Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
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 SUTURE/STAPLE REMOVAL

Facility

$125.00

Service Code	HCPCS 17999
Hospital Charge Code	93950029
Hospital Revenue Code	761
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

TCM SUTURE/STAPLE REMOVAL

Facility

$125.00

Service Code	HCPCS 17999
Hospital Charge Code	93950029
Hospital Revenue Code	761
Min. Negotiated Rate	$3.01
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) 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	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

TCM TD (ADULT) IM

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950097
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM TD (ADULT) IM

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950097
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$18.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$18.20
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

TCM TDAP

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	93950093
Hospital Revenue Code	636
Min. Negotiated Rate	$70.21
Max. Negotiated Rate	$1,456.70
Rate for Payer: Aetna Commercial	$1,107.09
Rate for Payer: Aetna Medicare Advantage	$874.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.92
Rate for Payer: Cigna Commercial	$1,456.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01
Rate for Payer: UnitedHealthcare Community & State	$70.21
Rate for Payer: Wellpoint Medicaid Managed Care	$77.21

TCM TDAP

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	93950093
Hospital Revenue Code	636
Min. Negotiated Rate	$437.01
Max. Negotiated Rate	$705.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01

TCM TD IM >7

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950099
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM TD IM >7

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950099
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$18.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$18.20
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

TCM TRIGGER POINT INJCTION >2

Facility

$242.00

Service Code	HCPCS 20553
Hospital Charge Code	93950035
Hospital Revenue Code	761
Min. Negotiated Rate	$5.83
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	$52.41
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	$72.60
Rate for Payer: Oxford Commercial	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$48.40
Rate for Payer: UnitedHealthcare Community & State	$5.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$6.41

TCM TRIGGER POINT INJCTION >2

Facility

$242.00

Service Code	HCPCS 20553
Hospital Charge Code	93950035
Hospital Revenue Code	761
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

TCM TRIGGER POINT INJCTON 1-2

Facility

$121.00

Service Code	HCPCS 20552
Hospital Charge Code	93950033
Hospital Revenue Code	761
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

TCM TRIGGER POINT INJCTON 1-2

Facility

$121.00

Service Code	HCPCS 20552
Hospital Charge Code	93950033
Hospital Revenue Code	761
Min. Negotiated Rate	$2.92
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	$58.33
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	$36.30
Rate for Payer: Oxford Commercial	$24.20
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$24.20
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

TCM URINE DIPSTICK

Facility

$103.00

Service Code	HCPCS 81000
Hospital Charge Code	93950049
Hospital Revenue Code	307
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCM URINE DIPSTICK

Facility

$103.00

Service Code	HCPCS 81000
Hospital Charge Code	93950049
Hospital Revenue Code	307
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.51
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: Cigna Medicare Advantage	$4.02
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Medicare Advantage	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

TCM URINE PREGNANCY

Facility

$414.00

Service Code	HCPCS 81025
Hospital Charge Code	93950051
Hospital Revenue Code	307
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
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	$31.08
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

TCM URINE PREGNANCY

Facility

$414.00

Service Code	HCPCS 81025
Hospital Charge Code	93950051
Hospital Revenue Code	307
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

TCM VARICELLA

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	93950095
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$160.26
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

TCM VARICELLA

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	93950095
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM WART REMOVAL

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	93950027
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	$69.70
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 WART REMOVAL

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	93950027
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM ZOSTAVAX

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	93950107
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

TCM ZOSTAVAX

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	93950107
Hospital Revenue Code	636
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

TCU ADL TRAINING EA 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008320
Hospital Revenue Code	430
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
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	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

Know your out-of-pocket cost for care.

All Charges