Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC ALLEVYN AG ADHESIVE 5 X %

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLEVYN DRSNG >48SQ IN W/O

Facility

$24.00

Service Code	HCPCS A6211
Hospital Charge Code	9808130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

WC ALLEVYN DRSNG >48SQ IN W/O

Facility

$24.00

Service Code	HCPCS A6211
Hospital Charge Code	9808130
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

WC ALLEVYN HEEL DRESSING

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

WC ALLEVYN HEEL DRESSING

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

WC ALLEVYN ISLAND 4X4

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

WC ALLEVYN ISLAND 4X4

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$721.30
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.45
Rate for Payer: Qualcare PPO/HMO/WC	$284.72
Rate for Payer: UnitedHealthcare Community & State	$45.75
Rate for Payer: Wellpoint Medicaid Managed Care	$50.30

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$721.30
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.45
Rate for Payer: Qualcare PPO/HMO/WC	$284.72
Rate for Payer: UnitedHealthcare Community & State	$45.75
Rate for Payer: Wellpoint Medicaid Managed Care	$50.30

WC AMP TOE/METATARSOPHALANGEAL

Facility

$4,822.60

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMP TOE/METATARSOPHALANGEAL

Facility

$4,822.60

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,446.78
Rate for Payer: Qualcare PPO/HMO/WC	$723.39
Rate for Payer: UnitedHealthcare Community & State	$116.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

WC AMPUTATION OF TOE - PARTIAL

Facility

$4,822.60

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,446.78
Rate for Payer: Qualcare PPO/HMO/WC	$723.39
Rate for Payer: UnitedHealthcare Community & State	$116.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

WC AMPUTATION OF TOE - PARTIAL

Facility

$4,822.60

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMPUTATION SGL TOE/METATSAL

Facility

$4,822.60

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,446.78
Rate for Payer: Qualcare PPO/HMO/WC	$723.39
Rate for Payer: UnitedHealthcare Community & State	$116.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

WC AMPUTATION SGL TOE/METATSAL

Facility

$4,822.60

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC ANKLE STRAPPING

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$193.05
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	$140.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

WC ANKLE STRAPPING

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WC APLIGRAF - PER SQ CM

Facility

$162.95

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF - PER SQ CM

Facility

$162.95

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

Know your out-of-pocket cost for care.

All Charges