Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC FETAL CONTRACTN STRESS TEST

Facility

$175.00

Service Code	HCPCS 59020
Hospital Charge Code	83652195
Hospital Revenue Code	510
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$866.98
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

WC FETAL CONTRACTN STRESS TEST

Facility

$175.00

Service Code	HCPCS 59020
Hospital Charge Code	83652195
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Qualcare PPO/HMO/WC	$51.90

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$387.20
Rate for Payer: Aetna Commercial	$131.48
Rate for Payer: Aetna Medicare Advantage	$103.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.23
Rate for Payer: Cigna Commercial	$173.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.80
Rate for Payer: Oxford Commercial	$69.20
Rate for Payer: Qualcare PPO/HMO/WC	$51.90
Rate for Payer: UnitedHealthcare Commercial	$69.20
Rate for Payer: UnitedHealthcare Community & State	$8.34
Rate for Payer: Wellpoint Medicaid Managed Care	$9.17

WC FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
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 FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSING 16SQ IN < W AD

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSING 16SQ IN < W AD

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
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 FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
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 GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

WC GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$20.85

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$20.85

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

WC GRAFT JACKET - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

WC GRAFT JACKET - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
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	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

WC GRAFT JACKET - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$94.62
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

WC GRAFT JACKET - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
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	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

WC HORIZON NJ VAGINAL DELIVERY

Professional

Both

$2,395.00

Service Code	HCPCS 59409
Hospital Charge Code	83652217
Hospital Revenue Code	960
Min. Negotiated Rate	$753.34
Max. Negotiated Rate	$2,414.25
Rate for Payer: Aetna Commercial	$978.54
Rate for Payer: Aetna Medicare Advantage	$978.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,414.25
Rate for Payer: Cigna Commercial	$1,767.33
Rate for Payer: Cigna Medicare Advantage	$1,767.33
Rate for Payer: Fidelis All Plans	$753.34
Rate for Payer: Marpai Administrators LLC Commercial	$791.82
Rate for Payer: Tricare Tricare	$1,069.04
Rate for Payer: UnitedHealthcare Commercial	$1,299.54
Rate for Payer: UnitedHealthcare Community & State	$1,299.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,299.54
Rate for Payer: Wellpoint Medicaid Managed Care	$828.79

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

WC HYDROPOL 4 1/4 X 4 1/4/

Facility

$40.00

Hospital Charge Code	9808245
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 HYDROPOL 4 1/4 X 4 1/4/

Facility

$40.00

Hospital Charge Code	9808245
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges