Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT MAGNUS 2.5CC

Facility

$5,975.00

Service Code	HCPCS C1763
Hospital Charge Code	270698652
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

ALLOGRAFT MATRIX AMNIO 2.0 ML

Facility

$9,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270683291
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

ALLOGRAFT MATRIX AMNIO 2.0 ML

Facility

$9,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270683291
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

ALLOGRAFT MATRIX AMNIO 3.0 ML

Facility

$7,350.00

Service Code	HCPCS C1762
Hospital Charge Code	270683292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

ALLOGRAFT MATRIX AMNIO 3.0 ML

Facility

$7,350.00

Service Code	HCPCS C1762
Hospital Charge Code	270683292
Hospital Revenue Code	278
Min. Negotiated Rate	$177.13
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$177.13
Rate for Payer: Wellpoint Medicaid Managed Care	$194.78

ALLOGRAFT MATRIX BG BIO4 10CC

Facility

$22,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270692781
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

ALLOGRAFT MATRIX BG BIO4 10CC

Facility

$22,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270692781
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

ALLOGRAFT MEMBRANE 14MM DISK

Facility

$1,497.50

Service Code	HCPCS Q4186
Hospital Charge Code	270666225
Hospital Revenue Code	278
Min. Negotiated Rate	$224.62
Max. Negotiated Rate	$362.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$329.45
Rate for Payer: Qualcare PPO/HMO/WC	$224.62

ALLOGRAFT MEMBRANE 14MM DISK

Facility

$1,497.50

Service Code	HCPCS Q4186
Hospital Charge Code	270666225
Hospital Revenue Code	278
Min. Negotiated Rate	$36.09
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	$299.50
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	$362.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$329.45
Rate for Payer: Qualcare PPO/HMO/WC	$224.62
Rate for Payer: UnitedHealthcare Community & State	$36.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$39.68

ALLOGRAFT MEMBRANE 2.0ML

Facility

$16,970.00

Hospital Charge Code	270670530
Hospital Revenue Code	278
Min. Negotiated Rate	$2,545.50
Max. Negotiated Rate	$4,106.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,106.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,733.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,545.50

ALLOGRAFT MEMBRANE 2.0ML

Facility

$16,970.00

Hospital Charge Code	270670530
Hospital Revenue Code	278
Min. Negotiated Rate	$408.98
Max. Negotiated Rate	$8,485.00
Rate for Payer: Aetna Commercial	$6,448.60
Rate for Payer: Aetna Medicare Advantage	$5,091.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,327.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,327.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,327.35
Rate for Payer: Cigna Commercial	$8,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,106.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,733.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,545.50
Rate for Payer: UnitedHealthcare Community & State	$408.98
Rate for Payer: Wellpoint Medicaid Managed Care	$449.70

ALLOGRAFT MEMBRANE 4x4CM

Facility

$17,225.00

Hospital Charge Code	270676800
Hospital Revenue Code	278
Min. Negotiated Rate	$415.12
Max. Negotiated Rate	$8,612.50
Rate for Payer: Aetna Commercial	$6,545.50
Rate for Payer: Aetna Medicare Advantage	$5,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,392.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,392.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,392.38
Rate for Payer: Cigna Commercial	$8,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,168.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,789.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,583.75
Rate for Payer: UnitedHealthcare Community & State	$415.12
Rate for Payer: Wellpoint Medicaid Managed Care	$456.46

ALLOGRAFT MEMBRANE 4x4CM

Facility

$17,225.00

Hospital Charge Code	270676800
Hospital Revenue Code	278
Min. Negotiated Rate	$2,583.75
Max. Negotiated Rate	$4,168.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,168.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,789.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,583.75

ALLOGRAFT OSTEO FACTOR XL

Facility

$20,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694325
Hospital Revenue Code	278
Min. Negotiated Rate	$498.87
Max. Negotiated Rate	$10,350.00
Rate for Payer: Aetna Commercial	$7,866.00
Rate for Payer: Aetna Medicare Advantage	$6,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,278.50
Rate for Payer: Cigna Commercial	$10,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,554.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00
Rate for Payer: UnitedHealthcare Community & State	$498.87
Rate for Payer: Wellpoint Medicaid Managed Care	$548.55

ALLOGRAFT OSTEO FACTOR XL

Facility

$20,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270694325
Hospital Revenue Code	278
Min. Negotiated Rate	$3,105.00
Max. Negotiated Rate	$5,009.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,554.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00

ALLOGRAFT PLACEN TIS MATR 2CC

Facility

$23,375.00

Service Code	HCPCS C1763
Hospital Charge Code	270694720
Hospital Revenue Code	278
Min. Negotiated Rate	$563.34
Max. Negotiated Rate	$11,687.50
Rate for Payer: Aetna Commercial	$8,882.50
Rate for Payer: Aetna Medicare Advantage	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,960.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,960.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,960.62
Rate for Payer: Cigna Commercial	$11,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,656.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,142.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,506.25
Rate for Payer: UnitedHealthcare Community & State	$563.34
Rate for Payer: Wellpoint Medicaid Managed Care	$619.44

ALLOGRAFT PLACEN TIS MATR 2CC

Facility

$23,375.00

Service Code	HCPCS C1763
Hospital Charge Code	270694720
Hospital Revenue Code	278
Min. Negotiated Rate	$3,506.25
Max. Negotiated Rate	$5,656.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,656.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,142.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,506.25

ALLOGRAFT TRIAD CR, 7X14X11

Facility

$7,275.00

Hospital Charge Code	270667696
Hospital Revenue Code	278
Min. Negotiated Rate	$175.33
Max. Negotiated Rate	$3,637.50
Rate for Payer: Aetna Commercial	$2,764.50
Rate for Payer: Aetna Medicare Advantage	$2,182.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,855.12
Rate for Payer: Cigna Commercial	$3,637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25
Rate for Payer: UnitedHealthcare Community & State	$175.33
Rate for Payer: Wellpoint Medicaid Managed Care	$192.79

ALLOGRAFT TRIAD CR, 7X14X11

Facility

$7,275.00

Hospital Charge Code	270667696
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.25
Max. Negotiated Rate	$1,760.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25

ALLOGRAFT TRIAD XR 6X14X11M

Facility

$7,275.00

Hospital Charge Code	270667693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.25
Max. Negotiated Rate	$1,760.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25

ALLOGRAFT TRIAD XR 6X14X11M

Facility

$7,275.00

Hospital Charge Code	270667693
Hospital Revenue Code	278
Min. Negotiated Rate	$175.33
Max. Negotiated Rate	$3,637.50
Rate for Payer: Aetna Commercial	$2,764.50
Rate for Payer: Aetna Medicare Advantage	$2,182.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,855.12
Rate for Payer: Cigna Commercial	$3,637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25
Rate for Payer: UnitedHealthcare Community & State	$175.33
Rate for Payer: Wellpoint Medicaid Managed Care	$192.79

ALLOGRAFT TRINITY EL 5.3ML

Facility

$14,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270700117
Hospital Revenue Code	278
Min. Negotiated Rate	$2,242.50
Max. Negotiated Rate	$3,617.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,617.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,289.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,242.50

ALLOGRAFT TRINITY EL 5.3ML

Facility

$14,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270700117
Hospital Revenue Code	278
Min. Negotiated Rate	$360.30
Max. Negotiated Rate	$7,475.00
Rate for Payer: Aetna Commercial	$5,681.00
Rate for Payer: Aetna Medicare Advantage	$4,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,812.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,812.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,812.25
Rate for Payer: Cigna Commercial	$7,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,617.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,289.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,242.50
Rate for Payer: UnitedHealthcare Community & State	$360.30
Rate for Payer: Wellpoint Medicaid Managed Care	$396.18

ALLOGRAFT VIADISC NP 100MG

Facility

$49,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270699928
Hospital Revenue Code	278
Min. Negotiated Rate	$7,496.25
Max. Negotiated Rate	$12,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,093.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,994.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,496.25

ALLOGRAFT VIADISC NP 100MG

Facility

$49,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270699928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.40
Max. Negotiated Rate	$24,987.50
Rate for Payer: Aetna Commercial	$18,990.50
Rate for Payer: Aetna Medicare Advantage	$14,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,743.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,743.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,743.62
Rate for Payer: Cigna Commercial	$24,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,093.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,994.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,496.25
Rate for Payer: UnitedHealthcare Community & State	$1,204.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1,324.34

Know your out-of-pocket cost for care.

All Charges