Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLN DEBRD SKN FULL THICKNESS

Facility

$545.00

Hospital Charge Code	75190015
Hospital Revenue Code	761
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.50
Rate for Payer: Oxford Commercial	$109.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Commercial	$109.00
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.44

CLN DEBRD SKN PRTL THICKNESS

Facility

$545.00

Service Code	HCPCS 11040
Hospital Charge Code	75190010
Hospital Revenue Code	761
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.50
Rate for Payer: Oxford Commercial	$109.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Commercial	$109.00
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.44

CLN DEBRD SKN PRTL THICKNESS

Facility

$545.00

Service Code	HCPCS 11040
Hospital Charge Code	75190010
Hospital Revenue Code	761
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

CLN DEBRD SKN & SUBCUT TISSUE

Facility

$1,147.40

Service Code	HCPCS 11042
Hospital Charge Code	75190020
Hospital Revenue Code	761
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.22
Rate for Payer: Oxford Commercial	$229.48
Rate for Payer: Qualcare PPO/HMO/WC	$172.11
Rate for Payer: UnitedHealthcare Commercial	$229.48
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$30.41

CLN DEBRD SKN & SUBCUT TISSUE

Facility

$1,147.40

Service Code	HCPCS 11042
Hospital Charge Code	75190020
Hospital Revenue Code	761
Min. Negotiated Rate	$172.11
Max. Negotiated Rate	$172.11
Rate for Payer: Qualcare PPO/HMO/WC	$172.11

CLN DX PAT-ABDOM COMP & CHEST

Facility

$788.00

Service Code	HCPCS 74022
Hospital Charge Code	75190290
Hospital Revenue Code	320
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$118.20
Rate for Payer: Qualcare PPO/HMO/WC	$118.20

CLN DX PAT-ABDOM COMP & CHEST

Facility

$788.00

Service Code	HCPCS 74022
Hospital Charge Code	75190290
Hospital Revenue Code	320
Min. Negotiated Rate	$18.99
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$20.88

CLN DX PAT-ABDOMEN SINGLE

Facility

$278.00

Service Code	HCPCS 74000
Hospital Charge Code	75190285
Hospital Revenue Code	320
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$105.64
Rate for Payer: Aetna Medicare Advantage	$83.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.89
Rate for Payer: Cigna Commercial	$139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$7.37

CLN DX PAT-ABDOMEN SINGLE

Facility

$278.00

Service Code	HCPCS 74000
Hospital Charge Code	75190285
Hospital Revenue Code	320
Min. Negotiated Rate	$41.70
Max. Negotiated Rate	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$41.70

CLN DX PAT-ANKLE AP/LA POS-LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	75190540
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

CLN DX PAT-ANKLE AP/LA POS-LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	75190540
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

CLN DX PAT-ANKLE AP&LAT 2-LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	75190535
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

CLN DX PAT-ANKLE AP&LAT 2-LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	75190535
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

CLN DX PAT-ANKLE AP&LAT 2-RT

Facility

$251.00

Service Code	HCPCS 73600RT
Hospital Charge Code	75190550
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

CLN DX PAT-ANKLE AP&LAT 2-RT

Facility

$251.00

Service Code	HCPCS 73600RT
Hospital Charge Code	75190550
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

CLN DX PAT-ANKLE AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	75190345
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ANKLE AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	75190345
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-ANKLE APLAT POS-BI

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	75190350
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ANKLE APLAT POS-BI

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	75190350
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-ANKLE APLAT POS-RT

Facility

$250.00

Service Code	HCPCS 73600RT
Hospital Charge Code	75190545
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-ANKLE APLAT POS-RT

Facility

$250.00

Service Code	HCPCS 73600RT
Hospital Charge Code	75190545
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ANKLE COMPLETE-BIL

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	75190355
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-ANKLE COMPLETE-BIL

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	75190355
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ANKLE COMPLETE-LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	75190555
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CLN DX PAT-ANKLE COMPLETE-LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	75190555
Hospital Revenue Code	320
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$126.16
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

Know your out-of-pocket cost for care.

All Charges