Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.12

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$70.40
Rate for Payer: Aetna Commercial	$53.50
Rate for Payer: Aetna Medicare Advantage	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.90
Rate for Payer: Cigna Commercial	$70.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.24
Rate for Payer: Qualcare PPO/HMO/WC	$21.12
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$39.33
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	$47.57
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	$489.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.80
Rate for Payer: UnitedHealthcare Community & State	$39.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.25

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$39.33
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	$56.71
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	$489.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.80
Rate for Payer: UnitedHealthcare Community & State	$39.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.25

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$860.41
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	$423.98
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	$489.21
Rate for Payer: Qualcare PPO/HMO/WC	$244.60
Rate for Payer: UnitedHealthcare Community & State	$39.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$43.21

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$39.30
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	$298.14
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	$489.21
Rate for Payer: Qualcare PPO/HMO/WC	$244.60
Rate for Payer: UnitedHealthcare Community & State	$39.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.21

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

WC OASIS - PER SQ CM

Facility

$36.90

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM

Facility

$36.90

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
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	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

WC OASIS - PER SQ CM JW

Facility

$36.90

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.45
Rate for Payer: Aetna Commercial	$14.02
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

WC OASIS - PER SQ CM JW

Facility

$36.90

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM- WASTE

Facility

$36.90

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM- WASTE

Facility

$36.90

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.45
Rate for Payer: Aetna Commercial	$14.02
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$208.81
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$82.42
Rate for Payer: UnitedHealthcare Community & State	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$14.56

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$208.81
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$82.42
Rate for Payer: UnitedHealthcare Community & State	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$14.56

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

Know your out-of-pocket cost for care.

All Charges