Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC LAYER VENOUS COMPRESSION RT

Facility

$595.12

Service Code	HCPCS 29581RT
Hospital Charge Code	9800277
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 RT

Facility

$595.12

Service Code	HCPCS 29581RT
Hospital Charge Code	9800277
Hospital Revenue Code	510
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$89.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

WC LC SKIN SUB HD/FT/DG 1ST100

Facility

$2,431.36

Service Code	HCPCS C5277
Hospital Charge Code	9808315
Hospital Revenue Code	510
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$1,215.68
Rate for Payer: Aetna Commercial	$923.92
Rate for Payer: Aetna Medicare Advantage	$729.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.00
Rate for Payer: Cigna Commercial	$1,215.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.41
Rate for Payer: Qualcare PPO/HMO/WC	$364.70
Rate for Payer: UnitedHealthcare Community & State	$58.60
Rate for Payer: Wellpoint Medicaid Managed Care	$64.43

WC LC SKIN SUB HD/FT/DG 1ST100

Facility

$2,431.36

Service Code	HCPCS C5277
Hospital Charge Code	9808315
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

WC LC SKIN SUB HD/FT/DG 1ST25C

Facility

$2,431.36

Service Code	HCPCS C5275
Hospital Charge Code	9808305
Hospital Revenue Code	510
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$1,215.68
Rate for Payer: Aetna Commercial	$923.92
Rate for Payer: Aetna Medicare Advantage	$729.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.00
Rate for Payer: Cigna Commercial	$1,215.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.41
Rate for Payer: Qualcare PPO/HMO/WC	$364.70
Rate for Payer: UnitedHealthcare Community & State	$58.60
Rate for Payer: Wellpoint Medicaid Managed Care	$64.43

WC LC SKIN SUB HD/FT/DG 1ST25C

Facility

$2,431.36

Service Code	HCPCS C5275
Hospital Charge Code	9808305
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

WC LC SKIN SUB HD/FT/DG ADD100

Facility

$1,183.95

Service Code	HCPCS C5278
Hospital Charge Code	9808320
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 LC SKIN SUB HD/FT/DG ADD100

Facility

$1,183.95

Service Code	HCPCS C5278
Hospital Charge Code	9808320
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB HD/FT/DG ADD25C

Facility

$1,183.95

Service Code	HCPCS C5276
Hospital Charge Code	9808310
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB HD/FT/DG ADD25C

Facility

$1,183.95

Service Code	HCPCS C5276
Hospital Charge Code	9808310
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 LC SKIN SUB TR/AR/L 1ST100C

Facility

$8,143.08

Service Code	HCPCS C5273
Hospital Charge Code	9808295
Hospital Revenue Code	510
Min. Negotiated Rate	$196.25
Max. Negotiated Rate	$4,071.54
Rate for Payer: Aetna Commercial	$3,094.37
Rate for Payer: Aetna Medicare Advantage	$2,442.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,076.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,076.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,076.49
Rate for Payer: Cigna Commercial	$4,071.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,442.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,221.46
Rate for Payer: UnitedHealthcare Community & State	$196.25
Rate for Payer: Wellpoint Medicaid Managed Care	$215.79

WC LC SKIN SUB TR/AR/L 1ST100C

Facility

$8,143.08

Service Code	HCPCS C5273
Hospital Charge Code	9808295
Hospital Revenue Code	510
Min. Negotiated Rate	$1,221.46
Max. Negotiated Rate	$1,221.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,221.46

WC LC SKIN SUB TR/AR/L 1ST25CM

Facility

$2,431.36

Service Code	HCPCS C5271
Hospital Charge Code	9808285
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

WC LC SKIN SUB TR/AR/L 1ST25CM

Facility

$2,431.36

Service Code	HCPCS C5271
Hospital Charge Code	9808285
Hospital Revenue Code	510
Min. Negotiated Rate	$58.60
Max. Negotiated Rate	$1,215.68
Rate for Payer: Aetna Commercial	$923.92
Rate for Payer: Aetna Medicare Advantage	$729.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.00
Rate for Payer: Cigna Commercial	$1,215.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.41
Rate for Payer: Qualcare PPO/HMO/WC	$364.70
Rate for Payer: UnitedHealthcare Community & State	$58.60
Rate for Payer: Wellpoint Medicaid Managed Care	$64.43

WC LC SKIN SUB TR/AR/L ADD100C

Facility

$1,183.95

Service Code	HCPCS C5274
Hospital Charge Code	9808300
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB TR/AR/L ADD100C

Facility

$1,183.95

Service Code	HCPCS C5274
Hospital Charge Code	9808300
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 LC SKIN SUB TR/AR/L ADD25CM

Facility

$1,183.95

Service Code	HCPCS C5272
Hospital Charge Code	9808290
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB TR/AR/L ADD25CM

Facility

$1,183.95

Service Code	HCPCS C5272
Hospital Charge Code	9808290
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 LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	9800355
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

WC LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	9800355
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

WC LEVEL 1 FOLLOWUP VIST+MOD25

Facility

$311.00

Service Code	HCPCS 9921125
Hospital Charge Code	9800360
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

WC LEVEL 1 FOLLOWUP VIST+MOD25

Facility

$311.00

Service Code	HCPCS 9921125
Hospital Charge Code	9800360
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

WC LEVEL 1 I&D FB REMOVAL

Facility

$1,061.25

Service Code	HCPCS 10120
Hospital Charge Code	9800020
Hospital Revenue Code	510
Min. Negotiated Rate	$25.58
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	$153.62
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	$318.38
Rate for Payer: Qualcare PPO/HMO/WC	$159.19
Rate for Payer: UnitedHealthcare Community & State	$25.58
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	$28.12

WC LEVEL 1 I&D FB REMOVAL

Facility

$1,061.25

Service Code	HCPCS 10120
Hospital Charge Code	9800020
Hospital Revenue Code	510
Min. Negotiated Rate	$159.19
Max. Negotiated Rate	$159.19
Rate for Payer: Qualcare PPO/HMO/WC	$159.19

WC LEVEL 1 I&D PUNCTURE DRAIN

Facility

$450.00

Service Code	HCPCS 10160
Hospital Charge Code	9800015
Hospital Revenue Code	510
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

Know your out-of-pocket cost for care.

All Charges