Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$104.54
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	$104.54
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	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HEPATITUS B (PEDS)

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	93950109
Hospital Revenue Code	636
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
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	$63.81
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	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

TCM HEPATITUS B (PEDS)

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	93950109
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$958.00
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.95
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.20
Rate for Payer: Qualcare PPO/HMO/WC	$114.60
Rate for Payer: UnitedHealthcare Community & State	$18.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$20.25

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$114.60
Max. Negotiated Rate	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,197.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.60

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$101.50
Rate for Payer: Aetna Commercial	$77.14
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Community & State	$4.89
Rate for Payer: Wellpoint Medicaid Managed Care	$5.38

TCM I&D OF ABSCESS, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950005
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

TCM I&D OF ABSCESS, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950005
Hospital Revenue Code	761
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$962.01
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	$49.39
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	$238.36
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	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

TCM I&D, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950003
Hospital Revenue Code	761
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$962.01
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	$49.39
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	$238.36
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	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

TCM I&D, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950003
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$101.50
Rate for Payer: Aetna Commercial	$77.14
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Community & State	$4.89
Rate for Payer: Wellpoint Medicaid Managed Care	$5.38

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM INIT HOSPITAL ADMISSION 3

Facility

$275.00

Service Code	HCPCS 99223
Hospital Charge Code	93950157
Hospital Revenue Code	510
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

TCM INIT HOSPITAL ADMISSION 3

Facility

$275.00

Service Code	HCPCS 99223
Hospital Charge Code	93950157
Hospital Revenue Code	510
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

TCM INTRALSNL INJCTNS UP TO 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	93950023
Hospital Revenue Code	761
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

TCM INTRALSNL INJCTNS UP TO 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	93950023
Hospital Revenue Code	761
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$860.41
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	$38.91
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	$238.36
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	$309.98
Rate for Payer: Oxford Commercial	$206.65
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$206.65
Rate for Payer: UnitedHealthcare Community & State	$24.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$27.38

TCM JOINT/BURSA TP AND/OR INJ

Facility

$440.00

Service Code	HCPCS 20610
Hospital Charge Code	93950037
Hospital Revenue Code	761
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

TCM JOINT/BURSA TP AND/OR INJ

Facility

$440.00

Service Code	HCPCS 20610
Hospital Charge Code	93950037
Hospital Revenue Code	761
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.00
Rate for Payer: Oxford Commercial	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Commercial	$88.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

TCM LACERATION REPAIR

Facility

$732.95

Service Code	HCPCS 12001
Hospital Charge Code	93950025
Hospital Revenue Code	761
Min. Negotiated Rate	$17.66
Max. Negotiated Rate	$860.41
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	$73.57
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	$238.36
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	$219.88
Rate for Payer: Oxford Commercial	$146.59
Rate for Payer: Qualcare PPO/HMO/WC	$109.94
Rate for Payer: UnitedHealthcare Commercial	$146.59
Rate for Payer: UnitedHealthcare Community & State	$17.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$19.42

Know your out-of-pocket cost for care.

All Charges