Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SKIN ARM PROTECTOR TAN

Facility

$36.15

Hospital Charge Code	270649354
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.07
Rate for Payer: Aetna Commercial	$13.74
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.22
Rate for Payer: Cigna Commercial	$18.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.85
Rate for Payer: Oxford Commercial	$7.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$7.23
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

SKIN CLEANSER ADULT

Facility

$26.90

Hospital Charge Code	60628317
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

SKIN CLEANSER ADULT

Facility

$26.90

Hospital Charge Code	60628317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

SKIN CLEANSER BABY

Facility

$17.95

Hospital Charge Code	60628318
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SKIN CLEANSER BABY

Facility

$17.95

Hospital Charge Code	60628318
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

SKIN CLOSURE DERMABOND PRINEO

Facility

$1,574.28

Service Code	HCPCS A4649
Hospital Charge Code	270687929
Hospital Revenue Code	272
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

SKIN CLOSURE DERMABOND PRINEO

Facility

$1,574.28

Service Code	HCPCS A4649
Hospital Charge Code	270687929
Hospital Revenue Code	272
Min. Negotiated Rate	$37.94
Max. Negotiated Rate	$787.14
Rate for Payer: Aetna Commercial	$598.23
Rate for Payer: Aetna Medicare Advantage	$472.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.44
Rate for Payer: Cigna Commercial	$787.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.28
Rate for Payer: Oxford Commercial	$314.86
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$314.86
Rate for Payer: UnitedHealthcare Community & State	$37.94
Rate for Payer: Wellpoint Medicaid Managed Care	$41.72

SKIN CLOSURE SYSTEM DERMABOND

Facility

$615.00

Hospital Charge Code	270655959
Hospital Revenue Code	271
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

SKIN CLOSURE SYSTEM DERMABOND

Facility

$615.00

Hospital Charge Code	270655959
Hospital Revenue Code	271
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$233.70
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.82
Rate for Payer: Cigna Commercial	$307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.50
Rate for Payer: Oxford Commercial	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$123.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: Wellpoint Medicaid Managed Care	$16.30

SKIN CREAM

Facility

$12.99

Hospital Charge Code	270302495
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SKIN CREAM

Facility

$12.99

Hospital Charge Code	270302495
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SKIN DEBRIDEMENT WITH CC

Facility

$56,741.54

Service Code	MSDRG 571
Min. Negotiated Rate	$17,277.07
Max. Negotiated Rate	$56,741.54
Rate for Payer: Aetna Commercial	$39,245.22
Rate for Payer: Aetna Medicare Advantage	$56,741.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,311.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,311.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,186.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,311.09
Rate for Payer: Cigna Commercial	$31,617.30
Rate for Payer: Cigna Medicare Advantage	$18,186.39
Rate for Payer: Clover Medicare Advantage	$17,277.07
Rate for Payer: EmblemHealth Commercial	$54,559.17
Rate for Payer: Humana Medicare Advantage	$18,731.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,186.39
Rate for Payer: Oxford Commercial	$22,723.78
Rate for Payer: UnitedHealthcare Commercial	$39,846.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,186.39
Rate for Payer: Wellcare Medicare Advantage	$18,186.39

SKIN DEBRIDEMENT WITH MCC

Facility

$97,195.27

Service Code	MSDRG 570
Min. Negotiated Rate	$29,594.71
Max. Negotiated Rate	$97,195.27
Rate for Payer: Aetna Commercial	$67,041.55
Rate for Payer: Aetna Medicare Advantage	$97,195.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67,922.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67,922.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,152.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67,922.12
Rate for Payer: Cigna Commercial	$55,039.75
Rate for Payer: Cigna Medicare Advantage	$31,152.33
Rate for Payer: Clover Medicare Advantage	$29,594.71
Rate for Payer: EmblemHealth Commercial	$93,456.99
Rate for Payer: Humana Medicare Advantage	$32,086.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31,152.33
Rate for Payer: Oxford Commercial	$39,557.79
Rate for Payer: UnitedHealthcare Commercial	$69,365.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,152.33
Rate for Payer: Wellcare Medicare Advantage	$31,152.33

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$39,184.39

Service Code	MSDRG 572
Min. Negotiated Rate	$11,931.15
Max. Negotiated Rate	$39,184.39
Rate for Payer: Aetna Commercial	$27,181.48
Rate for Payer: Aetna Medicare Advantage	$39,184.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,517.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,517.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,559.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,517.54
Rate for Payer: Cigna Commercial	$21,451.86
Rate for Payer: Cigna Medicare Advantage	$12,559.10
Rate for Payer: Clover Medicare Advantage	$11,931.15
Rate for Payer: EmblemHealth Commercial	$37,677.30
Rate for Payer: Humana Medicare Advantage	$12,935.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,559.10
Rate for Payer: Oxford Commercial	$15,417.74
Rate for Payer: UnitedHealthcare Commercial	$27,035.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,559.10
Rate for Payer: Wellcare Medicare Advantage	$12,559.10

