Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCM PREVNTIVE NEW PT 5-11 YRS

Facility

$175.00

Service Code	HCPCS 99383
Hospital Charge Code	93950177
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE EST PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	93950193
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	93950193
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	93950179
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE NEW PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	93950179
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
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) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM RAPID STREP

Facility

$125.00

Service Code	HCPCS 87880
Hospital Charge Code	93950059
Hospital Revenue Code	306
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.96
Rate for Payer: Aetna Medicare Advantage	$53.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: Cigna Medicare Advantage	$16.53
Rate for Payer: Clover Medicare Advantage	$15.70
Rate for Payer: EmblemHealth Commercial	$49.59
Rate for Payer: Humana Medicare Advantage	$17.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.53
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	$13.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.53
Rate for Payer: Wellcare Medicare Advantage	$16.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

TCM RAPID STREP

Facility

$125.00

Service Code	HCPCS 87880
Hospital Charge Code	93950059
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

TCM REMOVAL OF FOREIGN BODY

Facility

$475.00

Service Code	HCPCS 28190
Hospital Charge Code	93950041
Hospital Revenue Code	361
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

TCM REMOVAL OF FOREIGN BODY

Facility

$475.00

Service Code	HCPCS 28190
Hospital Charge Code	93950041
Hospital Revenue Code	361
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

TCM REMOVE SKIN TAG ECH AD 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	93950011
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

TCM REMOVE SKIN TAG ECH AD 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	93950011
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
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	$57.50
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	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

TCM SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
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 SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

TCM SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

Know your out-of-pocket cost for care.

All Charges