Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 SKIN SUB HD/FT/DG FIRST 100

Facility

$1,183.95

Service Code	HCPCS 15277
Hospital Charge Code	9800210
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 FIRST 100

Facility

$1,183.95

Service Code	HCPCS 15277
Hospital Charge Code	9800210
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
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: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC SKIN SUB HD/FT/DG FIRST 25C

Facility

$1,183.95

Service Code	HCPCS 15275KX
Hospital Charge Code	9800510
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 SKIN SUB HD/FT/DG FIRST 25C

Facility

$1,183.95

Service Code	HCPCS 15275KX
Hospital Charge Code	9800510
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 TR/AR/L ADD 100 CM

Facility

$1,183.95

Service Code	HCPCS 15274
Hospital Charge Code	9800205
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	$58.41
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 TR/AR/L ADD 100 CM

Facility

$1,183.95

Service Code	HCPCS 15274
Hospital Charge Code	9800205
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 TR/AR/L ADD 25CM

Facility

$1,183.95

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
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 SKIN SUB TR/AR/L ADD 25CM

Facility

$1,183.95

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
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 TR/AR/L FIRST 100C

Facility

$1,183.95

Service Code	HCPCS 15273
Hospital Charge Code	9800200
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 TR/AR/L FIRST 100C

Facility

$1,183.95

Service Code	HCPCS 15273
Hospital Charge Code	9800200
Hospital Revenue Code	510
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
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: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$31.37

WC SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,183.95

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
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 SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,183.95

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKN GRAFT TO FACE EA ADD 25

Facility

$496.50

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$248.25
Rate for Payer: Aetna Commercial	$188.67
Rate for Payer: Aetna Medicare Advantage	$148.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.61
Rate for Payer: Cigna Commercial	$248.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.95
Rate for Payer: Qualcare PPO/HMO/WC	$74.47
Rate for Payer: UnitedHealthcare Community & State	$11.97
Rate for Payer: Wellpoint Medicaid Managed Care	$13.16

WC SKN GRAFT TO FACE EA ADD 25

Facility

$496.50

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$74.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$32.62
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.12
Rate for Payer: Qualcare PPO/HMO/WC	$203.06
Rate for Payer: UnitedHealthcare Community & State	$32.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$35.87

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$203.06
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$496.50

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$74.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$496.50

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$248.25
Rate for Payer: Aetna Commercial	$188.67
Rate for Payer: Aetna Medicare Advantage	$148.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.61
Rate for Payer: Cigna Commercial	$248.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.95
Rate for Payer: Qualcare PPO/HMO/WC	$74.47
Rate for Payer: UnitedHealthcare Community & State	$11.97
Rate for Payer: Wellpoint Medicaid Managed Care	$13.16

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$203.06
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$32.62
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.12
Rate for Payer: Qualcare PPO/HMO/WC	$203.06
Rate for Payer: UnitedHealthcare Community & State	$32.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$35.87

WC SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
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 SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$215.20
Max. Negotiated Rate	$215.20
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

WC SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.39
Rate for Payer: Qualcare PPO/HMO/WC	$215.20
Rate for Payer: UnitedHealthcare Community & State	$34.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$38.02

Know your out-of-pocket cost for care.

All Charges