Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$66.71
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.40
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$415.20
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$66.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$73.35

WC COLLAGEN DRSSNG 16SQ IN OR

Facility

$43.00

Service Code	HCPCS A6022
Hospital Charge Code	9808070
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

WC COLLAGEN DRSSNG 16SQ IN OR

Facility

$43.00

Service Code	HCPCS A6022
Hospital Charge Code	9808070
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

WC COM REP TRUNK 2.6CM-7.5CM

Facility

$2,370.40

Service Code	HCPCS 13101
Hospital Charge Code	9808325
Hospital Revenue Code	510
Min. Negotiated Rate	$355.56
Max. Negotiated Rate	$355.56
Rate for Payer: Qualcare PPO/HMO/WC	$355.56

WC COM REP TRUNK 2.6CM-7.5CM

Facility

$2,370.40

Service Code	HCPCS 13101
Hospital Charge Code	9808325
Hospital Revenue Code	510
Min. Negotiated Rate	$57.13
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.12
Rate for Payer: Qualcare PPO/HMO/WC	$355.56
Rate for Payer: UnitedHealthcare Community & State	$57.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$62.82

WC CUL ALL DER SUB/1ST 100 ADD

Facility

$1,183.95

Hospital Charge Code	9800270
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC CUL ALL DER SUB/1ST 100 ADD

Facility

$1,183.95

Hospital Charge Code	9800270
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.19
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$28.53
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC CULTD ALLO DERM SUB/1ST 100

Facility

$1,183.95

Hospital Charge Code	9800265
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.19
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$28.53
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC CULTD ALLO DERM SUB/1ST 100

Facility

$1,183.95

Hospital Charge Code	9800265
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC CULTURD ALL SKIN SUB<25 ADD

Facility

$1,183.95

Hospital Charge Code	9800240
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC CULTURD ALL SKIN SUB<25 ADD

Facility

$1,183.95

Hospital Charge Code	9800240
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.19
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$28.53
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC CULTURED ALLOGN SKIN SUB<25

Facility

$1,183.95

Hospital Charge Code	9800235
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC CULTURED ALLOGN SKIN SUB<25

Facility

$1,183.95

Hospital Charge Code	9800235
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.19
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$28.53
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC DEBRID BONE ADDL 20 SQCM

Facility

$3,472.65

Service Code	HCPCS 11047
Hospital Charge Code	9800098
Hospital Revenue Code	510
Min. Negotiated Rate	$83.69
Max. Negotiated Rate	$1,736.33
Rate for Payer: Aetna Commercial	$1,319.61
Rate for Payer: Aetna Medicare Advantage	$1,041.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.53
Rate for Payer: Cigna Commercial	$1,736.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,041.80
Rate for Payer: Qualcare PPO/HMO/WC	$520.90
Rate for Payer: UnitedHealthcare Community & State	$83.69
Rate for Payer: Wellpoint Medicaid Managed Care	$92.03

WC DEBRID BONE ADDL 20 SQCM

Facility

$3,472.65

Service Code	HCPCS 11047
Hospital Charge Code	9800098
Hospital Revenue Code	510
Min. Negotiated Rate	$520.90
Max. Negotiated Rate	$520.90
Rate for Payer: Qualcare PPO/HMO/WC	$520.90

WC DEBRIDEMENT EX ECZEMATOUS 1

Facility

$1,147.40

Service Code	HCPCS 11000
Hospital Charge Code	9808001
Hospital Revenue Code	361
Min. Negotiated Rate	$172.11
Max. Negotiated Rate	$172.11
Rate for Payer: Qualcare PPO/HMO/WC	$172.11

WC DEBRIDEMENT EX ECZEMATOUS 1

Facility

$1,147.40

Service Code	HCPCS 11000
Hospital Charge Code	9808001
Hospital Revenue Code	361
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.11
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
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	$1,639.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1,607.24

WC DEBRIDEMENT SKIN FULL THICK

Facility

$843.05

Hospital Charge Code	9800080
Hospital Revenue Code	510
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.52
Rate for Payer: Aetna Commercial	$320.36
Rate for Payer: Aetna Medicare Advantage	$252.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.98
Rate for Payer: Cigna Commercial	$421.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.91
Rate for Payer: Qualcare PPO/HMO/WC	$126.46
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

WC DEBRIDEMENT SKIN FULL THICK

Facility

$843.05

Hospital Charge Code	9800080
Hospital Revenue Code	510
Min. Negotiated Rate	$126.46
Max. Negotiated Rate	$126.46
Rate for Payer: Qualcare PPO/HMO/WC	$126.46

WC DEBRIDEMENT SKIN PART THICK

Facility

$843.05

Hospital Charge Code	9800075
Hospital Revenue Code	510
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.52
Rate for Payer: Aetna Commercial	$320.36
Rate for Payer: Aetna Medicare Advantage	$252.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.98
Rate for Payer: Cigna Commercial	$421.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.91
Rate for Payer: Qualcare PPO/HMO/WC	$126.46
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

WC DEBRIDEMENT SKIN PART THICK

Facility

$843.05

Hospital Charge Code	9800075
Hospital Revenue Code	510
Min. Negotiated Rate	$126.46
Max. Negotiated Rate	$126.46
Rate for Payer: Qualcare PPO/HMO/WC	$126.46

WC DEBRIDEMENT SKIN&SQTIS/BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	9800095
Hospital Revenue Code	510
Min. Negotiated Rate	$191.44
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,383.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: UnitedHealthcare Community & State	$191.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27
Rate for Payer: Wellpoint Medicaid Managed Care	$210.50

WC DEBRIDEMENT SKIN&SQTIS/BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	9800095
Hospital Revenue Code	510
Min. Negotiated Rate	$1,191.51
Max. Negotiated Rate	$1,191.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51

WC DEBRIDEMENT SKIN&SQ TIS,MUS

Facility

$2,788.64

Service Code	HCPCS 11043
Hospital Charge Code	9800090
Hospital Revenue Code	510
Min. Negotiated Rate	$67.21
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.59
Rate for Payer: Qualcare PPO/HMO/WC	$418.30
Rate for Payer: UnitedHealthcare Community & State	$67.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$73.90

WC DEBRIDEMENT SKIN&SQ TIS,MUS

Facility

$2,788.64

Service Code	HCPCS 11043
Hospital Charge Code	9800090
Hospital Revenue Code	510
Min. Negotiated Rate	$418.30
Max. Negotiated Rate	$418.30
Rate for Payer: Qualcare PPO/HMO/WC	$418.30

Know your out-of-pocket cost for care.

All Charges