Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WC REMOVAL OF CAST

Facility

$276.50

Service Code	HCPCS 29700
Hospital Charge Code	9800165
Hospital Revenue Code	510
Min. Negotiated Rate	$41.48
Max. Negotiated Rate	$41.48
Rate for Payer: Qualcare PPO/HMO/WC	$41.48

WC REMOVAL OF CAST

Facility

$276.50

Service Code	HCPCS 29700
Hospital Charge Code	9800165
Hospital Revenue Code	510
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$1,199.43
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.95
Rate for Payer: Qualcare PPO/HMO/WC	$41.48
Rate for Payer: UnitedHealthcare Community & State	$6.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

WC REMOVAL OF FB, SUBQ FOOT

Facility

$1,603.75

Service Code	HCPCS 28190
Hospital Charge Code	9800135
Hospital Revenue Code	510
Min. Negotiated Rate	$38.65
Max. Negotiated Rate	$3,036.77
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.12
Rate for Payer: Qualcare PPO/HMO/WC	$240.56
Rate for Payer: UnitedHealthcare Community & State	$38.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$42.50

WC REMOVAL OF FB, SUBQ FOOT

Facility

$1,603.75

Service Code	HCPCS 28190
Hospital Charge Code	9800135
Hospital Revenue Code	510
Min. Negotiated Rate	$240.56
Max. Negotiated Rate	$240.56
Rate for Payer: Qualcare PPO/HMO/WC	$240.56

WC REMOVE NAIL PLATE

Facility

$518.75

Service Code	HCPCS 11730
Hospital Charge Code	9800060
Hospital Revenue Code	510
Min. Negotiated Rate	$12.50
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	$104.68
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	$155.62
Rate for Payer: Qualcare PPO/HMO/WC	$77.81
Rate for Payer: UnitedHealthcare Community & State	$12.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

WC REMOVE NAIL PLATE

Facility

$518.75

Service Code	HCPCS 11730
Hospital Charge Code	9800060
Hospital Revenue Code	510
Min. Negotiated Rate	$77.81
Max. Negotiated Rate	$77.81
Rate for Payer: Qualcare PPO/HMO/WC	$77.81

WC REMOVE NAIL PLATE ADDL

Facility

$256.25

Service Code	HCPCS 11732
Hospital Charge Code	9800065
Hospital Revenue Code	510
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$38.44

WC REMOVE NAIL PLATE ADDL

Facility

$256.25

Service Code	HCPCS 11732
Hospital Charge Code	9800065
Hospital Revenue Code	510
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$128.12
Rate for Payer: Aetna Commercial	$97.38
Rate for Payer: Aetna Medicare Advantage	$76.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.34
Rate for Payer: Cigna Commercial	$128.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.88
Rate for Payer: Qualcare PPO/HMO/WC	$38.44
Rate for Payer: UnitedHealthcare Community & State	$6.18
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

WC REST CNTC LAYR W/SILVER 4X

Facility

$29.40

Service Code	HCPCS A6207
Hospital Charge Code	9808100
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.70
Rate for Payer: Aetna Commercial	$11.17
Rate for Payer: Aetna Medicare Advantage	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.50
Rate for Payer: Cigna Commercial	$14.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.82
Rate for Payer: Oxford Commercial	$5.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.41
Rate for Payer: UnitedHealthcare Commercial	$5.88
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

WC REST CNTC LAYR W/SILVER 4X

Facility

$29.40

Service Code	HCPCS A6207
Hospital Charge Code	9808100
Hospital Revenue Code	272
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.41

WC REST NONADHERENT 4X5-CONT

Facility

$30.90

Service Code	HCPCS A6207
Hospital Charge Code	9808095
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

WC REST NONADHERENT 4X5-CONT

Facility

$30.90

Service Code	HCPCS A6207
Hospital Charge Code	9808095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.45
Rate for Payer: Aetna Commercial	$11.74
Rate for Payer: Aetna Medicare Advantage	$9.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.88
Rate for Payer: Cigna Commercial	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.27
Rate for Payer: Oxford Commercial	$6.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.63
Rate for Payer: UnitedHealthcare Commercial	$6.18
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

WC RHO D IMM GLOB IV 100 IU

Facility

$499.00

Hospital Charge Code	83652619
Hospital Revenue Code	636
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$249.50
Rate for Payer: Aetna Commercial	$189.62
Rate for Payer: Aetna Medicare Advantage	$149.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.25
Rate for Payer: Cigna Commercial	$249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.76
Rate for Payer: Qualcare PPO/HMO/WC	$74.85
Rate for Payer: UnitedHealthcare Community & State	$12.03
Rate for Payer: Wellpoint Medicaid Managed Care	$13.22

WC RHO D IMM GLOB IV 100 IU

Facility

$499.00

Hospital Charge Code	83652619
Hospital Revenue Code	636
Min. Negotiated Rate	$74.85
Max. Negotiated Rate	$120.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.76
Rate for Payer: Qualcare PPO/HMO/WC	$74.85

WC SALPINGECTOMY,COMP/UNI/BIL

Professional

Both

$22,067.72

Service Code	HCPCS 58700
Hospital Charge Code	83652187
Hospital Revenue Code	960
Min. Negotiated Rate	$1,270.30
Max. Negotiated Rate	$1,270.30
Rate for Payer: Aetna Medicare Advantage	$1,270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,270.30

WC SEPTIC ABORT,SURG CMPLTD

Professional

Both

$9,789.90

Service Code	HCPCS 59830
Hospital Charge Code	83652255
Hospital Revenue Code	960
Min. Negotiated Rate	$1,453.05
Max. Negotiated Rate	$1,453.05
Rate for Payer: Aetna Medicare Advantage	$1,453.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,453.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,453.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.05

WC SILVERCEL 4 1/4FT X 8IN

Facility

$52.00

Service Code	HCPCS A6197
Hospital Charge Code	9808090
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

WC SILVERCEL 4 1/4FT X 8IN

Facility

$52.00

Service Code	HCPCS A6197
Hospital Charge Code	9808090
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

WC SILVERCEL 4FT X 8IN

Facility

$52.00

Service Code	HCPCS A6197
Hospital Charge Code	9808085
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

WC SILVERCEL 4FT X 8IN

Facility

$52.00

Service Code	HCPCS A6197
Hospital Charge Code	9808085
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

WC SILVERCEL ANTIMCB DRESNG 2X

Facility

$12.00

Service Code	HCPCS A6196
Hospital Charge Code	9808080
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

WC SILVERCEL ANTIMCB DRESNG 2X

Facility

$12.00

Service Code	HCPCS A6196
Hospital Charge Code	9808080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

WC SKIN SUB HD/FT/DG ADD 100

Facility

$1,183.95

Service Code	HCPCS 15278
Hospital Charge Code	9800215
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) NJ Health	$68.48
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 SKIN SUB HD/FT/DG ADD 100

Facility

$1,183.95

Service Code	HCPCS 15278
Hospital Charge Code	9800215
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB HD/FT/DG ADD 25C

Facility

$1,183.95

Service Code	HCPCS 15276KX
Hospital Charge Code	9800515
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

Know your out-of-pocket cost for care.

All Charges