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
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	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

PT-RANGE OF MOTION TEST

Facility

$422.00

Hospital Charge Code	9109010
Hospital Revenue Code	920
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

PT-RANGE OF MOTION TEST

Facility

$422.00

Hospital Charge Code	9109010
Hospital Revenue Code	920
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$160.36
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$10.17
Rate for Payer: Wellpoint Medicaid Managed Care	$11.18

PT RE-EVAL 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	422597164
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 RE-EVAL 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	422597164
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	9109163
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 RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	9109163
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT REEVALUATION

Facility

$141.65

Service Code	HCPCS 97002GP
Hospital Charge Code	9001018
Hospital Revenue Code	424
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 REEVALUATION

Facility

$141.65

Service Code	HCPCS 97002GP
Hospital Charge Code	9001018
Hospital Revenue Code	424
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT REM/BIV CAST ARM/LEG FULL

Facility

$1,485.20

Service Code	HCPCS 29705GP
Hospital Charge Code	422529705
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM/BIV CAST ARM/LEG FULL

Facility

$1,485.20

Service Code	HCPCS 29705GP
Hospital Charge Code	422529705
Hospital Revenue Code	420
Min. Negotiated Rate	$35.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$564.38
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.56
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$35.79
Rate for Payer: Wellpoint Medicaid Managed Care	$39.36

PT REM/BIV CST GAUNTLT/BOOT/BD

Facility

$1,485.20

Service Code	HCPCS 29700GP
Hospital Charge Code	422529700
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM/BIV CST GAUNTLT/BOOT/BD

Facility

$1,485.20

Service Code	HCPCS 29700GP
Hospital Charge Code	422529700
Hospital Revenue Code	420
Min. Negotiated Rate	$35.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$564.38
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.56
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$35.79
Rate for Payer: Wellpoint Medicaid Managed Care	$39.36

PT REM CAST SPICA/MINER/RISSER

Facility

$1,485.20

Service Code	HCPCS 29710GP
Hospital Charge Code	422529710
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM CAST SPICA/MINER/RISSER

Facility

$1,485.20

Service Code	HCPCS 29710GP
Hospital Charge Code	422529710
Hospital Revenue Code	420
Min. Negotiated Rate	$35.79
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$564.38
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.56
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$35.79
Rate for Payer: Wellpoint Medicaid Managed Care	$39.36

PT-REM DEVIT TISS WO/ANES

Facility

$573.00

Hospital Charge Code	9109110
Hospital Revenue Code	420
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

PT-REM DEVIT TISS WO/ANES

Facility

$573.00

Hospital Charge Code	9109110
Hospital Revenue Code	420
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$217.74
Rate for Payer: Aetna Medicare Advantage	$171.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.12
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	$146.12
Rate for Payer: Cigna Commercial	$286.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$13.81
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

Know your out-of-pocket cost for care.

All Charges