Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TCU STRAPPING LOW BACK

Facility

$458.00

Service Code	HCPCS 29799
Hospital Charge Code	1008015
Hospital Revenue Code	429
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

TCU STRAPPING LOW BACK

Facility

$458.00

Service Code	HCPCS 29799
Hospital Charge Code	1008015
Hospital Revenue Code	429
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$135.13
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
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: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

TCU STRAPPING WRIST

Facility

$458.00

Service Code	HCPCS 29260
Hospital Charge Code	1008060
Hospital Revenue Code	420
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

TCU STRAPPING WRIST

Facility

$458.00

Service Code	HCPCS 29260
Hospital Charge Code	1008060
Hospital Revenue Code	420
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
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	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$49.06
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
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: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

TCU ST TREATMENT

Facility

$167.00

Service Code	HCPCS 92507GN
Hospital Charge Code	1008090
Hospital Revenue Code	442
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

TCU ST TREATMENT

Facility

$167.00

Service Code	HCPCS 92507GN
Hospital Charge Code	1008090
Hospital Revenue Code	442
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

TCU TRACTION - MECHANICAL

Facility

$148.00

Service Code	HCPCS 97012GP
Hospital Charge Code	1008130
Hospital Revenue Code	420
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

TCU TRACTION - MECHANICAL

Facility

$148.00

Service Code	HCPCS 97012GP
Hospital Charge Code	1008130
Hospital Revenue Code	420
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
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	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

TCU TRANSFER ACTIVITIES 15 MIN

Facility

$97.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008295
Hospital Revenue Code	430
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

TCU TRANSFER ACTIVITIES 15 MIN

Facility

$97.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008295
Hospital Revenue Code	430
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
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	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	1008190
Hospital Revenue Code	430
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	1008190
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GP
Hospital Charge Code	1008195
Hospital Revenue Code	420
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GP
Hospital Charge Code	1008195
Hospital Revenue Code	420
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

TCU UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	1008080
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

TCU UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	1008080
Hospital Revenue Code	420
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$135.13
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.61

TCU WHIRLPOOL

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008155
Hospital Revenue Code	420
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
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	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

TCU WHIRLPOOL

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008155
Hospital Revenue Code	420
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$163.95
Rate for Payer: Aetna Commercial	$124.60
Rate for Payer: Aetna Medicare Advantage	$98.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.61
Rate for Payer: Cigna Commercial	$163.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$49.19
Max. Negotiated Rate	$79.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$49.06
Max. Negotiated Rate	$49.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.06

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$163.54
Rate for Payer: Aetna Commercial	$124.29
Rate for Payer: Aetna Medicare Advantage	$98.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.41
Rate for Payer: Cigna Commercial	$163.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.13
Rate for Payer: Oxford Commercial	$65.42
Rate for Payer: Qualcare PPO/HMO/WC	$49.06
Rate for Payer: UnitedHealthcare Commercial	$65.42
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

Know your out-of-pocket cost for care.

All Charges