Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$93.99
Max. Negotiated Rate	$3,554.00
Rate for Payer: Aetna Commercial	$444.67
Rate for Payer: Aetna Medicare Advantage	$529.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$163.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590.11
Rate for Payer: Cigna Commercial	$327.70
Rate for Payer: Cigna Medicare Advantage	$163.48
Rate for Payer: Clover Medicare Advantage	$155.31
Rate for Payer: EmblemHealth Commercial	$490.44
Rate for Payer: Humana Medicare Advantage	$168.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$163.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$2,027.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$3,554.00
Rate for Payer: UnitedHealthcare Community & State	$93.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.48
Rate for Payer: Wellcare Medicare Advantage	$163.48
Rate for Payer: Wellpoint Medicaid Managed Care	$103.35

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

WC HYSTEROSCOPY,SURG W BX-POLY

Professional

Both

$746.00

Service Code	HCPCS 58558
Hospital Charge Code	83652169
Hospital Revenue Code	960
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Aetna Medicare Advantage	$10.30
Rate for Payer: Fidelis All Plans	$10.30

WC I&D ABSCESS COMPLCATED/MULT

Facility

$796.20

Service Code	HCPCS 10061
Hospital Charge Code	9800412
Hospital Revenue Code	510
Min. Negotiated Rate	$19.19
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	$214.18
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	$238.86
Rate for Payer: Qualcare PPO/HMO/WC	$119.43
Rate for Payer: UnitedHealthcare Community & State	$19.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$21.10

WC I&D ABSCESS COMPLCATED/MULT

Facility

$796.20

Service Code	HCPCS 10061
Hospital Charge Code	9800412
Hospital Revenue Code	510
Min. Negotiated Rate	$119.43
Max. Negotiated Rate	$119.43
Rate for Payer: Qualcare PPO/HMO/WC	$119.43

WC INCOMPLT A/B-COMPLTD SURGL

Professional

Both

$688.00

Service Code	HCPCS 59812
Hospital Charge Code	83652249
Hospital Revenue Code	960
Min. Negotiated Rate	$485.33
Max. Negotiated Rate	$485.33
Rate for Payer: Aetna Medicare Advantage	$485.33

WC INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	9800525
Hospital Revenue Code	510
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

WC INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	9800525
Hospital Revenue Code	510
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$912.17
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

WC INJECT TEN, LIG, CYST

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	9808190
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

WC INJECT TEN, LIG, CYST

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	9808190
Hospital Revenue Code	361
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$327.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

WC INTEGRA -PER SQ CC

Facility

$54.90

Service Code	HCPCS Q4104
Hospital Charge Code	9800220
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
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	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

WC INTEGRA -PER SQ CC

Facility

$54.90

Service Code	HCPCS Q4104
Hospital Charge Code	9800220
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC INTEGRA -PER SQ CC JW

Facility

$54.90

Service Code	HCPCS Q4104JW
Hospital Charge Code	9800220W
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC INTEGRA -PER SQ CC JW

Facility

$54.90

Service Code	HCPCS Q4104JW
Hospital Charge Code	9800220W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.45
Rate for Payer: Aetna Commercial	$20.86
Rate for Payer: Aetna Medicare Advantage	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.00
Rate for Payer: Cigna Commercial	$27.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

WC LAPAROSCOPY-REMV ADNX STRUC

Professional

Both

$1,394.00

Service Code	HCPCS 58661
Hospital Charge Code	83652181
Hospital Revenue Code	960
Min. Negotiated Rate	$506.09
Max. Negotiated Rate	$506.09
Rate for Payer: Aetna Medicare Advantage	$506.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$506.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.09

WC LAPARSCOPY,ASP CAVITY/CYST

Professional

Both

$788.00

Service Code	HCPCS 49322
Hospital Charge Code	83652113
Hospital Revenue Code	960
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$95.96
Rate for Payer: Aetna Commercial	$52.72
Rate for Payer: Aetna Medicare Advantage	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.96
Rate for Payer: Clover Medicare Advantage	$26.86
Rate for Payer: UnitedHealthcare Commercial	$4.01
Rate for Payer: UnitedHealthcare Community & State	$4.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.01

WC LAP.FULGTION/EXC LESIONS

Professional

Both

$1,530.00

Service Code	HCPCS 58662
Hospital Charge Code	83652183
Hospital Revenue Code	960
Min. Negotiated Rate	$63.54
Max. Negotiated Rate	$99.83
Rate for Payer: Aetna Commercial	$99.83
Rate for Payer: Aetna Medicare Advantage	$99.83
Rate for Payer: UnitedHealthcare Commercial	$63.54
Rate for Payer: UnitedHealthcare Community & State	$63.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$63.54

WC LAYER VENOUS COMPRES BILAT

Facility

$892.65

Service Code	HCPCS 2958150
Hospital Charge Code	9800176M
Hospital Revenue Code	510
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$446.32
Rate for Payer: Aetna Commercial	$339.21
Rate for Payer: Aetna Medicare Advantage	$267.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.63
Rate for Payer: Cigna Commercial	$446.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.80
Rate for Payer: Qualcare PPO/HMO/WC	$133.90
Rate for Payer: UnitedHealthcare Community & State	$21.51
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

WC LAYER VENOUS COMPRES BILAT

Facility

$892.65

Service Code	HCPCS 2958150
Hospital Charge Code	9800176M
Hospital Revenue Code	510
Min. Negotiated Rate	$133.90
Max. Negotiated Rate	$133.90
Rate for Payer: Qualcare PPO/HMO/WC	$133.90

WC LAYER VENOUS COMPRESSION

Facility

$788.30

Service Code	HCPCS 29581
Hospital Charge Code	9800176
Hospital Revenue Code	510
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$696.85
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	$103.75
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	$236.49
Rate for Payer: Qualcare PPO/HMO/WC	$118.25
Rate for Payer: UnitedHealthcare Community & State	$19.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$20.89

WC LAYER VENOUS COMPRESSION

Facility

$788.30

Service Code	HCPCS 29581
Hospital Charge Code	9800176
Hospital Revenue Code	510
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$118.25
Rate for Payer: Qualcare PPO/HMO/WC	$118.25

WC LAYER VENOUS COMPRESSION LT

Facility

$595.12

Service Code	HCPCS 29581LT
Hospital Charge Code	9800276
Hospital Revenue Code	510
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.56
Rate for Payer: Aetna Commercial	$226.15
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.54
Rate for Payer: Qualcare PPO/HMO/WC	$89.27
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

WC LAYER VENOUS COMPRESSION LT

Facility

$595.12

Service Code	HCPCS 29581LT
Hospital Charge Code	9800276
Hospital Revenue Code	510
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$89.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

Know your out-of-pocket cost for care.

All Charges