Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	1008145
Hospital Revenue Code	430
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	1008150
Hospital Revenue Code	420
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	1008145
Hospital Revenue Code	430
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	1008150
Hospital Revenue Code	420
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

TCU PT:CO-TX (GRP) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008235
Hospital Revenue Code	423
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$164.92
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

TCU PT:CO-TX (GRP) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008235
Hospital Revenue Code	423
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU PT:CO-TX (IND) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008225
Hospital Revenue Code	420
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$164.92
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

TCU PT:CO-TX (IND) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008225
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU PT:GROUP TX

Facility

$840.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008025
Hospital Revenue Code	424
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

TCU PT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GP
Hospital Charge Code	1008285
Hospital Revenue Code	423
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCU PT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GP
Hospital Charge Code	1008285
Hospital Revenue Code	423
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

TCU PT:GROUP TX

Facility

$840.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008025
Hospital Revenue Code	424
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$319.20
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
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	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22.26

TCU RE-EVALUATION OT

Facility

$103.00

Service Code	HCPCS 97004GO
Hospital Charge Code	1008115
Hospital Revenue Code	434
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
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	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

TCU RE-EVALUATION OT

Facility

$103.00

Service Code	HCPCS 97004GO
Hospital Charge Code	1008115
Hospital Revenue Code	434
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCU REEVALUATION PT

Facility

$164.00

Service Code	HCPCS 97002GP
Hospital Charge Code	1008110
Hospital Revenue Code	424
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

TCU REEVALUATION PT

Facility

$164.00

Service Code	HCPCS 97002GP
Hospital Charge Code	1008110
Hospital Revenue Code	424
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
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	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

TCU SPLINT/CAST FABRICATION

Facility

$458.00

Hospital Charge Code	1008410
Hospital Revenue Code	430
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
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	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

TCU SPLINT/CAST FABRICATION

Facility

$458.00

Hospital Charge Code	1008410
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

TCU SPORTS TAPE

Facility

$44.00

Hospital Charge Code	1008390
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

TCU SPORTS TAPE

Facility

$44.00

Hospital Charge Code	1008390
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

TCU ST:CO-TX (GRP) 15 MIN

Facility

$244.00

Service Code	HCPCS 97150GN
Hospital Charge Code	1008270
Hospital Revenue Code	440
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.72
Rate for Payer: Aetna Medicare Advantage	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

TCU ST:CO-TX (GRP) 15 MIN

Facility

$244.00

Service Code	HCPCS 97150GN
Hospital Charge Code	1008270
Hospital Revenue Code	440
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

TCU ST:CO-TX (IND) 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GN
Hospital Charge Code	1008205
Hospital Revenue Code	440
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$164.92
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

TCU ST:CO-TX (IND) 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GN
Hospital Charge Code	1008205
Hospital Revenue Code	440
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU ST DYSPHAGIA EVAL

Facility

$601.00

Service Code	HCPCS 92610GN
Hospital Charge Code	1008100
Hospital Revenue Code	444
Min. Negotiated Rate	$90.15
Max. Negotiated Rate	$90.15
Rate for Payer: Qualcare PPO/HMO/WC	$90.15

Know your out-of-pocket cost for care.

All Charges