Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WOODSON ELEVATOR W/SPATULAR

Facility

$195.00

Hospital Charge Code	270667513
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

WOODSON ELEVATOR W/SPATULAR

Facility

$195.00

Hospital Charge Code	270667513
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

WOUNDAVC CANISTER W/GEL 500ML

Facility

$180.02

Hospital Charge Code	270672869
Hospital Revenue Code	272
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.01
Rate for Payer: Aetna Commercial	$68.41
Rate for Payer: Aetna Medicare Advantage	$54.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.91
Rate for Payer: Cigna Commercial	$90.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.01
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

WOUNDAVC CANISTER W/GEL 500ML

Facility

$180.02

Hospital Charge Code	270672869
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

WOUND CLOSER 3-0 GR 18 V-20 12

Facility

$293.89

Hospital Charge Code	270683967
Hospital Revenue Code	272
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$146.94
Rate for Payer: Aetna Commercial	$111.68
Rate for Payer: Aetna Medicare Advantage	$88.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.94
Rate for Payer: Cigna Commercial	$146.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.17
Rate for Payer: Oxford Commercial	$58.78
Rate for Payer: Qualcare PPO/HMO/WC	$44.08
Rate for Payer: UnitedHealthcare Commercial	$58.78
Rate for Payer: UnitedHealthcare Community & State	$7.08
Rate for Payer: Wellpoint Medicaid Managed Care	$7.79

WOUND CLOSER 3-0 GR 18 V-20 12

Facility

$293.89

Hospital Charge Code	270683967
Hospital Revenue Code	272
Min. Negotiated Rate	$44.08
Max. Negotiated Rate	$44.08
Rate for Payer: Qualcare PPO/HMO/WC	$44.08

WOUND CULTURE PANEL

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475120
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

WOUND CULTURE PANEL

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475120
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.25

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$102,806.28

Service Code	MSDRG 464
Min. Negotiated Rate	$31,303.19
Max. Negotiated Rate	$102,806.28
Rate for Payer: Aetna Commercial	$70,896.97
Rate for Payer: Aetna Medicare Advantage	$102,806.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,950.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69,783.00
Rate for Payer: Cigna Commercial	$58,288.50
Rate for Payer: Cigna Medicare Advantage	$32,950.73
Rate for Payer: Clover Medicare Advantage	$31,303.19
Rate for Payer: EmblemHealth Commercial	$98,852.19
Rate for Payer: Humana Medicare Advantage	$33,939.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,950.73
Rate for Payer: Oxford Commercial	$41,892.71
Rate for Payer: UnitedHealthcare Commercial	$73,460.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,950.73
Rate for Payer: Wellcare Medicare Advantage	$32,950.73

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$186,351.36

Service Code	MSDRG 463
Min. Negotiated Rate	$56,741.60
Max. Negotiated Rate	$186,351.36
Rate for Payer: Aetna Commercial	$128,301.94
Rate for Payer: Aetna Medicare Advantage	$186,351.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131,657.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131,657.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$59,728.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131,657.26
Rate for Payer: Cigna Commercial	$106,660.44
Rate for Payer: Cigna Medicare Advantage	$59,728.00
Rate for Payer: Clover Medicare Advantage	$56,741.60
Rate for Payer: EmblemHealth Commercial	$179,184.00
Rate for Payer: Humana Medicare Advantage	$61,519.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$59,728.00
Rate for Payer: Oxford Commercial	$76,658.27
Rate for Payer: UnitedHealthcare Commercial	$134,422.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$59,728.00
Rate for Payer: Wellcare Medicare Advantage	$59,728.00

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$61,079.05

Service Code	MSDRG 465
Min. Negotiated Rate	$18,597.79
Max. Negotiated Rate	$61,079.05
Rate for Payer: Aetna Commercial	$42,225.60
Rate for Payer: Aetna Medicare Advantage	$61,079.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,498.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,498.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,576.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,498.07
Rate for Payer: Cigna Commercial	$34,128.72
Rate for Payer: Cigna Medicare Advantage	$19,576.62
Rate for Payer: Clover Medicare Advantage	$18,597.79
Rate for Payer: EmblemHealth Commercial	$58,729.86
Rate for Payer: Humana Medicare Advantage	$20,163.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,576.62
Rate for Payer: Oxford Commercial	$24,528.76
Rate for Payer: UnitedHealthcare Commercial	$43,011.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,576.62
Rate for Payer: Wellcare Medicare Advantage	$19,576.62

WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$64,013.88

Service Code	MSDRG 902
Min. Negotiated Rate	$19,491.41
Max. Negotiated Rate	$64,013.88
Rate for Payer: Aetna Commercial	$44,242.15
Rate for Payer: Aetna Medicare Advantage	$64,013.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,730.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,730.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,517.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,730.68
Rate for Payer: Cigna Commercial	$35,827.95
Rate for Payer: Cigna Medicare Advantage	$20,517.27
Rate for Payer: Clover Medicare Advantage	$19,491.41
Rate for Payer: EmblemHealth Commercial	$61,551.81
Rate for Payer: Humana Medicare Advantage	$21,132.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,517.27
Rate for Payer: Oxford Commercial	$25,750.03
Rate for Payer: UnitedHealthcare Commercial	$45,153.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,517.27
Rate for Payer: Wellcare Medicare Advantage	$20,517.27

WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$137,775.11

Service Code	MSDRG 901
Min. Negotiated Rate	$41,950.76
Max. Negotiated Rate	$137,775.11
Rate for Payer: Aetna Commercial	$94,924.54
Rate for Payer: Aetna Medicare Advantage	$137,775.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100,720.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100,720.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100,720.13
Rate for Payer: Cigna Commercial	$78,535.17
Rate for Payer: Cigna Medicare Advantage	$44,158.69
Rate for Payer: Clover Medicare Advantage	$41,950.76
Rate for Payer: EmblemHealth Commercial	$132,476.07
Rate for Payer: Humana Medicare Advantage	$45,483.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44,158.69
Rate for Payer: Oxford Commercial	$56,444.27
Rate for Payer: UnitedHealthcare Commercial	$98,976.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,158.69
Rate for Payer: Wellcare Medicare Advantage	$44,158.69

WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$39,937.53

Service Code	MSDRG 903
Min. Negotiated Rate	$12,160.47
Max. Negotiated Rate	$39,937.53
Rate for Payer: Aetna Commercial	$27,698.96
Rate for Payer: Aetna Medicare Advantage	$39,937.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,800.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,843.64
Rate for Payer: Cigna Commercial	$21,887.89
Rate for Payer: Cigna Medicare Advantage	$12,800.49
Rate for Payer: Clover Medicare Advantage	$12,160.47
Rate for Payer: EmblemHealth Commercial	$38,401.47
Rate for Payer: Humana Medicare Advantage	$13,184.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,800.49
Rate for Payer: Oxford Commercial	$15,731.12
Rate for Payer: UnitedHealthcare Commercial	$27,585.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,800.49
Rate for Payer: Wellcare Medicare Advantage	$12,800.49

WOUND DRAINAGE *********

Facility

$98.00

Hospital Charge Code	8001380
Hospital Revenue Code	279
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

WOUND DRAINAGE *********

Facility

$98.00

Hospital Charge Code	8001380
Hospital Revenue Code	279
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

WOUND DRAIN COLLECTOR 3-3/4

Facility

$59.00

Hospital Charge Code	270331141
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

WOUND DRAIN COLLECTOR 3-3/4

Facility

$59.00

Hospital Charge Code	270331141
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

WOUND DRAIN POUCH 4X9

Facility

$145.00

Hospital Charge Code	270331472
Hospital Revenue Code	278
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

WOUND DRAIN POUCH 4X9

Facility

$145.00

Hospital Charge Code	270331472
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

WOUND DRAIN W/Y ADAPTOR

Facility

$52.00

Hospital Charge Code	270605806
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

WOUND DRAIN W/Y ADAPTOR

Facility

$52.00

Hospital Charge Code	270605806
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

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,586.25
Max. Negotiated Rate	$2,559.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,559.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,326.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,559.15
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	$2,115.00
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	$2,559.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,326.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25
Rate for Payer: UnitedHealthcare Community & State	$254.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$280.24

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$17.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57

Know your out-of-pocket cost for care.

All Charges