Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$192.77
Max. Negotiated Rate	$3,999.38
Rate for Payer: Aetna Commercial	$3,039.53
Rate for Payer: Aetna Medicare Advantage	$2,399.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,039.68
Rate for Payer: Cigna Commercial	$3,999.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,759.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81
Rate for Payer: UnitedHealthcare Community & State	$192.77
Rate for Payer: Wellpoint Medicaid Managed Care	$211.97

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.81
Max. Negotiated Rate	$1,935.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,759.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$299.80
Max. Negotiated Rate	$6,220.00
Rate for Payer: Aetna Commercial	$4,727.20
Rate for Payer: Aetna Medicare Advantage	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,172.20
Rate for Payer: Cigna Commercial	$6,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00
Rate for Payer: UnitedHealthcare Community & State	$299.80
Rate for Payer: Wellpoint Medicaid Managed Care	$329.66

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$1,866.00
Max. Negotiated Rate	$3,010.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.50
Max. Negotiated Rate	$4,280.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,891.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$426.33
Max. Negotiated Rate	$8,845.00
Rate for Payer: Aetna Commercial	$6,722.20
Rate for Payer: Aetna Medicare Advantage	$5,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,510.95
Rate for Payer: Cigna Commercial	$8,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,891.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50
Rate for Payer: UnitedHealthcare Community & State	$426.33
Rate for Payer: Wellpoint Medicaid Managed Care	$468.79

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,392.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

ALLOGRAFT AMNIOTIC MEMBRANE4X4

Facility

$9,330.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633W
Hospital Revenue Code	636
Min. Negotiated Rate	$224.85
Max. Negotiated Rate	$4,665.00
Rate for Payer: Aetna Commercial	$3,545.40
Rate for Payer: Aetna Medicare Advantage	$2,799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,379.15
Rate for Payer: Cigna Commercial	$4,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,257.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.50
Rate for Payer: UnitedHealthcare Community & State	$224.85
Rate for Payer: Wellpoint Medicaid Managed Care	$247.25

ALLOGRAFT AMNIOTIC MEMBRANE4X4

Facility

$9,330.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,399.50
Max. Negotiated Rate	$2,257.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,257.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.50

ALLOGRAFTAMNIOTICMEMBRANE4X4CM

Facility

$15,000.00

Hospital Charge Code	270663472
Hospital Revenue Code	810
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

ALLOGRAFTAMNIOTICMEMBRANE4X4CM

Facility

$15,000.00

Hospital Charge Code	270663472
Hospital Revenue Code	810
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,500.00
Rate for Payer: Oxford Commercial	$3,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Commercial	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

ALLOGRAFT AMNIOTIC MENBRANE

Facility

$9,170.00

Service Code	HCPCS Q4100
Hospital Charge Code	270664960
Hospital Revenue Code	636
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

ALLOGRAFT AMNIOTIC MENBRANE

Facility

$9,170.00

Service Code	HCPCS Q4100
Hospital Charge Code	270664960
Hospital Revenue Code	636
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

ALLOGRAFT ANTIOBOTIC

Facility

$4,475.00

Hospital Charge Code	270665509
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

ALLOGRAFT ANTIOBOTIC

Facility

$4,475.00

Hospital Charge Code	270665509
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

ALLOGRAFTBIOVANCEAMNMEM2X3CM

Facility

$5,750.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698089
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

ALLOGRAFTBIOVANCEAMNMEM2X3CM

Facility

$5,750.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698089
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$1,391.50
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	$1,150.00
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	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

ALLOGRAFTBIOVANCEAMNMEM2X4CM

Facility

$7,000.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698090
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,694.00
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	$1,400.00
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	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

ALLOGRAFTBIOVANCEAMNMEM2X4CM

Facility

$7,000.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698090
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ALLOGRAFT BONE 10 BOOST 48DBM2

Facility

$7,000.00

Hospital Charge Code	270634500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges