Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	9800085
Hospital Revenue Code	510
Min. Negotiated Rate	$105.91
Max. Negotiated Rate	$105.91
Rate for Payer: Qualcare PPO/HMO/WC	$105.91

WC DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	9800085
Hospital Revenue Code	510
Min. Negotiated Rate	$17.02
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	$211.81
Rate for Payer: Qualcare PPO/HMO/WC	$105.91
Rate for Payer: UnitedHealthcare Community & State	$17.02
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	$18.71

WC DEBRIDE NAILS 1-5

Facility

$256.25

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$252.97
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.88
Rate for Payer: Qualcare PPO/HMO/WC	$38.44
Rate for Payer: UnitedHealthcare Community & State	$6.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

WC DEBRIDE NAILS 1-5

Facility

$256.25

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$38.44

WC DEBRIDE NAILS >5

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$72.11
Max. Negotiated Rate	$72.11
Rate for Payer: Qualcare PPO/HMO/WC	$72.11

WC DEBRIDE NAILS >5

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$252.97
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.21
Rate for Payer: Qualcare PPO/HMO/WC	$72.11
Rate for Payer: UnitedHealthcare Community & State	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$12.74

WC DEBRID GREATER THAN 20SQCM

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

WC DEBRID GREATER THAN 20SQCM

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$774.40
Rate for Payer: Aetna Commercial	$320.34
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$558.52
Rate for Payer: Aetna Commercial	$424.48
Rate for Payer: Aetna Medicare Advantage	$335.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.85
Rate for Payer: Cigna Commercial	$558.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.12
Rate for Payer: Qualcare PPO/HMO/WC	$167.56
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$167.56
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEBRID SQ ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$558.52
Rate for Payer: Aetna Commercial	$424.48
Rate for Payer: Aetna Medicare Advantage	$335.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.85
Rate for Payer: Cigna Commercial	$558.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.12
Rate for Payer: Qualcare PPO/HMO/WC	$167.56
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

WC DEBRID SQ ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$167.56
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

WC DERMAGRAFT - PER SQ CM

Facility

$182.70

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT - PER SQ CM

Facility

$182.70

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$69.43
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.84

WC DERMAGRAFT - PER SQ CM JW

Facility

$182.70

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$69.43
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.84

WC DERMAGRAFT - PER SQ CM JW

Facility

$182.70

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$182.70

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$182.70

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$69.43
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.84

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$213.16

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$106.58
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$63.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.36
Rate for Payer: Cigna Commercial	$106.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.97
Rate for Payer: UnitedHealthcare Community & State	$5.14
Rate for Payer: Wellpoint Medicaid Managed Care	$5.65

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$213.16

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$51.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.97

WC DEST BENIGN LESIONS >15

Facility

$623.14

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.47
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$15.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$16.51

WC DEST BENIGN LESIONS >15

Facility

$623.14

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

WC DEST BENIGN LESIONS-UP TO 1

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	9808045
Hospital Revenue Code	361
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

Know your out-of-pocket cost for care.

All Charges