Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$10.85
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	$140.34
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	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
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	$11.93

WC LEVEL 1 I&D - SKIN ABCESS

Facility

$641.65

Service Code	HCPCS 10060
Hospital Charge Code	9800010
Hospital Revenue Code	510
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$962.01
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	$49.39
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	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$96.25
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

WC LEVEL 1 I&D - SKIN ABCESS

Facility

$641.65

Service Code	HCPCS 10060
Hospital Charge Code	9800010
Hospital Revenue Code	510
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$96.25
Rate for Payer: Qualcare PPO/HMO/WC	$96.25

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

WC LEVEL 2 I&D HEMATOMA

Facility

$3,553.75

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$533.06
Max. Negotiated Rate	$533.06
Rate for Payer: Qualcare PPO/HMO/WC	$533.06

WC LEVEL 2 I&D HEMATOMA

Facility

$3,553.75

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$73.18
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	$73.18
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	$1,066.12
Rate for Payer: Qualcare PPO/HMO/WC	$533.06
Rate for Payer: UnitedHealthcare Community & State	$85.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$94.17

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$237.05
Rate for Payer: Aetna Commercial	$180.16
Rate for Payer: Aetna Medicare Advantage	$142.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.90
Rate for Payer: Cigna Commercial	$237.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.23
Rate for Payer: Qualcare PPO/HMO/WC	$71.11
Rate for Payer: UnitedHealthcare Community & State	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$17.36

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$5,037.05

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.12
Rate for Payer: Qualcare PPO/HMO/WC	$755.56
Rate for Payer: UnitedHealthcare Community & State	$121.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$133.48

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$5,037.05

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$755.56
Max. Negotiated Rate	$755.56
Rate for Payer: Qualcare PPO/HMO/WC	$755.56

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,103.75

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$465.56
Max. Negotiated Rate	$465.56
Rate for Payer: Qualcare PPO/HMO/WC	$465.56

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,103.75

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$57.50
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	$57.50
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	$931.12
Rate for Payer: Qualcare PPO/HMO/WC	$465.56
Rate for Payer: UnitedHealthcare Community & State	$74.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$82.25

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
Hospital Revenue Code	510
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.64
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$19.97
Rate for Payer: Wellpoint Medicaid Managed Care	$21.96

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

Know your out-of-pocket cost for care.

All Charges