Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PT RPR SPICA/CAST BODY/JACKET

Facility

$869.79

Service Code	HCPCS 29720GP
Hospital Charge Code	422529720
Hospital Revenue Code	420
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$330.52
Rate for Payer: Aetna Medicare Advantage	$260.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.80
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	$221.80
Rate for Payer: Cigna Commercial	$434.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.94
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.47
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$23.05

PT RPR SPICA/CAST BODY/JACKET

Facility

$869.79

Service Code	HCPCS 29720GP
Hospital Charge Code	422529720
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270507725
Hospital Revenue Code	278
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$1,277.20
Rate for Payer: Aetna Commercial	$970.67
Rate for Payer: Aetna Medicare Advantage	$766.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.37
Rate for Payer: Cigna Commercial	$1,277.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.97
Rate for Payer: Qualcare PPO/HMO/WC	$383.16
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: Wellpoint Medicaid Managed Care	$67.69

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270507725
Hospital Revenue Code	278
Min. Negotiated Rate	$383.16
Max. Negotiated Rate	$618.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.97
Rate for Payer: Qualcare PPO/HMO/WC	$383.16

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270705012
Hospital Revenue Code	278
Min. Negotiated Rate	$383.16
Max. Negotiated Rate	$618.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.97
Rate for Payer: Qualcare PPO/HMO/WC	$383.16

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270705012
Hospital Revenue Code	278
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$1,277.20
Rate for Payer: Aetna Commercial	$970.67
Rate for Payer: Aetna Medicare Advantage	$766.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.37
Rate for Payer: Cigna Commercial	$1,277.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.97
Rate for Payer: Qualcare PPO/HMO/WC	$383.16
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: Wellpoint Medicaid Managed Care	$67.69

PT SELF/HOME MGT/ADL EA 15 MIN

Facility

$508.00

Service Code	HCPCS 97535GP
Hospital Charge Code	422597535
Hospital Revenue Code	420
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$76.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.20

PT SELF/HOME MGT/ADL EA 15 MIN

Facility

$508.00

Service Code	HCPCS 97535GP
Hospital Charge Code	422597535
Hospital Revenue Code	420
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna Medicare Advantage	$152.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.54
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	$129.54
Rate for Payer: Cigna Commercial	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: Wellpoint Medicaid Managed Care	$13.46

PT-SENSORY INT TECH 15MIN

Facility

$120.00

Hospital Charge Code	9109050
Hospital Revenue Code	420
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

PT-SENSORY INT TECH 15MIN

Facility

$120.00

Hospital Charge Code	9109050
Hospital Revenue Code	420
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
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	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

PT SENSORY TECHNIQUE 15 MIN

Facility

$112.00

Service Code	HCPCS 97533GP
Hospital Charge Code	422597533
Hospital Revenue Code	420
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

PT SENSORY TECHNIQUE 15 MIN

Facility

$112.00

Service Code	HCPCS 97533GP
Hospital Charge Code	422597533
Hospital Revenue Code	420
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
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	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

PT SEP & ID HIGH REST

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479508
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

PT SEP & ID HIGH REST

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479508
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

PT SO 11-15-11

Facility

$40,585.00

Hospital Charge Code	270657065
Hospital Revenue Code	278
Min. Negotiated Rate	$978.10
Max. Negotiated Rate	$20,292.50
Rate for Payer: Aetna Commercial	$15,422.30
Rate for Payer: Aetna Medicare Advantage	$12,175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,349.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,349.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,349.17
Rate for Payer: Cigna Commercial	$20,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,821.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,928.70
Rate for Payer: Qualcare PPO/HMO/WC	$6,087.75
Rate for Payer: UnitedHealthcare Community & State	$978.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1,075.50

PT SO 11-15-11

Facility

$40,585.00

Hospital Charge Code	270657065
Hospital Revenue Code	278
Min. Negotiated Rate	$6,087.75
Max. Negotiated Rate	$9,821.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,821.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,928.70
Rate for Payer: Qualcare PPO/HMO/WC	$6,087.75

PT STIM US BONE LOW DENSITY

Facility

$152.08

Service Code	HCPCS 20979GP
Hospital Charge Code	422520979
Hospital Revenue Code	420
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$22.81
Rate for Payer: Qualcare PPO/HMO/WC	$22.81

PT STIM US BONE LOW DENSITY

Facility

$152.08

Service Code	HCPCS 20979GP
Hospital Charge Code	422520979
Hospital Revenue Code	420
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$57.79
Rate for Payer: Aetna Medicare Advantage	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.78
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	$38.78
Rate for Payer: Cigna Commercial	$76.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.62
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.81
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

PT STRAPPING KNEE

Facility

$244.50

Service Code	HCPCS 29530GP
Hospital Charge Code	9100150
Hospital Revenue Code	420
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
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	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6.48

PT STRAPPING KNEE

Facility

$244.50

Service Code	HCPCS 29530GP
Hospital Charge Code	9100150
Hospital Revenue Code	420
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

PT SUBSTITUTION

Facility

$119.00

Service Code	HCPCS 85611
Hospital Charge Code	38478009
Hospital Revenue Code	305
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

PT SUBSTITUTION

Facility

$119.00

Service Code	HCPCS 85611
Hospital Charge Code	38478009
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	$59.50
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	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
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	$3.15

PTT***

Facility

$25.00

Hospital Charge Code	3012036
Hospital Revenue Code	309
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PTT***

Facility

$25.00

Hospital Charge Code	3012036
Hospital Revenue Code	309
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

PTT-D 1-1 MIX (PTT MIXED)

Facility

$54.00

Service Code	HCPCS 85732
Hospital Charge Code	3035059A
Hospital Revenue Code	305
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

Know your out-of-pocket cost for care.

All Charges