Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCM LACERATION REPAIR

Facility

$732.95

Service Code	HCPCS 12001
Hospital Charge Code	93950025
Hospital Revenue Code	761
Min. Negotiated Rate	$109.94
Max. Negotiated Rate	$109.94
Rate for Payer: Qualcare PPO/HMO/WC	$109.94

TCM MENINGOCOCCAL

Facility

$193.00

Service Code	HCPCS 90733
Hospital Charge Code	93950105
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.71
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

TCM MENINGOCOCCAL

Facility

$193.00

Service Code	HCPCS 90733
Hospital Charge Code	93950105
Hospital Revenue Code	636
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$46.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.71
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

TCM MMR, SO LIVE

Facility

$130.00

Service Code	HCPCS 90707
Hospital Charge Code	93950089
Hospital Revenue Code	636
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$105.76
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

TCM MMR, SO LIVE

Facility

$130.00

Service Code	HCPCS 90707
Hospital Charge Code	93950089
Hospital Revenue Code	636
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

TCM MOD MED COMPLEX

Facility

$645.75

Service Code	HCPCS 99495
Hospital Charge Code	412399495
Hospital Revenue Code	510
Min. Negotiated Rate	$15.56
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	$193.72
Rate for Payer: Qualcare PPO/HMO/WC	$96.86
Rate for Payer: UnitedHealthcare Community & State	$15.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$17.11

TCM MOD MED COMPLEX

Facility

$645.75

Service Code	HCPCS 99495
Hospital Charge Code	412399495
Hospital Revenue Code	510
Min. Negotiated Rate	$96.86
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	$96.86

TCM NONPRESS INHALE TREATMENT

Facility

$503.00

Service Code	HCPCS 94640
Hospital Charge Code	93950115
Hospital Revenue Code	410
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.90
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$12.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$13.33

TCM NONPRESS INHALE TREATMENT

Facility

$503.00

Service Code	HCPCS 94640
Hospital Charge Code	93950115
Hospital Revenue Code	410
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

TCM OFFICE VST EST PAT MINIML

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	93950143
Hospital Revenue Code	510
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$43.32
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

TCM OFFICE VST EST PAT MINIML

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	93950143
Hospital Revenue Code	510
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

TCM OSTEO MANIPULTIN 1-2 AREA

Facility

$149.85

Service Code	HCPCS 98925
Hospital Charge Code	93950123
Hospital Revenue Code	761
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$92.59
Rate for Payer: Aetna Commercial	$69.77
Rate for Payer: Aetna Medicare Advantage	$83.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.59
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Clover Medicare Advantage	$24.37
Rate for Payer: EmblemHealth Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$26.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.95
Rate for Payer: Oxford Commercial	$29.97
Rate for Payer: Qualcare PPO/HMO/WC	$22.48
Rate for Payer: UnitedHealthcare Commercial	$29.97
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.65
Rate for Payer: Wellcare Medicare Advantage	$25.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

TCM OSTEO MANIPULTIN 1-2 AREA

Facility

$149.85

Service Code	HCPCS 98925
Hospital Charge Code	93950123
Hospital Revenue Code	761
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.48

TCM OSTEO MANIPULTIN 3-4 AREA

Facility

$149.85

Service Code	HCPCS 98926
Hospital Charge Code	93950125
Hospital Revenue Code	761
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$92.59
Rate for Payer: Aetna Commercial	$69.77
Rate for Payer: Aetna Medicare Advantage	$83.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.59
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Clover Medicare Advantage	$24.37
Rate for Payer: EmblemHealth Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$26.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.95
Rate for Payer: Oxford Commercial	$29.97
Rate for Payer: Qualcare PPO/HMO/WC	$22.48
Rate for Payer: UnitedHealthcare Commercial	$29.97
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.65
Rate for Payer: Wellcare Medicare Advantage	$25.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

TCM OSTEO MANIPULTIN 3-4 AREA

Facility

$149.85

Service Code	HCPCS 98926
Hospital Charge Code	93950125
Hospital Revenue Code	761
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.48

TCM OSTEO MANIPULTIN 5-6 AREA

Facility

$149.85

Service Code	HCPCS 98927
Hospital Charge Code	93950127
Hospital Revenue Code	761
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$92.59
Rate for Payer: Aetna Commercial	$69.77
Rate for Payer: Aetna Medicare Advantage	$83.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.59
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Clover Medicare Advantage	$24.37
Rate for Payer: EmblemHealth Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$26.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.95
Rate for Payer: Oxford Commercial	$29.97
Rate for Payer: Qualcare PPO/HMO/WC	$22.48
Rate for Payer: UnitedHealthcare Commercial	$29.97
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.65
Rate for Payer: Wellcare Medicare Advantage	$25.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

TCM OSTEO MANIPULTIN 5-6 AREA

Facility

$149.85

Service Code	HCPCS 98927
Hospital Charge Code	93950127
Hospital Revenue Code	761
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.48

TCM OSTEO MANIPULTIN 7-8 AREA

Facility

$149.85

Service Code	HCPCS 98928
Hospital Charge Code	93950129
Hospital Revenue Code	761
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$92.59
Rate for Payer: Aetna Commercial	$69.77
Rate for Payer: Aetna Medicare Advantage	$83.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.59
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Clover Medicare Advantage	$24.37
Rate for Payer: EmblemHealth Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$26.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.95
Rate for Payer: Oxford Commercial	$29.97
Rate for Payer: Qualcare PPO/HMO/WC	$22.48
Rate for Payer: UnitedHealthcare Commercial	$29.97
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.65
Rate for Payer: Wellcare Medicare Advantage	$25.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

TCM OSTEO MANIPULTIN 7-8 AREA

Facility

$149.85

Service Code	HCPCS 98928
Hospital Charge Code	93950129
Hospital Revenue Code	761
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.48

TCM OSTEO MANIPULTN 9-10 AREA

Facility

$376.35

Service Code	HCPCS 98929
Hospital Charge Code	93950131
Hospital Revenue Code	761
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$112.91
Rate for Payer: Aetna Commercial	$69.77
Rate for Payer: Aetna Medicare Advantage	$83.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.59
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Clover Medicare Advantage	$24.37
Rate for Payer: EmblemHealth Commercial	$76.95
Rate for Payer: Humana Medicare Advantage	$26.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.91
Rate for Payer: Oxford Commercial	$75.27
Rate for Payer: Qualcare PPO/HMO/WC	$56.45
Rate for Payer: UnitedHealthcare Commercial	$75.27
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.65
Rate for Payer: Wellcare Medicare Advantage	$25.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

TCM OSTEO MANIPULTN 9-10 AREA

Facility

$376.35

Service Code	HCPCS 98929
Hospital Charge Code	93950131
Hospital Revenue Code	761
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$56.45
Rate for Payer: Qualcare PPO/HMO/WC	$56.45

TCM PEDIATRIX

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	93950101
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$39.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

TCM PEDIATRIX

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	93950101
Hospital Revenue Code	636
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$194.72
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

TCM PHONE CONSULT 10-15 MIN

Facility

$75.00

Service Code	HCPCS 99442
Hospital Charge Code	93950203
Hospital Revenue Code	510
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

TCM PHONE CONSULT 10-15 MIN

Facility

$75.00

Service Code	HCPCS 99442
Hospital Charge Code	93950203
Hospital Revenue Code	510
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

Know your out-of-pocket cost for care.

All Charges