Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$42.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

WC PARING 2-4 LESIONS

Facility

$186.45

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$27.97
Rate for Payer: Qualcare PPO/HMO/WC	$27.97

WC PARING 2-4 LESIONS

Facility

$186.45

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$4.49
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	$61.60
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	$55.94
Rate for Payer: Qualcare PPO/HMO/WC	$27.97
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

WC PARING > 4 LESIONS

Facility

$283.75

Service Code	HCPCS 11057
Hospital Charge Code	9800110
Hospital Revenue Code	510
Min. Negotiated Rate	$42.56
Max. Negotiated Rate	$42.56
Rate for Payer: Qualcare PPO/HMO/WC	$42.56

WC PARING > 4 LESIONS

Facility

$283.75

Service Code	HCPCS 11057
Hospital Charge Code	9800110
Hospital Revenue Code	510
Min. Negotiated Rate	$6.84
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	$76.18
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	$85.12
Rate for Payer: Qualcare PPO/HMO/WC	$42.56
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

WC PARING SKIN LESION

Facility

$232.50

Service Code	HCPCS 11055
Hospital Charge Code	9800100
Hospital Revenue Code	510
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$34.88
Rate for Payer: Qualcare PPO/HMO/WC	$34.88

WC PARING SKIN LESION

Facility

$232.50

Service Code	HCPCS 11055
Hospital Charge Code	9800100
Hospital Revenue Code	510
Min. Negotiated Rate	$5.60
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	$54.90
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	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$34.88
Rate for Payer: UnitedHealthcare Community & State	$5.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.16

WC PELVIC EXAM UNDER ANESTHES

Facility

$232.00

Service Code	HCPCS 57410
Hospital Charge Code	83652135
Hospital Revenue Code	761
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

WC PELVIC EXAM UNDER ANESTHES

Facility

$232.00

Service Code	HCPCS 57410
Hospital Charge Code	83652135
Hospital Revenue Code	761
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.60
Rate for Payer: Oxford Commercial	$46.40
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$46.40
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

WC PERMANENT NAIL REMOVAL

Facility

$1,375.00

Service Code	HCPCS 11750
Hospital Charge Code	9800070
Hospital Revenue Code	510
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

WC PERMANENT NAIL REMOVAL

Facility

$1,375.00

Service Code	HCPCS 11750
Hospital Charge Code	9800070
Hospital Revenue Code	510
Min. Negotiated Rate	$33.14
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	$237.37
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	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

WC PHAL CLSD TX W/MANIPULATION

Facility

$787.35

Service Code	HCPCS 26755
Hospital Charge Code	9800535
Hospital Revenue Code	510
Min. Negotiated Rate	$118.10
Max. Negotiated Rate	$118.10
Rate for Payer: Qualcare PPO/HMO/WC	$118.10

WC PHAL CLSD TX W/MANIPULATION

Facility

$787.35

Service Code	HCPCS 26755
Hospital Charge Code	9800535
Hospital Revenue Code	510
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.21
Rate for Payer: Qualcare PPO/HMO/WC	$118.10
Rate for Payer: UnitedHealthcare Community & State	$18.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$20.86

WC POLYMEM ISLAND DRESSING 4X5

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808150
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 POLYMEM ISLAND DRESSING 4X5

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808150
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC POLYMEM SILVER 4X4

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808120
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 POLYMEM SILVER 4X4

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808120
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

WC PRENATAL >7 VISITS

Facility

$139.00

Service Code	HCPCS 59426
Hospital Charge Code	83652227
Hospital Revenue Code	514
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

WC PRENATAL >7 VISITS

Facility

$139.00

Service Code	HCPCS 59426
Hospital Charge Code	83652227
Hospital Revenue Code	514
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$106.48
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

WC PRIMATRIX - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4110
Hospital Charge Code	9800230
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 PRIMATRIX - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4110
Hospital Charge Code	9800230
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 PRIMATRIX - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4110JW
Hospital Charge Code	9800230W
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 PRIMATRIX - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4110JW
Hospital Charge Code	9800230W
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 PROMOGRAN MATRIX WD 4.34 SQ

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808075
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

WC PROMOGRAN MATRIX WD 4.34 SQ

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808075
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

Know your out-of-pocket cost for care.

All Charges