Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC APLIGRAF - PER SQ CM JW

Facility

$162.95

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
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 JW

Facility

$162.95

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.47
Rate for Payer: Aetna Commercial	$61.92
Rate for Payer: Aetna Medicare Advantage	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.55
Rate for Payer: Cigna Commercial	$81.47
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: Wellpoint Medicaid Managed Care	$4.32

WC APLIGRAF PER SQ CM - WASTE

Facility

$162.95

Hospital Charge Code	9800245WM
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 - WASTE

Facility

$162.95

Hospital Charge Code	9800245WM
Hospital Revenue Code	636
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.47
Rate for Payer: Aetna Commercial	$61.92
Rate for Payer: Aetna Medicare Advantage	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.55
Rate for Payer: Cigna Commercial	$81.47
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: Wellpoint Medicaid Managed Care	$4.32

WC APLIGRAFT TISS ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808200
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808200
Hospital Revenue Code	519
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$491.34
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.90
Rate for Payer: Qualcare PPO/HMO/WC	$193.95
Rate for Payer: UnitedHealthcare Community & State	$31.16
Rate for Payer: Wellpoint Medicaid Managed Care	$34.26

WC APLIGRAFT TISS CULT

Facility

$1,293.00

Service Code	HCPCS 15341
Hospital Charge Code	9808205
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT

Facility

$1,293.00

Service Code	HCPCS 15341
Hospital Charge Code	9808205
Hospital Revenue Code	519
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$491.34
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.90
Rate for Payer: Qualcare PPO/HMO/WC	$193.95
Rate for Payer: UnitedHealthcare Community & State	$31.16
Rate for Payer: Wellpoint Medicaid Managed Care	$34.26

WC APLIGRAFT TISS CULT ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808185
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808185
Hospital Revenue Code	519
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$491.34
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.90
Rate for Payer: Qualcare PPO/HMO/WC	$193.95
Rate for Payer: UnitedHealthcare Community & State	$31.16
Rate for Payer: Wellpoint Medicaid Managed Care	$34.26

WC APPLICATION SHORT LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	9800162
Hospital Revenue Code	510
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$1,199.43
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

WC APPLICATION SHORT LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	9800162
Hospital Revenue Code	510
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

WC ASPIRATION/INJ INT JT/BURSA

Facility

$740.00

Service Code	HCPCS 20605
Hospital Charge Code	9800130
Hospital Revenue Code	510
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

WC ASPIRATION/INJ INT JT/BURSA

Facility

$740.00

Service Code	HCPCS 20605
Hospital Charge Code	9800130
Hospital Revenue Code	510
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC ASPIRATION/INJ SM JT/BURSA

Facility

$740.00

Service Code	HCPCS 20600
Hospital Charge Code	9800125
Hospital Revenue Code	510
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

WC ASPIRATION/INJ SM JT/BURSA

Facility

$740.00

Service Code	HCPCS 20600
Hospital Charge Code	9800125
Hospital Revenue Code	510
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC BILATERAL UNNA BOOT

Facility

$697.50

Service Code	HCPCS 2958050
Hospital Charge Code	9800175
Hospital Revenue Code	510
Min. Negotiated Rate	$104.62
Max. Negotiated Rate	$104.62
Rate for Payer: Qualcare PPO/HMO/WC	$104.62

WC BILATERAL UNNA BOOT

Facility

$697.50

Service Code	HCPCS 2958050
Hospital Charge Code	9800175
Hospital Revenue Code	510
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$348.75
Rate for Payer: Aetna Commercial	$265.05
Rate for Payer: Aetna Medicare Advantage	$209.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.86
Rate for Payer: Cigna Commercial	$348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.25
Rate for Payer: Qualcare PPO/HMO/WC	$104.62
Rate for Payer: UnitedHealthcare Community & State	$16.81
Rate for Payer: Wellpoint Medicaid Managed Care	$18.48

WC BX OF VULVA PERINEUM 1 LESI

Facility

$469.00

Service Code	HCPCS 56605
Hospital Charge Code	83652127
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$70.35

WC BX OF VULVA PERINEUM 1 LESI

Facility

$469.00

Service Code	HCPCS 56605
Hospital Charge Code	83652127
Hospital Revenue Code	361
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$3,949.84
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,949.84
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.35
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$12.43

WC BX SKIN, SQ TIS ADDL LESION

Facility

$241.10

Service Code	HCPCS 11101
Hospital Charge Code	9800120
Hospital Revenue Code	510
Min. Negotiated Rate	$36.16
Max. Negotiated Rate	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$36.16

WC BX SKIN, SQ TIS ADDL LESION

Facility

$241.10

Service Code	HCPCS 11101
Hospital Charge Code	9800120
Hospital Revenue Code	510
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$120.55
Rate for Payer: Aetna Commercial	$91.62
Rate for Payer: Aetna Medicare Advantage	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.48
Rate for Payer: Cigna Commercial	$120.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.33
Rate for Payer: Qualcare PPO/HMO/WC	$36.16
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

WC BX SKIN, SQ TISSUE 1 LESION

Facility

$241.10

Service Code	HCPCS 11100
Hospital Charge Code	9800115
Hospital Revenue Code	510
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Commercial	$91.62
Rate for Payer: Aetna Medicare Advantage	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.48
Rate for Payer: Cigna Commercial	$120.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.33
Rate for Payer: Qualcare PPO/HMO/WC	$36.16
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

WC BX SKIN, SQ TISSUE 1 LESION

Facility

$241.10

Service Code	HCPCS 11100
Hospital Charge Code	9800115
Hospital Revenue Code	510
Min. Negotiated Rate	$36.16
Max. Negotiated Rate	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$36.16

WC CIRCUMC CLAMP/DEV WDP/R-BLC

Facility

$2,768.00

Service Code	HCPCS 54150
Hospital Charge Code	83652115
Hospital Revenue Code	361
Min. Negotiated Rate	$415.20
Max. Negotiated Rate	$415.20
Rate for Payer: Qualcare PPO/HMO/WC	$415.20

Know your out-of-pocket cost for care.

All Charges