SKIN FULL GRAFT SCLP/ARM/LEG

Facility

$16,584.80

Service Code	HCPCS 15220
Hospital Charge Code	16000659
Hospital Revenue Code	360
Min. Negotiated Rate	$399.69
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,975.44
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,487.72
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$399.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$439.50

SKIN FULL GRAFT SCLP/ARM/LEG

Facility

$16,584.80

Service Code	HCPCS 15220
Hospital Charge Code	16000659
Hospital Revenue Code	360
Min. Negotiated Rate	$2,487.72
Max. Negotiated Rate	$2,487.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,487.72

SKIN FULL GRFT TRUNK =< 20SQCM

Facility

$26,848.40

Service Code	HCPCS 15200
Hospital Charge Code	16000437
Hospital Revenue Code	360
Min. Negotiated Rate	$647.05
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,054.52
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$647.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$711.48

SKIN FULL GRFT TRUNK =< 20SQCM

Facility

$26,848.40

Service Code	HCPCS 15200
Hospital Charge Code	16000437
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$87,809.12

Service Code	MSDRG 577
Min. Negotiated Rate	$26,736.75
Max. Negotiated Rate	$87,809.12
Rate for Payer: Aetna Commercial	$60,592.22
Rate for Payer: Aetna Medicare Advantage	$87,809.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61,641.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61,641.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,143.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61,641.65
Rate for Payer: Cigna Commercial	$49,605.20
Rate for Payer: Cigna Medicare Advantage	$28,143.95
Rate for Payer: Clover Medicare Advantage	$26,736.75
Rate for Payer: EmblemHealth Commercial	$84,431.85
Rate for Payer: Humana Medicare Advantage	$28,988.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,143.95
Rate for Payer: Oxford Commercial	$35,651.92
Rate for Payer: UnitedHealthcare Commercial	$62,516.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,143.95
Rate for Payer: Wellcare Medicare Advantage	$28,143.95

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$160,548.96

Service Code	MSDRG 576
Min. Negotiated Rate	$48,885.10
Max. Negotiated Rate	$160,548.96
Rate for Payer: Aetna Commercial	$110,572.76
Rate for Payer: Aetna Medicare Advantage	$160,548.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132,122.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132,122.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132,122.48
Rate for Payer: Cigna Commercial	$91,721.06
Rate for Payer: Cigna Medicare Advantage	$51,458.00
Rate for Payer: Clover Medicare Advantage	$48,885.10
Rate for Payer: EmblemHealth Commercial	$154,374.00
Rate for Payer: Humana Medicare Advantage	$53,001.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51,458.00
Rate for Payer: Oxford Commercial	$65,921.14
Rate for Payer: UnitedHealthcare Commercial	$115,594.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$51,458.00
Rate for Payer: Wellcare Medicare Advantage	$51,458.00

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$54,055.59

Service Code	MSDRG 578
Min. Negotiated Rate	$16,459.23
Max. Negotiated Rate	$54,055.59
Rate for Payer: Aetna Commercial	$37,399.70
Rate for Payer: Aetna Medicare Advantage	$54,055.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,325.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,450.21
Rate for Payer: Cigna Commercial	$30,062.17
Rate for Payer: Cigna Medicare Advantage	$17,325.51
Rate for Payer: Clover Medicare Advantage	$16,459.23
Rate for Payer: EmblemHealth Commercial	$51,976.53
Rate for Payer: Humana Medicare Advantage	$17,845.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,325.51
Rate for Payer: Oxford Commercial	$21,606.08
Rate for Payer: UnitedHealthcare Commercial	$37,886.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,325.51
Rate for Payer: Wellcare Medicare Advantage	$17,325.51

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$14,414.07

Service Code	APR-DRG 3121
Min. Negotiated Rate	$14,131.44
Max. Negotiated Rate	$14,414.07
Rate for Payer: UnitedHealthcare Community & State	$14,131.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,414.07
Rate for Payer: Wellpoint Medicaid Managed Care	$14,131.44

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$37,929.76

Service Code	APR-DRG 3123
Min. Negotiated Rate	$37,186.04
Max. Negotiated Rate	$37,929.76
Rate for Payer: UnitedHealthcare Community & State	$37,186.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$37,929.76
Rate for Payer: Wellpoint Medicaid Managed Care	$37,186.04

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$67,651.57

Service Code	APR-DRG 3124
Min. Negotiated Rate	$66,325.07
Max. Negotiated Rate	$67,651.57
Rate for Payer: UnitedHealthcare Community & State	$66,325.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$67,651.57
Rate for Payer: Wellpoint Medicaid Managed Care	$66,325.07

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$22,766.29

Service Code	APR-DRG 3122
Min. Negotiated Rate	$22,319.89
Max. Negotiated Rate	$22,766.29
Rate for Payer: UnitedHealthcare Community & State	$22,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,766.29
Rate for Payer: Wellpoint Medicaid Managed Care	$22,319.89

Know your out-of-pocket cost for care.

All Charges